The Development Path of Gynecological Cytology after Papanicolaou: from Bethesda to Artificial Intelligence and Personalized Medicine.

BACKGROUND: Cervical cancer is the fourth most common cancer whose incidence was significantly reduced with the help of Pap smear and organized cervical cancer screening. Implementation of HPV vaccination and addition of HPV primary screening, automation and most recently digitalization and application of artificial intelligence have taken cervical cancer prevention into a new era. SUMMARY: This review paper covers gynecological cytology from terminology and shows The Bethesda System as a model for further terminology systems. Liquid-based cytology enabled the application of ancillary techniques elegantly from one vial as well as digitalization and the implementation of artificial intelligence. HPV primary screening further shaped the field and led to the decline of cytology volumes. Nevertheless, genotyping and dual staining allow the implementation of personalized medicine in screening scenarios. KEY MESSAGES: The field of gynecological cytology has slowly but surely evolved from the conventional Pap smear to liquid-based cytology, automation and now digitalization, artificial intelligence and inclusion of HPV testing with genotyping enabling personalized prevention in cervical cancer screening and diagnostics.