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Re: GYN: Endometrial cells on papFrom: Dr. Ainsworth (ainsron@sbcglobal.net)Tue Sep 30 18:23:00 2003
Carmen R. Gomez-Fernandez, MD, Parvin Ganjei-Azar, MD, Katayoon Behshid, MD, Hervy E. Averette, MD, and Mehrdad Nadji, MD. Normal Endometrial Cells in Papanicolaou Smears: Prevalence in Women With and Without Endometrial Disease Obstetrics & Gynecology, December 2000, Volume 96, Number 6, Pages 874 – 878. Normal endometrial cells were present in the Papanicolaou smears of few women: 2% of those with endometrial hyperplasia or carcinoma and 5% of those without significant endometrial disease. Abnormal vaginal bleeding was the reason for further evaluation of these patients. The prevalence of normal endometrial cells did not differ significantly between the two groups of patients, therefore there was no evidence that the presence of these cells in Papanicolaou smears was indicative of an increased likelihood of endometrial hyperplasia or carcinoma. Our series was large, and we had 80% power to detect a meaningful difference if one existed. In no study patient, postmenopausal or otherwise, did the presence of normal endometrial cells in Papanicolaou smears lead to the discovery of endometrial hyperplasia or carcinoma. Other studies have reported similar findings. The results of our study of 490 women demonstrate that normal endometrial cells are just as likely to be present in the Papanicolaou smears of women with benign endometrial tissue as in the smears of women with endometrial hyperplasia or carcinoma. The presence of normal endometrial cells in Papanicolaou smears, therefore, is not indicative of an increased likelihood of significant endometrial disease. These findings and those of our previous study dispute the recommendation of the Bethesda System to report the presence of normal endometrial cells in the Papanicolaou smears of postmenopausal women. Likewise, with regard to premenopausal women who are in the second half of their cycle, our data call into question the meaning of the presence of normal endometrial cells in Papanicoloau smears and the practice of reporting this cytologic finding. Instead of alerting clinicians to the possibility of significant endometrial disease, Papanicolaou smear reports of normal endometrial cells may only serve to create a management problem that leads to unnecessary procedures with potential morbidity and unjustifiable patient anxiety.
>52 YO postmenopausal woman, not on HRT, no bleeding, has endometrial
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