Re: GYN: Endometrial cells on pap
From: Lynn D. Montgomery, M.D. (apgar10@montanadsl.net)
Wed Oct 1 10:49:14 2003
That's if you can rely on your pathologist to be able to call a "normal"
endometrial cell...
Lynn
--
Lynn D. Montgomery, M.D.
Rocky Mountain Women's Health
2835 Fort Missoula Rd., Suite 303
Missoula, Montana, 59804
406-549-0978
fax 406-549-0987
e-mail: apgar10@montanadsl.net
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Braun,
R. Daniel
Sent: Wednesday, October 01, 2003 5:24 AM
To: Multiple recipients of list OB-GYN-L
Subject: Re: GYN: Endometrial cells on pap
I love it when a good study backs up my opinion.
Dan
-----Original Message-----
From: Dr. Ainsworth [mailto:ainsron@sbcglobal.net]
Sent: Tuesday, September 30, 2003 6:25 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: GYN: Endometrial cells on pap
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
>cells on her pap.
>
>Would you:
>
>1. Do nothing?
>2. Endo biopsy/ECC?
>3. Ultrasound for endometrial thickness?
>4. Other?
>
>Garry
>
>--
>Garry E. Siegel, M.D.
>Private Practice
>Roswell, GA
>
