OB-GYN-L Messages for October, 2003: Re: GYN: Endometrial cells on pap

Re: GYN: Endometrial cells on pap

From: art fougner, md

evsono@pipeline.com

Wed Oct 1 10:50:15 2003

J Reprod Med. 2001 Sep;46(9):795-8.

Significance of benign endometrial cells in Pap smears from postmenopausal women.

Wu HH, Schuetz MJ 3rd, Cramer H.

Department of Pathology, Ball Memorial Hospital, 2401 University Avenue, Muncie, IN 47303, USA. wuh@palab.com

OBJECTIVE: To assess the significance of benign exfoliated endometrial epithelial or stromal cells on cervicovaginal Pap smears obtained from postmenopausal women not receiving exogenous hormones. STUDY DESIGN: A computerized search of the cytology database at two institutions was performed for a five-year period, and all cervical cytology cases from postmenopausal patients diagnosed with benign endometrial cells were identified. Those cases with histologic follow-up within 12 months of the original cytologic evaluation were selected for analysis, and their cytology and surgical pathology slides were reviewed. RESULTS: A total of 227 postmenopausal women with benign endometrial cells were identified. Of the 61 patients with histologic follow-up, 25 (41%) had significant endometrial diseases, including hyperplasia without atypia (11), atypical endometrial hyperplasia (5), well-differentiated adenocarcinoma (8) and high grade serous carcinoma (1). Benign diagnoses, including atrophy (15), weakly proliferative endometrium (9) and proliferative endometrium (6), were noted in 30 patients (49%). Endometrial polyp was identified in three patients (5%). There were three cases of nondiagnostic histologic specimens that lacked endometrial tissue (5%). Two of nine women (22%) with proven carcinoma were asymptomatic. CONCLUSION: The diagnosis of endometrial cells, cytologically benign, in a postmenopausal woman not receiving hormone on Pap smears is associated with a significant number of cases of endometrial hyperplasia, atypical hyperplasia and carcinoma.

art

At Tue, 30 Sep 2003, Dr. Ainsworth wrote: >
>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
>>

-- art fougner, md ich bin ein New Yorker

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