Re: GYN: Endometrial cells on pap
From: art fougner, md (evsono@pipeline.com)
Wed Oct 1 16:46:57 2003
TJ
sorry don't have the full text ... just the abstract - good question.
art
At Wed, 1 Oct 2003, Terrence.Jones@kp.org wrote:
>
>This got cyber-sidestepped the first try, but think Bruce has remedied the
>problem. Anyway, agree with Dan - and would also inquire re: the original
>cytol findings in the group with 'significant disease'. Were they "normal
>endometrial cells"? tj
>----- Forwarded by Terrence Jones/CA/KAIPERM on 10/01/2003 01:46 PM -----
>
> Terrence Jones
> To: ob-gyn-l@obgyn.net
> 10/01/2003 09:19 cc:
> AM Subject: Re: GYN: Endometrial cells on pap(Document link: Terrence Jones)
>
> Art, Howard Beal is 'soylent green'. Spose I could go shlepping thru
>the pile of jnls in front of me to find the jrep citation. But, since You
>brought it up, maybe You can tell us - why did the 61 pts (out of 227) get
>histologic follow-up? Of the 14 pts (5+8+1) with 'significant disease' -
>(app 5% of total in this series), how many had no other clinical feature
>suggesting histologic evaluation? How many of this sub-group had "nml"
>endometrial cells? I do think one must know their Pathologist, and their
>Patient. Otherwise, follow the cookbook. tj
>
> evsono@pipeline.c
> om (art fougner, To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
> md) cc:
> Sent by: Subject: Re: GYN: Endometrial cells on pap
> ob-gyn-l@obgyn.ne
> t
>
> 10/01/2003 08:52
> AM
> Please respond to
> ob-gyn-l
>
>But see:
>
>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
>
--
art fougner, md
ich bin ein New Yorker
