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Re: Benign Endometrial cells on pap smear in Postmenopausal women.From: Zachariah Newton (zbnewton@bellsouth.net)Thu Oct 23 18:29:29 2003
Chaos, science, observation, selection, discernment, interpretation, judgment, numbers, statistical analysis with power note. There always remains the smell test. Empirical evidence does enter the equation. It validates those of us who do not qualify for genius purveyance. Zach Newton Z. B. Newton, III, M.D, Atlanta/Gyn
> ----- Original Message ----- Yes Harrison, I understood Your concerns WRT ascertainment bias, selection bias, methodology and statistical validation, when first mentioned. What puzzles Me, is why would neoplastic endometrium be assiociated with a greater exfoliation of normal endometrial cells? (Tho, as You've pointed out, we don't know the rate of endometrial Ca, in this study pop, with normal pap and no EM cells.) Our regional cytolopathologist described the sampling achieved by cytobrush (frequently can reach lower segment) - which seemed a reasonable explanation for EM cells on pap. But what is the biologic plausibility for the assoc with neoplasia? I think You're correct in implicating historic confounders. Increased BMI, peripheral conversion of A to E1, insulin resistance (and inc IGFBP1 effects on endometrium), would all be red flags for an endometrium at risk for both benign proliferation, as well as neoplastic. Clinically, it would be of important to kn! ow the effects of these variables on predictive value. And, as is the case with asymptomatic Pt on Tamoxifen: what is the relationship to final staging when the currently asymptomatic patient later becomes symptomatic. (I'm not referring to incidence, Dan, but the impact of delay in diagnosis.) Using the cervix as an analogy is not valid, as the symptom we are observing (irregular bleeding) is frequently present in the endometrium lesion, while still pre-invasive. One of our East Bay residents did a study on our regional pop database, as his research project. I'll try to find the numbers. I believe there was an intent to publish, but - who can keep up, nowadays?! And thanks for YOUR interest! tj Harrison Sheld <hsheld@anv.net> Sent by: ob-gyn-l@obgyn.net 10/23/2003 02:16 PM Please respond to ob-gyn-l To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net> cc: Subject: Re: Benign Endometrial cells on pap smear in Postmenopausal women. There is the statement: "6 of the 10 patients with EH/CA did not have vaginal bleeding and were referred for evaluation based solely on their cytological abnormality showing benign endometrial cells (four patients) or foamy histiocytes (two patients.)" They did exclude 10 patients who had atypical glandular cells. It is hard for me to accept that that the sole reason for referral was the cytology when there is no statement that a complete medical history and physical examination was performed on all reported patients; we don't know what confounding factors those patients had. Neither do we know what in the 34/159 patients' medical histories or physical examinations that may have been responsible for no followup and their exclusion from the study. There are no details about how the specimens were obtained or by whom. Neither is there indication on who obtained the information about bleeding and HRT. Could have been done by secretarial help in the office checking or not checking a box on the Pap requisition. Thanks for your interest.
Terrence.Jones@kp.org wrote:
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