Re: Benign Endometrial cells on pap smear in Postmenopausal women.
From: art fougner, md (evsono@pipeline.com)
Sat Oct 25 09:19:39 2003
Interesting - we do amniocentesis for far lower risk than 4%. Could it
be that an entity more intolerable than cancer is Down's syndrome? just
a random thought ...
art
At Fri, 24 Oct 2003, Braun, R. Daniel wrote:
>
>Oh yeah, I forgot to say "If I get a 4% cancer return rate on Pipelle
>biopsy, I will do one on every patient who has that risk." 4% is a lot
>higher than we get on Post menopausal bleeders. Now as Harrison points
>out, I may not get that high a positive return rate due to the Authors
>skewed patient population.
>
>Dan
>
> -----Original Message-----
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf
>Of Terrence.Jones@kp.org
> Sent: Thursday, October 23, 2003 1:41 PM
> To: Multiple recipients of list OB-GYN-L
> Subject: Re: Benign Endometrial cells on pap smear in
>Postmenopausal women.
>
> Thanks Harrison! I hadn't time to hunt down the article, so
>delayed comment. Wonder if there is mention of the cytologic appearance
>of the endometrial cells in the 4 Pts with adenoca? Were they 'benign
>appearing' in every case? Also, any discussion regarding cytobrush, vs
>spatula alone, WRT specificity? tj
>
> Harrison Sheld <hsheld@anv.net>
>Sent by: ob-gyn-l@obgyn.net
>
>10/22/2003 04:44 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.
>
> I have reviewed the article in the JLGTD. I believe there are
>several
> problems with it.
>
> First, the patients were drawn from the population of a tertiary
>care
> medical center and may not be representative of the general
>population.
>
> Second, aside from hormone therapy, there are no historical data
>as to
> reproductive history, previous HRT, current medications
>including those
> considered alternative, concurrent medical conditions, previous
>abnormal
> Paps or previous GYN surgery; all possible confounders in the
>analysis.
>
> Third, the number patients in that hospital's catchment area who
>did not
> have endometrial cells or histiocytes but who had "asymptomatic"
> endometrial carcinoma is not known. Knowing that the sensitivity
>of the
> Pap smear with regard to detecting endometrial pathology is not
>nearly
> 100%, it may be that the "negative" population also had a 4% or
>greater
> incidence of endometrial cancer. In other words one cannot
>assume that
> all the patients who did not have endometrial cells or
>histiocytes on
> their Pap did not have endometrial cancer.
>
> Fourth, 12 patients on followup had insufficient tissue on
>sampling and
> were not included in the analysis. Since a common finding in
>endometrial
> sampling of postmenopausal patients is insufficient tissue
>commonly from
> an atrophic endometrium, these patients could have been
>included. Their
> inclusion would not have substantially changed the findings.
>
> Finally, the Bethesda system as recently revised does not
>include
> endometrial cells as an epithelial abnormality in women over 40.
>I would
> be hard pressed absent other risks for endometrial cancer to
>justify
> cell sampling every postmenopausal patient who had one Pap that
>showed
> histiocytes and/or normal endometrial cells on the basis of this
>study
> (nor did the authors make that suggestion.)
>
> "Braun, R. Daniel" wrote:
> >
> > They were assymptomatic and there was no relationship to their
>being on
> > estrogen or not according to the study. How many negative
>
>samplings do
> > you get for every 4 malignancies when you sample 40 yr olds
>with
> > menomenorrhagia?? I'll bet it is a lot more than 96, still it
>is the
> > standard of care.
> >
> > Dan
> >
> > -----Original Message-----
> > From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf
>Of
> > Harrison Sheld
> > Sent: Tuesday, October 21, 2003 12:18 PM
> > To: Multiple recipients of list OB-GYN-L
> > Subject: Re: Benign Endometrial cells on pap smear in
>
>Postmenopausal
> > women.
> >
> > I have not read the article in the ASCCP Journal but there are
>other
> > articles that have a different statistics. I would advise the
>patient of
> > the statistics (some studies report a only 1% malignancy level
>in
> > asymptomatic patients), and would let her make the decision.
>That said,
> > patients who are on estrogen, symptomatic, or with risk
>
>factors for
> > endometrial CA should be sampled. Doing endometrial sampling
>on
> > menopausal patients is often times difficult and
>
>uncomfortable.
> > According to the article cited, and I don't know if the
>
>patients were at
> > risk for CA, on estrogen, or symptomatic, 96 out of 100
>
>samplings would
> > be unnecessary. If the patient chose not to be sampled I would
>inform
> > her to report in a timely fashion symptoms if they should
>
>occur and
> > return for a Pap in 4 months. Just my opinion and I could be
>wrong.
>
--
art fougner, md
ich bin ein New Yorker
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