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Re: Benign Endometrial cells on pap smear in Postmenopausal women. From: Harrison Sheld (hsheld@anv.net) Wed Oct 22 18:43:19 2003 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: DrSavvas Savvas: "Interasting case" Previous message: Charlie Chambers: "fetal pac" Maybe in reply to: Braun, R. Daniel: "Benign Endometrial cells on pap smear in Postmenopausal women." Next in thread: Terrence.Jones@kp.org: "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. Next message: DrSavvas Savvas: "Interasting case" Previous message: Charlie Chambers: "fetal pac" Maybe in reply to: Braun, R. Daniel: "Benign Endometrial cells on pap smear in Postmenopausal women." Next in thread: Terrence.Jones@kp.org: "Re: Benign Endometrial cells on pap smear in Postmenopausal women."

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