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Re: Benign Endometrial cells on pap smear in Postmenopausal women.From: Braun, R. Daniel (rbraun@iupui.edu)Fri Oct 24 06:30:42 2003
They said they were all "normal" appearing endometrial cells. 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:
>
samplings do
> you get for every 4 malignancies when you sample 40 yr olds
Postmenopausal
> women.
factors for
> endometrial CA should be sampled. Doing endometrial sampling
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
occur and
> return for a Pap in 4 months. Just my opinion and I could be
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