Clinical significance of benign endometrial cells found in papanicolaou tests of Turkish women aged 40 years and older

Abstract

Background:Spontaneously exfoliated benign-appearing endometrial cells (BEC) on a Papanicolaou smear might indicate endometrial pathology in postmenopausal women, necessitating further investigation. A cut-off age of 40 years was included in the Bethesda System 2001 based on studies of clinical significance of endometrial cells in Pap smears in Western countries.Aims:The purpose of this study was to determine the significance of age subgroup for women with a cytological diagnosis of BEC, regardless of menopausal status, in a retrospective cohort of Turkish women.Materials and Methods:Between October 2006 and November 2011, 41 patients with a BEC diagnosis and 64 patients with a cytological diagnosis of normal smear (NS) were enrolled; regardless of menopausal status, these women were 40 years and older and for whom follow-up endometrial biopsies had been performed.Results:On subsequent histopathologic evaluation, no malignant lesion was detected in women aged 40-50 years compared to three endometrioid-type adenocarcinomas in women older than 50 years with cytological diagnosis of BEC. There was a significant difference between women older than 50 years with cytologic diagnosis of BEC and NS in relation to premalignant lesions on histopathologic evaluation; however, this was not the case for women aged 40-50 years.Conclusions:According to our study, reporting BEC for women aged between 40 and 50 years has minor clinical significance but is significant for women older than 50 years, regardless of menopausal status. Larger sample size would be appropriate to confirm the results of the current study.

Endometrial cells on Pap tests: ideal reporting is more complex than just finding the right age

“…Our data indicates that there is no benefit to report EMCs below 50 years of age, in fact reporting EMCs only in postmenopausal women seems to be a reasonable alternative. Setting the cut‐off age for reporting to ≥50 has been supported by other authors and this is also close to the average age of menopause. Although many factors (racial/ethnic and socioeconomic differences, diet, environmental influences, and physical activity) have some effect on it, the average age of menopause is approximately 51 years in the well‐developed industrialized countries .…”

“…As an alternative, when the postmenopausal status is clearly indicated on the requisition reporting EMCs below 50 years may still have value for the clinicians. The possibility of letting the local communities determine the reporting guidelines have been raised and the difference in menopausal profile, clinical management and the amount of available clinical information in different geographic locations and communities would support that.…”

Evaluating the Age Cutoff Criterion for Reporting Benign-Appearing Endometrial Cells in Routine Pap Tests: An 8-Year Retrospective Review

“…Of the 63 cases of EC that were identified, only 1 (1.6%) had BECs on Pap test, and this patient developed EC at the age of 51 years. Many other groups have also produced similar results in various patient clinical settings [13][14][15][16] .…”

Abnormal Endometrial Cells on Pap Smear in Endometrial Cancer

“…Pap test is very important tool for cervical cancer screening, and the presence of endometrial cells during Pap test performance in postmenopausal women usually denotes the presence of uterine pathology [1]. The presence of endometrial cells in Pap test is associated with endometrial cancer, especially aggressive subtypes such as uterine papillary serous subtypes [2].…”