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Cytopathologists recognize that certain Pap smear findings are suspicious for endometrial pathology in menopausal women. To study their prognostic importance in the directed cervical smear, six parameters were used to evaluate smears for evidence of an endometrial lesion: the presence of (1) histiocytes, (2) multinucleated histiocytes, (3) nonspecific inflammation, (4) bleeding, (5) elevated squamous cell maturation index, and (6) the degree of cytologic atypicality of endometrial glandular cells, expressed as a "score" from 0 to 6. Clinical pathologic correlation of 102 women with these parameters was undertaken. A multivariable statistical analysis determined which of these six parameters was most predictive of an endometrial lesion. Cytologically "scored" endometrial glandular cells was the only parameter predictive of endometrial pathology. Its emergence as the sole prognostic cervical Pap smear parameter for endometrial pathology has not been previously reported. This predictive value was consistent even with control for bleeding history and age. Appropriate interpretation of abnormal Pap smear findings contributes substantial diagnostic information in the evaluation of the endometrium.
Cytopathologists recognize that certain Pap smear findings are suspicious for endometrial pathology in menopausal women. To study their prognostic importance in the directed cervical smear, six parameters were used to evaluate smears for evidence of an endometrial lesion: the presence of (1) histiocytes, (2) multinucleated histiocytes, (3) nonspecific inflammation, (4) bleeding, (5) elevated squamous cell maturation index, and (6) the degree of cytologic atypicality of endometrial glandular cells, expressed as a "score" from 0 to 6. Clinical pathologic correlation of 102 women with these parameters was undertaken. A multivariable statistical analysis determined which of these six parameters was most predictive of an endometrial lesion. Cytologically "scored" endometrial glandular cells was the only parameter predictive of endometrial pathology. Its emergence as the sole prognostic cervical Pap smear parameter for endometrial pathology has not been previously reported. This predictive value was consistent even with control for bleeding history and age. Appropriate interpretation of abnormal Pap smear findings contributes substantial diagnostic information in the evaluation of the endometrium.
This article deals with a 6-yr mass screening program for the early detection of endometrial cancer, which took place 1978-1983. The diagnostic accuracy of endometrial cytology and the possibility of integrating this technique with the hysteroscopy and endometrial biopsy were studied. The authors analyzed 2,504 outpatients, all over the age of 45. The results of endometrial cytology were compared with those found using hysteroscopy and endometrial biopsy. Endometrial cytology showed high sensitivity in diagnosing endometrial cancer (97.7%) and high specificity in diagnosing true negatives. However, this technique was not adequate in identifying benign endometrial pathology, e.g., endometrial hyperplasia, polyps, or submucous fibromas. Epidemiological and clinical data in our series were fundamental in establishing mass screening for the early detection of endometrial cancer using integrated techniques. These data should be taken into consideration for creating new projects. The significantly high prevalence of endometrial neoplasia even in asymptomatic women over 45 years of age (4 per 1000) and the possibility of improving the accuracy of endometrial diagnosis using hysteroscopy and endometrial biopsy were the cornerstones of this project.
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