Normal-Appearing Endometrial Cells in Pap Tests of Women Aged Forty Years or Older and Cytohistological Correlates

Abstract

Objective: The Bethesda System 2001 for reporting cervical cytology recommends reporting benign-appearing, exfoliated endometrial cells in women aged 40 years or older. The objective of this study was to determine the significance of normal endometrial cells in conventional Papanicolaou (Pap) tests of women aged 40 years and older and to correlate this finding with histological follow-up. Study Design: Over a period of 5 years, all Pap tests showing endometrial cells in women aged ≥40 years were identified. Histological follow-up and outcome were evaluated. Results: Out of 17,275 Pap tests, 199 (1.15%) showed benign endometrial cells. Forty-seven of these 199 patients had subsequent tissue sampling by surgical procedures including endometrial curettage (n = 31), lower genital tract biopsy (n = 30) and hysterectomy (n = 2). Overall, out of 47 cases, 3 (6.4%) had significant endometrial pathology including 2 simple hyperplasias without atypia and 1 complex hyperplasia with atypia. Conclusion: The incidence of clinically significant endometrial lesions associated with the presence of endometrial cells in Pap tests of women aged 40 years and older was very low. Considering this finding, women aged between 40 and 50 years with benign endometrial cells in a Pap test should undertake endometrial sampling only when additional clinical indicators are recognized.

Contribution of cervical cytology in the diagnostic work‐up of patients with endometrial cancer

“…We defined abnormal cytology more strictly as the presence of atypical glandular cells or EC cells, whereas Roelofsen et al included the presence of endometrial cells into abnormal cervical cytology . Categorization of the presence of endometrial cells into normal cervical cytology is supported by recent data of Izadi‐Mood et al, 25 who demonstrated in a series of 199 cases that the presence of endometrial cells in cervical cytology tests of women older than 40 years was not associated with significant endometrial lesions …”

Efficacy of Uterobrush in Endometrial Sample Collection for the Cytology and Diagnosis of Endometrial Lesions

“…Slične probleme navode i drugi autori. 21,24,28,29 Jedno stavna hiperplazija endometrija točno je dijagnostici rana kod 11 od 13 bolesnica (84,6%), a kompleksna hiperplazija samo u njih 50% (2/4) (slika 3.). Katkad se degenerativne promjene endometrijskih stanica poput, npr., povećanja jezgara mogu interpretirati kao atipija.…”

“…Slične rezultate navode i drugi autori. 15,21,[24][25][28][29] S obzirom na sve širu i opsežniju uporabu histero skopskih zahvata u dijagnostici endometrijskih pore mećaja, na trenutak se čini da citologija endometrija nema kliničku svrhu. Ipak, to nije točno.…”

Clinical Significance of Endometrial Cells in Papanicolaou Smears of Women Attending an Organized Cervical Cancer Screening Program

“…I read with interest the recently published article entitled ‘Normal-appearing endometrial cells in Pap tests of woman aged forty years or older and cytohistological correlates' by Izadi-Mood et al [1]. They report that the incidence of clinically significant endometrial lesions associated with the presence of endometrial cells (EMC) in Papanicolaou (Pap) tests of women aged 40 years and older was very low and suggest endometrial sampling only when additional clinical indicators are present.…”