Significant increase of benign endometrial cells on Papanicolaou smears in women using hormone replacement therapy

Abstract

We found that HRT is significantly associated with an increased prevalence of benign endometrial cells on Papanicolaou smears. Women on HRT who have benign endometrial cells on their Papanicolaou smears, however, have less abnormal endometrial histology compared with women not using HRT who have benign endometrial cells on their Papanicolaou smears.

Normal appearing endometrial cells in cervical smears of asymptomatic postmenopausal women have predictive value for significant endometrial pathology

“…We only found 56 cases EM1 in a population of 29,144 women (0.2%). This is in line with other studies, where normal endometrial cells were found in low proportions also (Sarode et al (14) : 0.24%, Cherkis et al (7) : 0.23%, Mount et al (12) : 1.1%). The higher proportion of EM1 smears in the study of Mount et al was probably related to a high frequency of women who took HRT.…”

“…Therefore, we think it is valid to assume that these cases have a normal clinical outcome. A second reason is the possibility of introducing a selection bias when using histologic follow-up results only, as stated by Chang et al (16) and Mount et al (12) . Cases that were found to be at higher risk during follow-up are evaluated by endometrial sampling.…”

“…Interacting variables such as increasing age, use of exogenous hormones (hormone replacement therapy [HRT]), and elevated maturation index (MI) of squamous cells in the smear have been described earlier (3,(10)(11)(12)(13)(14) . Therefore, we examined the individual impact of these variables on the outcome as well as their combined effect on the PRR.…”

The Role of Papanicolaou Test in the Diagnosis of Endometrial Carcinoma

“…In another study, Sarode et al (15) have encountered endometrial pathology in 28 (34%) of the 81 postmenopausal women with NEC detected by Pap smear test and reported that 4 (4.9%) of those were endometrial carcinoma. Benign endometrial findings, polyps, simple hyperplasia, atypical hyperplasia and carcinoma were reported in 22-97%, 1-41%, 1-20%, 0.6-8% and 1-15% of the women with NEC identified by Pap smear test in many studies, respectively (15)(16)(17). In our study, the rates of atypical cells were higher in the smear samples of postmenopausal patients.…”

Morphometric analysis of endometrial cells in liquid‐based cervical cytology samples

“…30,31 It has been observed that most highgrade carcinomas and other malignant endometrial lesions may also have benign appearing endometrial cells in addition to malignant cells or atypical cells in the cervical smears. [32][33][34][35] Salomao et al 32 compared women with atypical endometrial cells in cervical samples and adenocarcinoma on biopsy versus those with atypical cells but benign follow-up. They found that an increased nuclear size to at least two times that of an intermediate cell nucleus and the absence of cell clusters with irregular borders were more indicative of adenocarcinoma than a benign endometrial process.…”