The Clinical Significance of Endometrial Cells Detected on Pap Testing: The Impact of Revisions to the 3rd Edition of the Bethesda System for Reporting Cervical Cytology

Goals. This study aims to examine the effects of raising the reporting age for benign endometrial cells (BEC) on Papanicolaou (Pap) tests according to the 2014 3rd edition of the Bethesda System for Cervical Cytology, as well as the sequelae of the 2012 American Society of Colposcopy and Cervical Pathology (ASCCP) guidelines recommending endometrial asessment only for postmenopausal or symptomatic premenopausal women. Procedures. We retrospectively examined clinical and histologic data from 4438 women aged ≥40 with BEC on Pap tests, of whom 608 (14%) were biopsied. Results. Fifty‐three (8.7%) histologic abnormalities were discovered upon biopsy. There was no significant difference (p=0.52) in abnormalities found between premenopausal women aged ≥40 and premenopausal women aged ≥45. Furthermore, there were no high‐grade cancers in women between ages 40–44. There were also 3 high‐grade cancers in patients aged 46, 46, and 49. Each of these women was asymptomatic and premenopausal. Conclusion. Our results affirm the raising of the reporting age of BEC on Pap tests from 40 to 45 in our patient population. Because there were 3 asymptomatic, premenopausal patients with high‐grade cancers in our 45–49 age group, we cannot completely adhere to the ASCCP guidelines nor can we advocate raising the reporting age further to 50. Other laboratories must review their own follow‐up data to validate appropriate reporting criteria for BEC for their patients.

[1]  O. Fadare,et al.  Age cut‐off for reporting endometrial cells on a Papanicolaou test: 50 years may be more appropriate than 45 years , 2016, Cytopathology : official journal of the British Society for Clinical Cytology.

[2]  A. Repše-Fokter.  Clinical Significance of Endometrial Cells in Papanicolaou Smears of Women Attending an Organized Cervical Cancer Screening Program , 2015, Acta Cytologica.

[3]  S. Sarmadi,et al.  Normal-Appearing Endometrial Cells in Pap Tests of Women Aged Forty Years or Older and Cytohistological Correlates , 2015, Acta Cytologica.

[4]  Robert P Berkowitz,et al.  2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. , 2013, Obstetrics and gynecology.

[5]  H. Cetiner,et al.  Clinical significance of benign endometrial cells found in papanicolaou tests of Turkish women aged 40 years and older , 2013, Journal of cytology.

[6]  N. Moatamed,et al.  In Papanicolaou smears, benign appearing endometrial cells bear no significance in predicting uterine endometrial adenocarcinomas , 2013, Diagnostic cytopathology.

[7]  Chengquan Zhao,et al.  Histologic follow-up in patients with Papanicolaou test findings of endometrial cells: results from a large academic women's hospital laboratory. , 2012, American journal of clinical pathology.

[8]  Elizabeth Jones,et al.  Clinical Significance of Reporting Benign-Appearing Endometrial Cells in Pap Tests in Women Aged 40 Years and Over , 2009, Acta Cytologica.

[9]  E. Pirog,et al.  The Bethesda System 2001 recommendation for reporting of benign appearing endometrial cells in Pap tests of women age 40 years and older leads to unwarranted surveillance when followed without clinical qualifiers. , 2007, Gynecologic oncology.

[10]  J. Moroney,et al.  Normal endometrial cells in liquid-based cervical cytology specimens in women aged 40 or older. , 2007, Gynecologic oncology.

[11]  Mohamed El-Fakharany,et al.  Reporting Endometrial Cells in Papanicolaou Smears of Women Age 40 and Older , 2007, Acta Cytologica.

[12]  D. Dabbs,et al.  Routine endometrial sampling of asymptomatic premenopausal women shedding normal endometrial cells in papanicolaou tests is not cost effective , 2007, Cancer.

[13]  D. Roder,et al.  Endometrial cells as a predictor of uterine cancer , 2007, The Australian & New Zealand journal of obstetrics & gynaecology.

[14]  S. Bean,et al.  Incidence and clinical significance of morphologically benign‐appearing endometrial cells in patients age 40 years or older , 2005, Cancer.

[15]  E. Cibas,et al.  The clinical significance of benign-appearing endometrial cells on a Papanicolaou test in women 40 years or older. , 2005, American journal of clinical pathology.

[16]  Michael J. Thrall,et al.  Significance of benign endometrial cells in papanicolaou tests from women aged ≥ 40 years , 2005, Cancer.

[17]  M. Spitzer,et al.  Endometrial Cells in Pap Smears of Postmenopausal Women: Cytohistologic Correlation , 2003, Journal of lower genital tract disease.

[18]  R. Ashfaq,et al.  Clinical relevance of benign endometrial cells in postmenopausal women , 2001, Diagnostic cytopathology.

[19]  H. Cramer,et al.  Significance of benign endometrial cells in Pap smears from postmenopausal women. , 2001, The Journal of reproductive medicine.

[20]  F. Abdul-Karim,et al.  Significance of Cytologically Normal Endometrial Cells in Cervical Smears from Postmenopausal Women , 2001, Acta Cytologica.

[21]  C. Gomez-Fernandez,et al.  Reporting normal endometrial cells in Pap smears: an outcome appraisal. , 1999, Gynecologic oncology.

[22]  Diane Solomon,et al.  The Bethesda System for Reporting Cervical/Vaginal Cytologic Diagnoses , 1994, Springer US.

[23]  M. Yancey,et al.  Classification of Endometrial Cells on Cervical Cytology , 1990, Obstetrics and gynecology.

[24]  J. Dickinson,et al.  Significance of Normal Endometrial Cells Detected by Cervical Cytology , 1988, Obstetrics and gynecology.

[25]  M. Feldstein,et al.  The validity of pap smear parameters as predictors of endometrial pathology in menopausal women , 1985, Cancer.

[26]  E. King,et al.  Significance of endometrial cells in cervicovaginal smears. , 1977, Annals of clinical and laboratory science.

[27]  J. Reagan,et al.  Significance of endometrial cells in the detection of endometrial carcinoma and its precursors. , 1974, Acta cytologica.

[28]  A. Moriarty,et al.  Endometrial Cells: The How and When of Reporting , 2015 .