Hinweis auf endometriale Gewebsatypien durch Endometriumzellen im Zervixabstrich: Effekte der Hormonsubstitution - Predictive Value of Endometrial Cells in Cervical Smears Reflecting Endometrial Pathology: Effects of Hormonal Replacement Therapy -

Abstract

Objective: The presence of endometrial cells in cervical Pap smears can reflect endocrine anomalies or endometrial pathology. Endometrial shedding due to endocrine anomalies is rare in postmenopausal women without hormone replacement therapy. We aimed to evaluate the predictive value of endometrial shedding for endometrial pathology in postmenopausal women with and without hormone replacement therapy. Methods: We reviewed the results of 75 099 cytologic cervical smears obtained between 1985 and 1994. We analyzed the histologic findings and clinical course of patients with asynchronous (>12th day of the cycle) or postmenopausal shedding of endometrial cells according to menopausal status. Results: A total of 968 cases with adequate follow-up were analyzed. 85 patients had cytology suggestive of endometrial adenocarcinoma. 80 of these patients were found to have cancer and 4 had atypical endometrial hyperplasia. Of the 883 patients with asynchronous shedding of endometrial cells without cytologic features of malignancy, histology showed adenocarcinoma or atypical hyperplasia in 31 (7.8%) of 397 premenopausal women, 19 (15%) of 130 postmenopausal women with hormone replacement, and 96 (27%) of 356 postmenopausal women without hormone replacement therapy. The difference between postmenopausal patients with or without hormone replacement is significant (p < 0.006). Conclusion: In postmenopausal women the predictive value of endometrial cells in cervical smears reflecting endometrial pathology is strongly influenced by hormone replacement therapy.