Reporting Normal Endometrial Cells in Pap Smears: An Outcome Appraisal

Abstract

Gynecol Oncol 1999;74:381–384 This study was designed to determine whether there was clinical relevance to reporting of normal endometrial cells on Pap smears. Two hundred-six consecutive Pap smears in women over the age of 35 with normal endometrial cells were reviewed. Clinical follow-up was available for all patients. One hundred sixty-two women presented with abnormal vaginal bleeding. They were evaluated by endometrial sampling. 10 cases of endometrial hyperplasia and 7 cases of endometrial adenocarcinoma were found. The remaining 44 women were clinically asymptomatic and had a minimum of 3 years follow-up. All had negative clinical courses. The authors concluded that the presence of normal endometrial cells has little impact in patient management. Clinically asymptomatic women who have report of endometrial cells are not significant. Many clinicians choose to disregard this finding. Editorial Comment: Obviously, patients with postmenopausal bleeding need to be evaluated. In this group of patients, 60 postmenopausal women were evaluated, six with endometrial hyperplasia and six with endometrial carcinoma. Premenopausal women with abnormal vaginal bleeding had a 5% incidence of hyperplasia or carcinoma. Therefore, these women certainly need evaluation as well. However, in none of the postmenopausal women with endometrial cells found on Pap smear was there any evidence of hyperplasia or cancer. It appears safe to consider this a normal finding certainly in premenopausal women and, perhaps, even in postmenopausal women. The authors final conclusion is that a report of normal endometrial cells in Pap smears may create unjustifiable patient apprehension and led to unnecessary diagnostic procedures. (CJD)