Age cut-off for reporting endometrial cells on a Papanicolaou test: 50 years may be more appropriate than 45 years

Weiss, Vivian L.; Cate, Frances; Bloom, Leonard; Fadare, Oluwole; Coogan, Alice; Desouki, Mohamed Mokhtar

doi:10.1111/cyt.12280

Cited by 13 publications

(16 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our data indicates that there is no benefit to report EMCs below 50 years of age, in fact reporting EMCs only in postmenopausal women seems to be a reasonable alternative. Setting the cut‐off age for reporting to ≥50 has been supported by other authors and this is also close to the average age of menopause. Although many factors (racial/ethnic and socioeconomic differences, diet, environmental influences, and physical activity) have some effect on it, the average age of menopause is approximately 51 years in the well‐developed industrialized countries .…”

Section: Discussionsupporting

confidence: 65%

“…While most publications understandably focus on the ideal age of reporting EMCs, our findings suggest that reporting EMCs in postmenopausal women would be just as efficient, but it requires consistent reporting of the menopausal status and LMP. The inclusion of risk factors (diabetes, postmenopausal status, strong family history of breast, and endometrial cancers) in the reporting guidelines for EMCs as suggested by other authors would also require reliable clinical information on the requisitions.…”

Section: Discussionmentioning

confidence: 99%

“…Since this dramatic change did not achieve the desired results and led to numerous unnecessary endometrial samplings with no significant pathology, the Bethesda guidelines were later modified in 2014 to report EMCs in women ≥45 years; however, there continues to be no consensus on the optimal age for reporting. It also has been suggested that other factors (menopausal status, family history, and other risk factors) should be considered as requirements for reporting EMCs . The situation is further complicated by the lack of standardized clinical follow‐up of EMCs on Pap tests.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Endometrial cells on Pap tests: ideal reporting is more complex than just finding the right age

Fischer

Haddad

Cormier

2017

Diagnostic Cytopathology

View full text Add to dashboard Cite

Combined effort by pathologists and clinicians necessitates determining the best standardized clinicopathologic guidelines to report EMCs and appropriate follow-up. Increasing the required age to ≥50 years would provide more optimal patient management; however, there are other considerations beyond age. Reporting EMCs in postmenopausal women is a reasonable alternative requiring consistent and accurate recording of LMP. Improving provided information for pathologists, determining reporting requirements for EMCs and standardizing clinical follow-up should be a multidisciplinary effort. Diagn. Cytopathol. 2017;45:587-591. © 2017 Wiley Periodicals, Inc.

show abstract

Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Endometrial cells on Pap tests: ideal reporting is more complex than just finding the right age

Fischer

Haddad

Cormier

2017

Diagnostic Cytopathology

View full text Add to dashboard Cite

show abstract

“…Of the 63 cases of EC that were identified, only 1 (1.6%) had BECs on Pap test, and this patient developed EC at the age of 51 years. Many other groups have also produced similar results in various patient clinical settings [13][14][15][16] .…”

Section: Discussionmentioning

confidence: 69%

“…[13] reported that BECs on Pap tests and subsequent endometrial sampling leads to the detection of underlying EC in women (regardless of the menstrual cycle) ≥ 50 years old. Researchers from Vanderbilt found that only 1.4% of BECs are associated with ECs in patients over the age of 50 years [14] . This group also gathered all endometrial cancer cases and back-tracked the prior Pap test.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the Age Cutoff Criterion for Reporting Benign-Appearing Endometrial Cells in Routine Pap Tests: An 8-Year Retrospective Review

Grada¹,

Paquette²,

Eklund³

et al. 2017

Acta Cytologica

View full text Add to dashboard Cite

Objective: The 2014 Bethesda System recommends that benign-appearing endometrial cells (BECs) in routine Pap tests should be reported in patients aged ≥45 years. This is a change from previous guidelines to report BECs in women ≥40 years of age. BECs are reported to have 1% chance of endometrial lesion on follow-up. This study tests whether the new threshold may increase the specificity of the test for the detection of clinically significant endometrial lesions. Study Design: After institutional review board approval, 1,177 BECs, reported during an 8-year study period in patients aged ≥40 years, were retrieved from 672,000 routine ThinPrep Pap tests. The results of subsequent workup were collected by chart review, and the Fisher exact test was used to compare results in patients aged <50 and ≥50 years. Results: No endometrial carcinoma and only 2 cases of endometrial hyperplasia were detected in women aged <50 years, whereas 5.5% of women aged ≥50 years with BECs had carcinoma and/or endometrial hyperplasia (p = 0.000169). Conclusion: Investigation of BECs on routine Pap test are useful in patients aged ≥50 years as 5.5% of cases were confirmed to have significant endometrial disease. Our data as well as other studies support raising the BEC-reporting age threshold from ≥45 to ≥50 years, as the new threshold may improve the specificity of the test.

show abstract

Detection rates and factors affecting thereof in endometrial hyperplasia, endometrial carcinoma, and cervical glandular lesions on cervical smear

Cheung

Lee

et al. 2023

Cancer Medicine

View full text Add to dashboard Cite

IntroductionEndometrial lesions are morphologically diverse and uncommon on cervical smears, with its detection rate and associated diagnostic categories uncharacterized. In this study, cervical smears matched to histologically proven endometrial hyperplasias and carcinomas were reviewed and compared with cervical in‐situ‐carcinomas/carcinomas, aiming to detail the diagnostic performance of cervical smears for upper tract and glandular lesions.MethodsPathology reports of cervical smears, hysterectomies, endometrial and cervical biopsies from 1995 to 2021 were retrieved. Diagnoses of cervical smears were matched to endometrial hyperplasias and carcinomas, or cervical carcinomas and reviewed.ResultsTotally 832 cervical smears (272 cervical carcinomas, 312 endometrial carcinomas, and 248 hyperplasias) were included. Considering all cytologic glandular diagnosis as positive, the detection rate of cervical adenocarcinoma‐in‐situ was the highest (64.3%), followed by cervical adenocarcinoma (63.8%), endometrial carcinoma (31.7%), and hyperplasia (with atypia–8.5%; without atypia–2.3%) (p < 0.001). Endometrial hyperplasia was most often diagnosed as atypical squamous cells of undetermined significance (ASCUS) (5.0%) or atypical glandular cells, not otherwise specified (3.6%) without indication of endometrial origin. For endometrial carcinomas, higher FIGO grading and endocervical involvement were associated with higher detection rates across all diagnostic categories (p = 0.002–0.028). High FIGO grade was associated with suspicious/favor neoplastic (C4) (31.1%vs10.3%, p < 0.001) and carcinoma (C5) (17.8% vs. 5.6%, p = 0.005) categories, but not for all glandular diagnoses combined (33.3% vs. 31.0%, p = 0.761).ConclusionDetection rates for endometrial lesions are lower than cervical lesions but not insignificant. Endometrial hyperplasia should be recognized as a differential of human papilloma virus‐negative ASCUS and prompt consideration of investigation of the upper genital tract.

show abstract

Age cut-off for reporting endometrial cells on a Papanicolaou test: 50 years may be more appropriate than 45 years

Abstract: In asymptomatic women less than 50 years, E40 correlated with benign, non-hyperplastic endometrium. However, post-menopausal women with E40 had a risk of EC. Perhaps endometrial cells should only be reported in post-menopausal women or women greater than or equal to 50 years of age.

Cited by 13 publications

References 29 publications

Endometrial cells on Pap tests: ideal reporting is more complex than just finding the right age

Endometrial cells on Pap tests: ideal reporting is more complex than just finding the right age

Evaluating the Age Cutoff Criterion for Reporting Benign-Appearing Endometrial Cells in Routine Pap Tests: An 8-Year Retrospective Review

Detection rates and factors affecting thereof in endometrial hyperplasia, endometrial carcinoma, and cervical glandular lesions on cervical smear

Contact Info

Product

Resources

About