Cytologic detection of endometrial pathology by pap smears

Gray, Jo-Ann; Nguyen, Gia‐Khanh

doi:10.1002/(sici)1097-0339(199903)20:3<181::aid-dc15>3.0.co;2-u

Cited by 23 publications

(8 citation statements)

References 5 publications

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“…The poor documentation of the LMP by the Pap test providers has been one of the main reasons why the reporting guidelines for EMCs are set by patient's age as opposed to menstrual status. It is beyond dispute that the value of diagnostic evaluation for potential endometrial pathology is compromised by the lack of relevant clinical information, and this holds true for both histology and cytology samples. Based on the guidelines of the Clinical Laboratory Improvement Amendments, laboratories must ensure the test requisition for Pap tests solicits information on the patients' LMP, previous abnormal report, treatment or biopsy .…”

Section: Discussionmentioning

confidence: 99%

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

Fischer

Haddad

Cormier

2017

Diagnostic Cytopathology

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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.

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Section: Discussionmentioning

confidence: 99%

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

Fischer

Haddad

Cormier

2017

Diagnostic Cytopathology

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“…However, these findings by themselves do not necessarily support a conclusion that the shedding of nEMC after Day 12 of the cycle is inherently abnormal. Prior studies5–7, 24 have shown that nEMC that are exfoliated “out of cycle” in premenopausal women are rarely associated with significant pathology. This is confirmed in our study as well, as only 2 patients with shedding of nEMC after Day 12 had significant pathology.…”

Section: Discussionmentioning

confidence: 99%

“…Historically, nEMC were reported in postmenopausal women and when encountered out of phase (after Day 12) in menstruating women. These practices were modified in the Bethesda system 1991 (TBS1991), which recommended the reporting of spontaneously exfoliated cells only in postmenopausal women 5–8. This was based on findings that a small proportion of women with endometrial cancer are asymptomatic and that spontaneously exfoliated nEMC in a postmenopausal women may indicate endometrial pathology 5, 9–11.…”

mentioning

confidence: 99%

Ultrastructural and molecular distinctions between the porcine inner cell mass and epiblast reveal unique pluripotent cell states

Hall

Jacobsen

Rasmussen

et al. 2010

Developmental Dynamics

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Characterization of the pluripotent cell populations within the porcine embryo is essential for understanding pluripotency and self-renewal regulation in the inner cell mass (ICM) and epiblast. In this study, we perform detailed ultrastructural and molecular characterization of the developing pluripotent cell population as it develops from the ICM to the late epiblast. The ultrastructural observations revealed that the outer cells of the ICM have a high nuclear:cytoplasmic ratio but are transcriptionally inactive and contain mitochondria with few cristae. In contrast, the epiblast cells have a reduced nuclear:cytoplasmic ratio, are more transcriptionally active, and contain abundant cellular organelles. This study also revealed cavitation and potential unfolding of the epiblast. As the ICM forms the epiblast, SSEA1 is lost and VIMENTIN is lost and re-expressed. The D6 blastocyst expressed high levels of STELLA, TERF1, and GDF3, and the epiblast expressed epithelial markers, MUC1 and E-CADHERIN, and the pluripotency markers, DNMT3B and CRIPTO. Developmental Dynamics 239:2911-2920,

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“…These include a clear definition of what constitutes ''significant pathology,'' the menopausal status of the patient, when the smears were obtained (for normally cycling premenopausal women), whether or not the patient was on contraceptive agents (and the type), whether or not the patient was on hormonal agents (hormone replacement therapy or tamoxifen), and the presence or absence of clinical symptoms such as vaginal bleeding. [19][20][21][22][23][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59] It is well recognized by the authors that many of these factors are typically considered in concert; however, to better appreciate the relative contributions of each to the general assessment of NECs in cervicovaginal smears, an attempt will be made to consider each in isolation.…”

Section: Significance Of Normal Exfoliated Endometrial Cells In Cervimentioning

confidence: 99%

The Significance of Benign Endometrial Cells in Cervicovaginal Smears

Fadare¹,

Ghofrani²,

Chacho³

et al. 2005

Advances in Anatomic Pathology

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The success of the routine Papanicolaou (pap) smear in reducing the incidence and mortality of cervical cancer has been chronicled extensively. Unfortunately, endometrial cancer, the most common malignancy of the gynecologic tract, continues to lack a screening modality of comparable efficacy. It is generally accepted that the Papanicolau test has a low sensitivity for detecting endometrial disease. Nonetheless, it remains true that endometrial cells are not uncommonly identified on routine cervicovaginal smears and along with each case comes an associated responsibility for pathologists to assess cytologic features, assign a potential clinical significance, and make a decision on reporting this finding. When endometrial cells with an entirely normal cytologic appearance are identified on an otherwise unremarkable cervicovaginal smear, the central question raised is whether such cells are exfoliating physiologically or whether their exfoliation is pathologic in response to an underlying endometrial disease. Additionally, in the former scenario, could subsets of patients be defined in which the reporting of this finding is deemed unnecessary in the cytologic report? In this contribution, we explore the clinical significance of finding normal endometrial cells in cervicovaginal smears based on a review of the medical literature of the last half-century. The historical and evidentiary basis for the Bethesda 2001 recommendations, which calls for the reporting of cytologically benign endometrial cells only in patients 40 years and older, is reviewed in detail.

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Cytologic detection of endometrial pathology by pap smears

Cited by 23 publications

References 5 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

Ultrastructural and molecular distinctions between the porcine inner cell mass and epiblast reveal unique pluripotent cell states

The Significance of Benign Endometrial Cells in Cervicovaginal Smears

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