The validity of pap smear parameters as predictors of endometrial pathology in menopausal women

Abstract

Cytopathologists recognize that certain Pap smear findings are suspicious for endometrial pathology in menopausal women. To study their prognostic importance in the directed cervical smear, six parameters were used to evaluate smears for evidence of an endometrial lesion: the presence of (1) histiocytes, (2) multinucleated histiocytes, (3) nonspecific inflammation, (4) bleeding, (5) elevated squamous cell maturation index, and (6) the degree of cytologic atypicality of endometrial glandular cells, expressed as a "score" from 0 to 6. Clinical pathologic correlation of 102 women with these parameters was undertaken. A multivariable statistical analysis determined which of these six parameters was most predictive of an endometrial lesion. Cytologically "scored" endometrial glandular cells was the only parameter predictive of endometrial pathology. Its emergence as the sole prognostic cervical Pap smear parameter for endometrial pathology has not been previously reported. This predictive value was consistent even with control for bleeding history and age. Appropriate interpretation of abnormal Pap smear findings contributes substantial diagnostic information in the evaluation of the endometrium.

Classification of benign endometrial glandular cells in cervical smears from postmenopausal women

“…Zucker et al reported that advanced age, abnormal bleeding, and the presence of endometrial cells were predictive of endometrial adenocarcinoma in univariate and multivariate analyses. 3 The study population consisted of 102 women with Papanicolaou (Pap) smears that contained findings suggestive of an endometrial lesion, including histiocytes, high squamous maturation index, or endometrial cells, scored on a scale from 1 (benign) to 6 (malignant). It was found that 18 patients had endometrial adenocarcinoma, and all had endometrial cells on their Pap smears that were benign in 3 smears and abnormal in 15 smears.…”

“…None of the women in the study was on HRT. 3 Cherkis et al studied 440 women with Pap smears that contained benign endometrial cells without regard to whether they were receiving HRT. 16 Twenty of 179 patients (11%) with 12 months of follow-up had endometrial adenocarcinoma, and 5 patients (25%) had been asymptomatic.…”

“…Those authors identified age, abnormal bleeding, and Pap smear results as independent predictors of significant endometrial pathology (atypical hyperplasia or carcinoma) and recommended an office endometrial biopsy upon finding any type of endometrial cell on cervical cytology in PMP patients, or, if this is not possible or is nondiagnostic, then they may recommend proceeding with dilatation and curettage. 4 Vaginal bleeding is an established clinical indicator of endometrial disease 3,13,15 and has been identified as an independent predictor of disease. 3 However, symptomatic vaginal bleeding, per se, does not identify all women with an underlying endometrial process.…”

“…4 Vaginal bleeding is an established clinical indicator of endometrial disease 3,13,15 and has been identified as an independent predictor of disease. 3 However, symptomatic vaginal bleeding, per se, does not identify all women with an underlying endometrial process. In 1974, Ng and coworkers detailed the results of endocervical canal aspiration cytology in which benign endometrial cells were found out of phase in premenopausal or PMP women.…”

“…5 The finding in our study of a 6% rate (2 of 33 patients) of endometrial carcinoma in the group of PMP women who were not receiving HRT is consistent with these prior studies. [2][3][4][5]16 Very few studies have investigated the significance of endometrial cells in PMP women on HRT. In 1990, Yancey and coworkers reported the results of a study evaluating the significance of benign and atypical endometrial cells in smears from PMP and premenopausal women after Day 12 of the cycle.…”