Reporting normal endometrial cells in pap smears: An outcome appraisal

Objective. The purpose of this study was to determine the clinical relevanc e of reporting the presence of normal endometrial cells in the Pap smears o f women over the age of 35 years and the significance of this practice as i t relates to patient management. Methods. From January 1992 to December 1995, normal endometrial cells were reported in 206 consecutive Pap smears of women over the age of 35 years. C linical follow-up was available for all patients, including the results of diagnostic procedures whenever performed. Results. Of the 206 women with normal endometrial cells in their Pap smears , 162 presented with the chief complaint of abnormal vaginal bleeding. They were all evaluated by direct endometrial sampling, resulting in detection of 10 endometrial hyperplasias and 7 endometrial carcinomas. The remaining 44 women who were clinically asymptomatic were followed up with only routin e annual gynecologic examinations for a minimum of 3 years. All had negativ e clinical courses. Conclusion. Reporting the presence of normal endometrial cells in Pap smear s has little, if any, impact on subsequent patient management. Women who pr esent with abnormal uterine bleeding are worked up for endometrial disease regardless of their Pap smear findings. In clinically asymptomatic patients , practitioners may, and in our experience often do, choose to disregard no rmal endometrial cells in Pap smear reports. The negative follow-up for the asymptomatic women in our study supports this practice. Therefore, reporti ng the presence of normal endometrial cells in Pap smears is of no clinical relevance and may, in fact, create a management dilemma for clinicians. (C ) 1999 Academic Press.