Predictive value of endometrial cells in cervical smears reflecting endometrial pathology: Effects of hormonal replacement therapy

Objective: The presence of endometrial cells in cervical Pap smears can ref lect endocrine anomalies or endometrial pathology. Endometrial shedding due to endocrine anomalies is rare in postmenopausal women without hormone rep lacement therapy. We aimed to evaluate the predictive value of endometrial shedding for endometrial pathology in postmenopausal women with and without hormone replacement therapy. Methods: We reviewed the results of 75 099 cytologic cervical smears obtain ed between 1985 and 1994. We analyzed the histologic findings and clinical course of patients with asynchronous (> 12th day of the cycle) or postmenop ausal shedding of endometrial cells according to menopausal status. Results: A total of 968 cases with adequate follow-up were analyzed. 85 pat ients had cytology suggestive of endometrial adenocarcinoma. 80 of these pa tients were found to have cancer and 4 had atypical endometrial hyperplasia . Of the 883 patients with asynchronous shedding of endometrial cells witho ut cytologic features of malignancy, histology showed adenocarcinoma or aty pical hyperplasia in 31 (7.8%) of 397 premenopausal women, 19 (15%) of 130 postmenopausal women with hormone replacement, and 96 (27%) of 356 postmeno pausal women without hormone replacement therapy. The difference between po stmenopausal patients with or without hormone replacement is significant (p < 0.006). Conclusion: In postmenopausal women the predictive value of endometrial cel ls in cervical smears reflecting endometrial pathology is strongly influenc ed by hormone replacement therapy.