Clinical relevance of benign endometrial cells in postmenopausal women

Our objective was to determine if the finding of benign endometrial cells o n a Papanicolaou (Pap) smear of a postmenopausal woman is associated with e ndometrial/uterine pathology, independent of symptomatology and hormone rep lacement therapy (HRT) status. The medical records of 146 postmenopausal pa tients who had a Pap smear showing normal-appearing endometrial cells betwe en January 9, 1997 and January 12, 2000 were reviewed. Uterine pathology fo r each patient was determined by reviewing the results of endometrial sampl ing (endometrial biopsy, or dilatation and curettage), hysterectomy, or pel vic sonogram, which were performed within 24 mo of the cytologic smear. The results were then correlated with clinical symptomatology and HRT status o f each patient at the time the cytologic smear was obtained. Of the 146 Pap smears coded with "endometrial cells in a postmenopausal woman," 50 were e xcluded due to prior hysterectomy, pen. menopausal status, and absence of f urther follow-up. Of the remaining 96 women, 27 (28%) had benign pathologic findings including polyps, leiomyomata, and simple hyperplasia without aty pia, whereas 11 (12%) had significant pathologic findings including hyperpl asia with atypia, adenocarcinoma, mixed Mullerian tumor, and leiomyosarcoma . Of the 11 patients with significant pathology, only one patient did not h ave abnormal vaginal bleeding but instead had a 30-wk-size irregular uterus on examination, and only 2 patients received hormone replacement therapy. In conclusion, Reporting endometrial cells on Pap smears in postmenopausal women did not lead to the diagnosis of any cases of significant pathology t hat would have gone unsuspected clinically. Moreover, HRT status did not af fect the incidence of normal endometrial cells on Pap smears in postmenopau sal women, nor did it aid in distinguishing which postmenopausal women had endometrial/uterine pathology. This calls into question the usefulness of t he current Bethesda guideline to report "benign endometrial cells in a post menopausal woman." (C) 2001 Wiley-Liss, Inc.