[NP-Clinical] endometrial cells on PAPs

[Kimberly Spering]

Benign Endometrial Cells Algorithm Annotations

2-6. Benign Endometrial Cells (BEC) Present

Key Points:

  a.. The Bethesda System 2001 reports the presence of normal, cytologically 
benign-appearing exfoliated endometrial glandular cells only in women age 40 
or greater.
  b.. Benign-appearing endometrial cells are noted in up to 12% of cervical 
cancer screenings performed over one year, more commonly in premenopausal 
than in postmenopausal women.
The presence of benign endometrial glandular cells on cervical screening 
tests may reflect physiologic shedding or shedding in response to a 
pathological process. In women over age 40, the presence of benign-appearing 
endometrial cells on cervical cytology has been found to be less than 2%. 
Benign-appearing endometrial cells are more likely to be identified on 
cervical cytology in the first 10 to 12 days of the menstrual cycle 
(prevalence 21% to 24%) than in the remainder of the cycle (prevalence 2%). 
The presence of benign endometrial cells on cervical cytology are reported 
so that a clinician can determine the significance of the finding in an 
individual woman.

Eighty-four percent (84%) of pre- and postmenopausal women who underwent 
endometrial sampling due to findings of benign endometrial cells on cervical 
pathology had no pathology, benign pathology or nondiagnostic pathology. 
Sixteen percent (16%) of these women were found to have significant 
pathology (simple or complex hyperplasia with or without atypia or 
carcinoma) at the time of their endometrial sampling.

If a woman has symptoms of endometrial cancer (abnormal uterine 
bleeding/spotting) or she is at increased risk of endometrial cancer (i.e., 
postmenopausal; family or personal history of ovarian, breast, colon or 
endometrial cancer; tamoxifen use; chronic anovulation; obesity; or prior 
endometrial hyperplasia), a sampling of the endometrium with endometrial 
biopsy or dilation and curettage (D & C) is suggested to rule out 
endometrial cancer. If the above symptoms or risk factors are not present, 
routine gynecological care should be continued, as women have not been 
proven to be at increased risk of endometrial cancer based on the presence 
of benign endometrial cells on cytology alone.

Evidence supporting this recommendation is of classes: B, C, D, R

http://www.guideline.gov/summary/summary.aspx?doc_id=10041&nbr=005341&string=endometrial+AND+cells+AND+PAP+AND+smear




Initial Evaluation. Colposcopy with endocervical sampling is recommended for 
women with all subcategories of AGC, with the exception that women with 
atypical endometrial cells should initially be evaluated with endometrial 
sampling (AII). Endometrial sampling should be performed in conjunction with 
colposcopy in women older than 35 years with AGC and in younger women with 
AGC who have unexplained vaginal bleeding (AII).

http://www.guideline.gov/summary/summary.aspx?doc_id=3286&nbr=002512&string=endometrial+AND+cells+AND+PAP+AND+smear
----- Original Message ----- 
From: "Sue Wiers" <sgwiers at hotmail.com>
To: <np-clinical at nurse.net>
Sent: Thursday, March 15, 2007 7:10 AM
Subject: Re: [NP-Clinical] (no subject)


> Kim,
>
> I did a lot of research into this a couple of years ago which included a 
> literature search, discussing with three ob-gyns, and a pathologist.  In a 
> nutshell, I could not find definitive guidelines or an established 
> standard-of-care  Do you know if any exist now?  One gyn and the 
> pathologist felt that this interpretation is now included due to someone 
> probably getting sued at some point and that too many unncessary 
> endometrial biopsies are probably being done.
>
> My approach has been to evaluate the findings within the context of the 
> woman's risk for endometrial cancer (relative age, whether the cells were 
> found in-phase or out-of-phase, whether or not she has been on OCs, etc). 
> In the relatively younger woman who is having regular menstrual cycles, 
> whose pap was done within 10 days of her last period I discuss with her 
> the risk of missing an endometrial cancer vs the risk associated with 
> endometrial biopsy (while not particularly risky, still not risk free).  I 
> give them the option of ruling out cancer with biopsy or repeating a pap 
> out-of-phase.  I don't believe that there is a right or wrong answer. 
> In the older patient without regular or with no menses, we do the 
> endometrial biopsy.
>
> Sue Wiers, FNP
>
>
>>From: "Kimberly Spering" <crnp2001 at westgateoptical.com>
>>Reply-To: NP Clinical <np-clinical at nurse.net>
>>To: "NP Clinical" <np-clinical at nurse.net>
>>Subject: Re: [NP-Clinical] (no subject)
>>Date: Thu, 15 Mar 2007 06:44:23 -0400
>>
>>My opinion is for #3:
>>
>>She needs an endometrial biopsy.  It may just be proliferative 
>>endometrium, but you definitely want to rule out hyperplasia, CA, etc.  On 
>>occasion, I've heard comments from others who mention that perhaps the 
>>cytobrush sampled "too far" into the cervix, but since usual cervical 
>>lengths are longer than the size of that brush, I don't agree with that 
>>opinion.  It would be hard to get into the main body of the uterus with a 
>>cytobrush, IMO, unless you were speaking of a patient post-op cold cone 
>>biopsy (with a BIG wedge removal).
>>
>>Kim Spering
>>OB-GYN
>>   ----- Original Message -----
>>   From: arezendes at aol.com
>>   To: np-clinical at nurse.net
>>   Sent: Wednesday, March 14, 2007 6:01 PM
>>   Subject: [NP-Clinical] (no subject)
>>
>>
>>   I am looking for some expert opinions on a couple of issues,
<snip>
>>   3. Woman who is 44 having usual periods but had endometrial cells on 
>> her pap. LMP was 2/22 and pap done 3/1.  Any guidelines?
>>
>>   Thanks to all ahead of time.
>>   Ann, NP