“Endometrial Cells in Pap smears- Role in prediction of Endometrial Pathology- A three year study”

Introduction: Endometrial Carcinoma is one of the most common malignancy of female genital tract and third most common worldwide. No widely accepted screening test for endometrial carcinoma exists. However, cervical cytology has been found to be useful in detecting endometrial disease. The 2001 Bethesda system recommends the reporting of endometrial cells in women of 40 years and more, regardless of menstrual status or clinical history. Aims & objectives: The purpose of the current study is to identify the endometrial cells in Pap smears and correlate with the presence or absence of significant endometrial pathology. Materials & methods: A total of 29,736 conventional Pap smears, during a three year study period (July 2010 to June 2013) were studied and evaluated for presence of any significant endometrial pathology on histopathology. In all these patients, clinical information including age, menopausal status, use of hormonal replacement therapy, presence of abnormal bleeding were noted. Results: In the current study, 49 of 189 women had histopathological correlation. 85.7% cases of endometrial carcinoma on biopsy had abnormal cells in Pap smears except 1 case which showed benign EMCs. 1 of the 5 cases of endometrial hyperplasia had atypical endometrial cells. Other benign conditions had benign EMCs in Pap smears. Most of the women with significant endometrial pathology on biopsy had benign EMCs (13/20 cases) in Pap smears. However, abnormal EMCs were noted in 6 of 7 cases of endometrial carcinoma. Only 1 case with benign EMCs in Pap had endometrial carcinoma on follow up. No malignancy was noted in women aged <40 years of age. Conclusion: Underlying significant endometrial pathology is likely to be present in symptomatic women aged >40 years with benign EMCs on cytology, post-menopausal women with or without symptoms and in women with abnormal EMCs in Pap smears regardless of their age and necessitates further evaluation.