Grada Zakaria, Paquette Cherie, Eklund Claire M, Zhang Cunxian, Sung C James, Steinhoff Margaret, Quddus M Ruhul
Department of Pathology, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, RI, USA.
Acta Cytol. 2017;61(3):194-198. doi: 10.1159/000473694. Epub 2017 May 10.
The 2014 Bethesda System recommends that benign-appearing endometrial cells (BECs) in routine Pap tests should be reported in patients aged ≥45 years. This is a change from previous guidelines to report BECs in women ≥40 years of age. BECs are reported to have 1% chance of endometrial lesion on follow-up. This study tests whether the new threshold may increase the specificity of the test for the detection of clinically significant endometrial lesions.
After institutional review board approval, 1,177 BECs, reported during an 8-year study period in patients aged ≥40 years, were retrieved from 672,000 routine ThinPrep Pap tests. The results of subsequent workup were collected by chart review, and the Fisher exact test was used to compare results in patients aged <50 and ≥50 years.
No endometrial carcinoma and only 2 cases of endometrial hyperplasia were detected in women aged <50 years, whereas 5.5% of women aged ≥50 years with BECs had carcinoma and/or endometrial hyperplasia (p = 0.000169).
Investigation of BECs on routine Pap test are useful in patients aged ≥50 years as 5.5% of cases were confirmed to have significant endometrial disease. Our data as well as other studies support raising the BEC-reporting age threshold from ≥45 to ≥50 years, as the new threshold may improve the specificity of the test.
2014年贝塞斯达系统建议，在常规巴氏试验中，对于年龄≥45岁的患者，应报告外观良性的子宫内膜细胞（BECs）。这与之前建议对年龄≥40岁女性报告BECs的指南有所不同。据报道，BECs后续发生子宫内膜病变的几率为1%。本研究旨在测试新的阈值是否可能提高检测具有临床意义的子宫内膜病变的试验特异性。
经机构审查委员会批准，从672,000例常规薄层液基巴氏试验中检索出在8年研究期间报告的1177例年龄≥40岁患者的BECs。通过查阅病历收集后续检查结果，并采用Fisher精确检验比较年龄<50岁和≥50岁患者的结果。
年龄<50岁的女性中未检测到子宫内膜癌，仅发现2例子宫内膜增生，而年龄≥50岁且有BECs的女性中有5.5%患有癌和/或子宫内膜增生（p = 0.000169）。
对年龄≥50岁的患者进行常规巴氏试验中BECs的检查是有用的，因为5.5%的病例被证实患有有意义的子宫内膜疾病。我们的数据以及其他研究支持将报告BECs的年龄阈值从≥45岁提高到≥50岁，因为新的阈值可能会提高试验的特异性。
