Colletti Shanna M, Tranesh Ghassan A, Nassar Aziza
Address: Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Florida, USA.
Cytojournal. 2017 Sep 25;14:22. doi: 10.4103/cytojournal.cytojournal_16_17. eCollection 2017.
The 2014 Bethesda System recommends reporting the finding of benign-appearing, exfoliated endometrial cells on Papanicolaou (Pap) tests in women aged 45 years and older. We aimed to determine the significance of normal endometrial cells on liquid-based Pap tests in women aged 40 years and older and to correlate this finding with clinical factors and cytologic/histologic follow-up.
We retrospectively identified all women aged 40 years and older who had benign endometrial cells (BECs) on Pap tests at our institution during a 6-year period. Histologic follow-up and outcomes were evaluated.
Among 18,850 Pap tests during the study period, 255 (1.4%) had findings of BECs and 159 (62.4%) of these women had follow-up Pap tests or subsequent tissue sampling by surgical procedures. Of the 159 cases, only 4 (2.5%) had significant endometrial pathologic processes, all endometrial endometrioid adenocarcinoma (three women had postmenopausal bleeding and 1 was perimenopausal with menorrhagia). No women between ages 40 and 45 years had significant pathologic findings and only one woman between 46 and 50 years (47 years) had an endometrial endometrioid carcinoma (1.5%). Women older than 47 years have higher odds (5.38) of having a significant endometrial lesion ( = 0.029) than those who are ≤47.
Clinically significant endometrial lesions occurred predominantly in women older than 50 years (4.6%) and in only one woman between ages 46 and 50 years (1.5%). Therefore, endometrial sampling should be performed in women aged 47 years and older with BECs, especially when additional clinical indicators (e.g., postmenopausal bleeding) are recognized.
2014年贝塞斯达系统建议报告在45岁及以上女性的巴氏试验中发现外观良性的脱落子宫内膜细胞。我们旨在确定40岁及以上女性液基巴氏试验中正常子宫内膜细胞的意义，并将这一发现与临床因素以及细胞学/组织学随访结果相关联。
我们回顾性地确定了在6年期间于我们机构进行巴氏试验时发现有良性子宫内膜细胞（BECs）的所有40岁及以上女性。对组织学随访和结果进行了评估。
在研究期间的18,850次巴氏试验中，255次（1.4%）发现有BECs，其中159名（62.4%）女性进行了随访巴氏试验或随后通过手术进行了组织取样。在这159例病例中，只有4例（2.5%）存在显著的子宫内膜病理过程，均为子宫内膜样腺癌（3名女性有绝经后出血，1名处于围绝经期且月经过多）。40至45岁的女性中没有显著的病理发现，46至50岁之间只有一名47岁的女性患有子宫内膜样癌（1.5%）。47岁以上的女性发生显著子宫内膜病变的几率（5.38）高于47岁及以下的女性（P = 0.029）。
具有临床意义的子宫内膜病变主要发生在50岁以上的女性中（4.6%），46至50岁之间只有一名女性（1.5%）。因此，对于47岁及以上有BECs的女性应进行子宫内膜取样，尤其是当识别出其他临床指标（如绝经后出血）时。
