Department of Gynecology-Oncology, University Hospital UZ Brussel, Brussels, Belgium.
Department of Pathology, University Hospital UZ Brussel, Brussels, Belgium.
J Am Soc Cytopathol. 2023 Nov-Dec;12(6):469-475. doi: 10.1016/j.jasc.2023.08.001. Epub 2023 Aug 13.
Within the Bethesda System, the recommendation of describing benign-appearing endometrial cells (BECs) has changed over recent years. Since the 2014 revision, their presence in cervical cytology reports has been deemed essential, beginning with age 45. Recent studies have suggested rising the reporting age to 50 years. Does the presence of these cells necessitate further assessment?
This retrospective cohort study included patients aged between 45 and 65 years in whom BECs were present on cervical cytology between January 2001 and December 2010, with a follow-up at 5 and 10 years. Women who had abnormal cervical cells or atypical endometrial cells on cervical cytology were excluded, as well as women with a history of cervical or endometrial cancer, or a history of hysterectomy and incomplete follow-up data.
One hundred seventy-six women were included. Of these, 31% were postmenopausal of which 65% used hormonal substitution therapy. Twenty-eight percent presented with abnormal uterine bleeding at inclusion. During the follow-up period of 10 years, 87.5% had a normal gynecological follow-up and 11.4% underwent a hysterectomy for benign pathology. One percent (2 patients) had been diagnosed with endometrial malignancy, both presenting with postmenopausal bleeding and aged over 60 years.
Our study confirmed that the presence of BECs is not a reason for concern when no additional clinical indicator is recognized, especially with normal ultrasonographic examination. Further invasive exploration may be controversial. If reporting BECs in cervical cytology continues, we strongly agree on rising the reporting age to 50 years or postmenopausal state.
在贝塞斯达系统中，近年来对良性子宫内膜细胞（BEC）的描述建议发生了变化。自 2014 年修订以来，在 45 岁开始，其在宫颈细胞学报告中的存在被认为是必不可少的。最近的研究表明，报告年龄应提高到 50 岁。这些细胞的存在是否需要进一步评估？
这项回顾性队列研究包括年龄在 45 至 65 岁之间的患者，他们在 2001 年 1 月至 2010 年 12 月的宫颈细胞学检查中存在 BEC，随访 5 年和 10 年。排除了宫颈细胞学检查中存在异常宫颈细胞或非典型子宫内膜细胞的妇女，以及有宫颈或子宫内膜癌病史或子宫切除术病史和不完整随访数据的妇女。
共纳入 176 例患者。其中，31%为绝经后妇女，其中 65%使用激素替代疗法。28%在纳入时出现异常子宫出血。在 10 年的随访期间，87.5%有正常的妇科随访，11.4%因良性病变行子宫切除术。1%（2 例）被诊断为子宫内膜癌，均表现为绝经后出血，年龄超过 60 岁。
我们的研究证实，当没有识别出其他临床指标时，BEC 的存在不是一个值得关注的原因，尤其是超声检查正常时。进一步的侵入性探索可能存在争议。如果继续报告宫颈细胞学中的 BEC，我们强烈同意将报告年龄提高到 50 岁或绝经后状态。
