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Reporting Endometrial Cells in Women 40 Years and Older
Assessing the Clinical Usefulness of Bethesda 2001

Aylin Simsir MD, William Carter, Paul Elgert CT(ASCP), Joan Cangiarella MD
DOI: http://dx.doi.org/10.1309/LJRD8JGJ7E5ERBUW 571-575 First published online: 1 April 2005


We assessed the usefulness of revised Bethesda System reporting of exfoliated benign endometrial cells (EMs) in postmenopausal women. Cervicovaginal cytology specimens with benign EMs in postmenopausal women and “out-of-phase EMs” in premenopausal women 40 years and older were identified. Cases with histologic follow-up within 12 months were selected.

There was tissue follow-up for 130 postmenopausal women: 10 (7.7%) had significant findings (endometrial adenocarcinoma, 6 [2 (33%) in asymptomatic women]; complex atypical endometrial hyperplasia [CAH], 3; leiomyosarcoma, 1); 20 were receiving hormone replacement therapy (HRT; n = 15) or tamoxifen (n = 5); 2 (10%) had significant pathology (endometrial adenocarcinoma, 1; CAH, 1). Eight not taking hormones (7.3%) had significant pathology (adenocarcinoma, 5; CAH, 2; leiomyosarcoma, 1). There were follow-up data for 96 premenopausal women; only 1 (who had vaginal bleeding) had significant pathology (CAH).

The difference in incidence of preneoplastic and neoplastic conditions after a cytologic interpretation of “benign EM” between postmenopausal and premeno-pausal women was significant (P ≤ .025); There was no difference between postmenopausal women receiving or not receiving HRT (P > .05). Reporting benign EMs for premenopausal women 40 years and older has no clinical significance but does for postmenopausal women, regardless of HRT and symptoms.

Key Words:
  • Endometrial cells
  • Cervicovaginal smears
  • Bethesda System
  • Hormone replacement therapy
  • Tamoxifen