The 2001 Bethesda System for Reporting Cervical Cytology recommends reporting benign exfoliated endometrial cells in women age 40 and older, and a review of the literature supports this recommendation. Stromal cells and histiocytes do not need to be reported. The effect of hormonal therapy on endometrial shedding is reviewed. Clinical information should be provided to the laboratory so that appropriate educational notes can be appended to the cytology report. Benign endometrial cells in premenopausal women in the first half of the cycle are not associated with significant pathology and such women do not need additional evaluation. Significant pathology is also unlikely in the second half of the cycle and evaluation may not be required unless clinically indicated. Initial evaluation of other women with benign endometrial cells may include either endometrial sampling or transvaginal ultrasound. Atypical endometrial cells are associated with a higher rate of significant pathology and should lead to additional evaluation. Additional prospective studies on the management of patients with endometrial cells on Pap tests are needed.
This review of the literature evaluates the morphological criteria, clinical assessment, and management guidelines for endometrial cells on Pap tests.
1Department of Obstetrics and Gynecology, Maricopa Medical Center, Affiliate of The University of Arizona College of Medicine, 2601 East Roosevelt Street, Phoenix, AZ 85008; 2Anatomic Pathology, Quest Diagnostics, Teterboro, NJ; 3Department of Pathology and Laboratory Medicine, University of Kentucky, Medical Center, Lexington, KY; 4Department of Pathology and Laboratory Medicine, University of Medicine and Dentistry of New Jersey, Newark NJ; and 5Ameripath Indiana, Indianapolis, IN
Reprint requests to: David L. Greenspan, MD, Department of Obstetrics and Gynecology, Maricopa Medical Center, Affiliate of The University of Arizona College of Medicine, 2601 East Roosevelt Street, Phoenix, AZ 85008. E-mail: Greenspandavid@hotmail.com