The Clinical Significance of Endometrial Cells Detected on Pap Testing: The Impact of Revisions to the 3rd Edition of the Bethesda System for Reporting Cervical Cytology

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This study aims to examine the effects of raising the reporting age for benign endometrial cells (BEC) on Papanicolaou (Pap) tests according to the 2014 3rd edition of the Bethesda System for Cervical Cytology, as well as the sequelae of the 2012 American Society of Colposcopy and Cervical Pathology (ASCCP) guidelines recommending endometrial asessment only for postmenopausal or symptomatic premenopausal women.


We retrospectively examined clinical and histologic data from 4438 women aged ≥40 with BEC on Pap tests, of whom 608 (14%) were biopsied.


Fifty-three (8.7%) histologic abnormalities were discovered upon biopsy. There was no significant difference (p=0.52) in abnormalities found between premenopausal women aged ≥40 and premenopausal women aged ≥45. Furthermore, there were no high-grade cancers in women between ages 40–44. There were also 3 high-grade cancers in patients aged 46, 46, and 49. Each of these women was asymptomatic and premenopausal.


Our results affirm the raising of the reporting age of BEC on Pap tests from 40 to 45 in our patient population. Because there were 3 asymptomatic, premenopausal patients with high-grade cancers in our 45–49 age group, we cannot completely adhere to the ASCCP guidelines nor can we advocate raising the reporting age further to 50. Other laboratories must review their own follow-up data to validate appropriate reporting criteria for BEC for their patients.

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