Significance of benign endometrial cells in Papanicolaou tests from women aged ≥ 40 years

BACKGROUND. The 2001 Bethesda System recommends reporting benign endometrial cells (BECs) in women aged a 40 years and considers these women at risk for endometrial pathology. The current study examines the relative risk of hyperplasia or malignancy conferred by the presence versus the absence of BECs in Papanicolaou (Pap) tests of women aged a 40 years. METHODS. Women aged a 40 years represented 29,177 (46.2%) of 63,202 Pap tests obtained over 1 year from a largely suburban screened population. Of these, 866 Pap tests (3%) showed BECs. Over the same 1 year period, 789 women aged a 40 years had endometrial histologic evaluations between 14 days and 6 months following a Pap test. The Pap tests of 159 women had BECs, and 33 had atypical (n = 32) or malignant (n = 1) endometrial cells. The 597 remaining women, who had Pap tests without endometrial cells but who had endometrial sampling for other reasons, served as controls. RESULTS. There were nine endometrial hyperplasias (5.7%) and no adenocarcinomas in the BECs group, whereas 34 hyperplasias (5.7%) and 6 adenocarcinomas (1%) were diagnosed in the controls. These differences were not statistically significant, even after restricting the analysis to women aged a 50 years or to women known to be postmenopausal. CONCLUSIONS. The current study found that women aged a 40 years with BECs in their Pap tests did not have more endometrial hyperplasias or malignancies when compared with women who had endometrial sampling for reasons other than the presence of endometrial cells in a Pap test.