Normal endometrial cells in cervical cytology: systematic review of prevalence and relation to significant endometrial pathology

J Med Screen 2008;15:188-198
doi:10.1258/jms.2008.008069
© 2008 Medical Screening Society

 

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Original Articles


Karen CanfellDPhil, Sydney Rotary Research Fellow 
,


Cancer Epidemiology Research Unit, Cancer Council New South Wales, 153 Dowling Street, Woolloomooloo, New South Wales, Sydney, Australia and School of Public Health, The University of Sydney, Australia


Yoon Jung KangMPH (Hons), PhD Student
,


Cancer Epidemiology Research Unit, New South Wales, 153 Dowling Street, Woolloomooloo, New South Wales, Sydney, Australia and School of Public Health, The University of Sydney, Australia


Mark ClementsPhD, Research Fellow
,


The National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia


Aye Myat MoaMPH, Research Assistant
,


Cancer Epidemiology Research Unit, New South Wales, 153 Dowling Street, Woolloomooloo, New South Wales, Sydney, Australia


Valerie BeralFRS, Director
,


Cancer Epidemiology Unit, The University of Oxford, Oxford, UK

Correspondence to: Dr Karen Canfell, Sydney Rotary Research Fellow, Cancer Epidemiology Research Unit, Cancer Council NSW, 153 Dowling Street, Woolloomooloo, New South Wales, Australia; karenc{at}nswcc.org.au


Objectives To estimate the prevalence of normal endometrial cells (NECs)and the proportion of NECs associated with significant endometrialpathology in conventional and liquid-based cytology (LBC) cervicalsmears; and to assess the association between NECs and clinicalsymptoms in women with endometrial hyperplasia or carcinoma.

Methods Systematic review of the literature and meta-analysis of prevalenceand proportion data. The review was confined to studies reportingon NECs in smears from postmenopausal women or women aged 40+.

Results A total of 22 relevant primary studies were identified from 1970 to 2007. The overall summary estimate for the prevalence of NECs in smears from postmenopausal women or women aged 40+ in all screening smears was 0.4% (95% CI 0.2–0.7%); this was 0.3% (95% CI 0.1–0.5%) and 0.9% (95% CI 0.5–1.4%) for conventional and LBC smears, respectively; P = 0.003 for difference. The overall estimate for the proportion of NECs associated with significant endometrial pathology was 7% (95% CI 4–10%); this was 11% (95% CI 8–14%) and 2% (95% CI 1–2%) for conventional and LBC smears, respectively; P < 0.001 for difference. In women with significant endometrialpathology, the presence of NECs in followed-up women was associatedwith abnormal uterine bleeding in 79% (95% CI 68–87%)of cases.

Conclusion Compared with conventional cytology, LBC may be associated witha higher prevalence of NECs but these are less likely to beassociated with endometrial pathology. This finding might beexplained by more consistent use of sampling instruments forLBC with better access to the endocervical canal or alternativelyby changes over time, broadly coincident with the introductionof LBC, in the population in which NECs are reported. In followed-upwomen with NECs, most endometrial pathology is accompanied bysymptoms, implying that a relatively smaller number of additionalcases are identified through follow-up of asymptomatic women.


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