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Normal appearing endometrial cells in cervical smears of asymptomatic postmenopausal women have predictive value for significant endometrial pathology
  1. A. G. Siebers*,
  2. A. L.M. Verbeek,
  3. L. F. Massuger,
  4. J. M.M. Grefte* and
  5. J. Bulten*,§
  1. * Department of Pathology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  2. Department of Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  3. Department of Gynaecology and Obstetrics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  4. § Department of Foundation for Prevention of Cervical Cancer East Netherlands, Arnhem, The Netherlands
  1. Address correspondence and reprint requests to: Albertus G. Siebers, MSc, Department of Pathology, 437 PA, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands. Email: b.siebers{at}
  1. This work was presented in part at the 30th European Congress of Cytology, Athens, Greece, October 12–15, 2004.


The objective of this study was to determine whether postmenopausal asymptomatic women with normal endometrial cells in their smear are at higher risk for endometrial pathology compared with women without these cells. Histologic follow-up outcome and otherwise cytologic follow-up of 29,144 asymptomatic postmenopausal women was determined. Presence of normal endometrial cells, age, use of hormones, and reported elevated maturation index were assessed. The effect of each variable on outcome as well as the combined effect were evaluated. Prevalence rate of (pre)malignant uterine disease was significantly higher when normal endometrial cells were found in the cervical smear (6.5%) as compared to smears without these cells (0.2%), resulting in a relative risk of 40.2 (95% CI 9.4–172.2). Neither age nor hormone use or elevated maturation index showed significant impact on the outcome. Asymptomatic postmenopausal women with normal endometrial cells in their smear are at significant higher risk for (pre)cancerous endometrial lesion than women without these cells. These cases should be reported to the physician with an explicit comment that normal endometrial cells in a smear of a postmenopausal woman is an abnormal finding, possibly associated with significant endometrial pathology. It raises the question whether further gynecological examination would be more appropriate.

  • asymptomatic
  • normal endometrial cells
  • Pap smear
  • postmenopause

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