Postmenopozal Kanamalı Kadınlarda Endometriyal Patolojilerin Servikal Smearle Öngörülmesi

Amaç: Endometrium kanseri en yaygın görülen jinekolojik malignitedir ve bu kanser için tarama testi belirlenmemiştir. Bu çalışmada kliniğimizde postmenopozal kanama nedeniyle endometrial örnekleme yapılmış olan hastaların histopatoloji ve servikal smear sonuçları arasındaki ilişki incelendi. Gereç ve yöntemler: 2008-2010 tarihleri arasında postmenopozal kanama nedeniyle endometrial örnekleme yapılan 277 hastanın patoloji sonuçları ve biyopsi öncesi 6 ay içerisinde yapılmış servikal smearleri retrospektif olarak incelendi. Endometrial örneklemeden elde edilen tanılar ciddi endometrial patoloji (endometrium kanseri ve atipili endometrial hiperplazi), benign endometrial patoloji (atipisiz endometrial hiperplazi, endometrial polip) ve fizyolojik endometrium (sekretuar, proliferatif ve atrofik endometrium) olarak sınıflandırıldı. Servikal smear tanıları anormal ve normal olarak sınıflandırıldı. Benign endometrial hücre (BEH), malign endometrial hücre (MEH) ve atipik glandüler hücre (AGH) varlığı anormal smear olarak kabul edildi. Bulgular: Hastaların ortalama yaşı 57.6 ± 8.3 yıl (41-86) idi. Ciddi endometrial patolojisi olan hastaların servikal smear sonuçlarında % 23.3 BEH, %13.3 MEH, %20 AGH izlendi. Benign endometrial patolojisi olan hastaların smearlerinde BEH oranı %44.8 bulundu. Bu oran diğer gruplardan daha yüksekti ve istatistiksel olarak anlamlıydı (p1

Prediction of endometrial pathologies in women with postmenopausal bleeding on cervical smear

Objective: The most common seen gynecological cancer is endometrial cancer and there is no a screening test. In this study, relatioship between histopathology and cervical smear results of patients who underwent endometrial sampling due to postmenopausal bleeding was examined. Material and methods: Between 2008 and 2010, the results of endometrial histopathology and cervical smear,within six months of 277 patients underwent endometrial sampling due to postmenopausal bleeding,were examined retrospectively. Diagnoses of endometrial sampling were classified as serious endometrial pathology (endometrial carcinoma and endometrial hyperplasia with atypia), benign endometrial pathology (endometrial polyp and endometrial hyperplasia without atypia) and physiological endometrial changes (secretory, proliferative and atrophic endometrium). Diagnoses of cervical smear were classified as normal and abnormal. Benign endometrial cell (BEC), malign endometrial cell (MEC) and atypic glandular cell (AGC) were accepted as abnormal smears. Results: The mean age of patients was 57.6 ± 8.3(range 41-86). In patients with serious endometrial pathology, the rates of BEC, MEC and AGC on cervical smear were 23.3%, 13.3% and 20% respectively. In patients with benign endometrial pathology, the rate of BEC was found 44.8%. This rate was higher than other groups and statistically significant (p1<0.05, p2<0.05, Chi-square test). The sensitivity, specificity, positive and negative predictive value of cervical smear were measured as 56.6%, 90.2%, 41.4% and 94.4% respectively in detection of serious endometrial pathology. Conclusion: According to the result, cervical smear has a low sensitivity in detection of serious endometrial pathology and, is not appropriate to use in endometrial carcinoma screening. However, the endometrial cells on cervical smear in postmenopausal period may be early sign for the presence of endometrial pathology. In these patients, evaluation with endometrial sampling can be provided early diagosis and tratment.

___

  • 1- Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, et al. Cancer statistics. CA Cancer J Clin. 2008;58(2):71-96.
  • 2- Smith RA, Cokkinides V, Brooks D, Saslow D, Shah M, Brawley OW. Cancer screening in the United States, 2011: A review of current American Cancer Society guidelines and issues in cancer screening. CA Cancer J Clin. 2011;61(1):8-30.
  • 3- Zucker PK, Kasdon EJ, Feldstein ML. The validity of Servikal smear parameters as predictors of endometrial pathology in menopausal women. Cancer. 1985;56(9):2256-63.
  • 4- Van den Bosch T, Vandendael A, Wranz PA, Lombard CJ. Cervical cytology in menopausal women at high risk for endometrial disease. Eur J Cancer Prev. 1998;7(2):149–52.
  • 5- Yancey M, Magelssen D, Demaurez A, Lee RB. Classification of endometrial cells on cervical cytology. Obstet Gynecol 1990;76(6):1000–5.
  • 6- Moroney JW, Zahn CM, Heaton RB, Crothers B, Kendall BS, Elkas JC. Normal endometrial cells in liquid-based cervical cytology specimens in women aged 40 or older. Gynecol Oncol. 2007;105(3):672-6.
  • 7- Johnson EJ, Patnick J; National Co-ordinator of the NHS Cervical Screening Programme (NHSCSP). Achievable standards, benchmarks for reporting, and criteria for evaluating cervical cytopathology. Second edition including revised performance indicators. Cytopathology. 2000;11(4):212-41.
  • 8- Solomon D, Davey D, Kurman R, Moriarty A, O’Connor D, Prey M, et al; Forum Group Members; Bethesda 2001 Workshop. The 2001 Bethesda System: terminology for reporting results of cervical cytology. JAMA. 2002;287(16):2114-9.
  • 9- Gomez-Fernandez CR, Ganjei-Azar P, CapoteDishaw J, Averette HE, Nadji M. Reporting normal endometrial cells in Servikal smears: an outcome appraisal. Gynecol Oncol. 1999;74(3):381-4.
  • 10- Cherkis RC, Patten SF, Andrews TJ, Dickinson JC, Patten FW. Significance of normal endometrial cells detected by cervical cytology. Obstet Gynecol. 1988;71(2):242–4.
  • 11- Ashfaq R, Sharma S, Dulley T, Saboorian MH, Siddiqui MT, Warner C. Clinical relevance of benign endometrial cells in postmenopausal women. Diagn Cytopathol. 2001;25(4):235–8.
  • 12- DuBeshter B, Deuel C, Gillis S, Glantz C, Angel C, Guzick D. Endometrial cancer: the potential role of cervical cytology in current surgical staging. Obstet Gynecol. 2003;101(3):445-50.
  • 13- Doornewaard H, Sie-Go DM, Woudt JM, Kooijman CD. The significance of endometrial cells in the cervical smear. Ned Tijdschr Geneeskd. 1993;137(17):868–72.
  • 14- Browne TJ, Genest DR, Cibas ES. The clinical significance of benign-appearing endometrial cells on a Servikalanicolaou test in women 40 years or older. Am J Clin Pathol. 2005;124(6):834-7.
  • 15- Brogi E, Tambouret R, Bell DA. Classification of benign endometrial glandular cells in cervical smears from postmenopausal women. Cancer. 2002;96(2):60–6.
  • 16- Mount SL, Wegner EK, Eltabbakh GH, Olmstead JI, Drejet AE. Significant increase of benign endometrial cells on Servikalanicolaou smears in women using hormone replacement therapy. Obstet Gynecol. 2002;100(3):445-50.
  • 17- Gondos B, King EB. Significance of endometrial cells in cervicovaginal smears. Ann Clin Lab Sci. 1977;7(6):486–90.
  • 18- Kerpsack JT, Finan MA, Kline RC. Correlation between endometrial cells on Papanicolaou smear and endometrial carcinoma. South Med J. 1998;91(8):749–52.
  • 19- Kaur J, Dey P, Saha SC, Rajwanshi A, Nijhawan R, Radhika S, et al. Cervical cytology in patients with postmenopausal bleeding. Diagn Cytopathol. 2010;38(7):496-8.