Age cutoff for reporting of benign-appearing endometrial cells in Papanicolaou specimens; should it be raised? A 10-year retrospective study from a large county hospital

Stacy Hinson, Kyle Molberg, Mariam Mir, Melinda Flores, Wenxin Zheng, Elena Lucas

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1 Citation (Scopus)

Abstract

Introduction: The recommendation for reporting benign-appearing endometrial cells in Papanicolaou specimens was increased from 40 to 45 years in the 2014 edition of The Bethesda System. Recent studies suggest that increasing the reporting age to 50 years would have no significant negative impact. Reporting of benign endometrial cells may trigger unnecessary procedures and increase the cost of patient care. The goal of our study was to perform cytohistologic correlations and determine an optimal age cutoff for reporting endometrial cells in cervical cytology specimens. Materials and methods: The pathology database was searched between 2006 and 2015 for Papanicolaou tests with benign-appearing endometrial cells that were followed by endometrial sampling within 1 year of the cytology result in women ≥45 years. In cases where more than one follow-up surgical specimen was available, only the most significant result was included. Endometrial carcinoma or atypical hyperplasia was considered a significant histologic result. The data were organized into 4 age groups, 45 to 49, 50 to 54, 55 to 59, and ≥60 years. Results: Among 453,420 Papanicolaou specimens, 1121 cases reported endometrial cells in women ≥45 years. Of these, 588 (52%) had an endometrial biopsy/curettage or hysterectomy. Benign diagnosis was reported for 558 (95%) and 12 (2%) samples were insufficient for diagnosis. Significant histologic findings were present in 18 (3%) of cases, of which all were endometrial carcinoma. The difference was statistically significant between the age groups 45 to 54 and ≥55 (1.5% versus 17% of cases had significant endometrial pathology, P < 0.05). Conclusions: Increasing the current reporting age appears safe and may improve efficiency and cost savings.

Original languageEnglish (US)
JournalJournal of the American Society of Cytopathology
DOIs
StateAccepted/In press - Jan 1 2018

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County Hospitals
Age Factors
Retrospective Studies
Endometrial Neoplasms
Cell Biology
Age Groups
Pathology
Unnecessary Procedures
Papanicolaou Test
Curettage
Cost Savings
Hysterectomy
Hyperplasia
Patient Care
Databases
Biopsy
Costs and Cost Analysis

Keywords

  • Cervical cytology
  • Endometrial carcinoma
  • Endometrial cells
  • Papanicolaou test
  • The Bethesda System for reporting cervical cytology

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

@article{026f2a1be1e943e28fbd988fe3871145,
title = "Age cutoff for reporting of benign-appearing endometrial cells in Papanicolaou specimens; should it be raised? A 10-year retrospective study from a large county hospital",
abstract = "Introduction: The recommendation for reporting benign-appearing endometrial cells in Papanicolaou specimens was increased from 40 to 45 years in the 2014 edition of The Bethesda System. Recent studies suggest that increasing the reporting age to 50 years would have no significant negative impact. Reporting of benign endometrial cells may trigger unnecessary procedures and increase the cost of patient care. The goal of our study was to perform cytohistologic correlations and determine an optimal age cutoff for reporting endometrial cells in cervical cytology specimens. Materials and methods: The pathology database was searched between 2006 and 2015 for Papanicolaou tests with benign-appearing endometrial cells that were followed by endometrial sampling within 1 year of the cytology result in women ≥45 years. In cases where more than one follow-up surgical specimen was available, only the most significant result was included. Endometrial carcinoma or atypical hyperplasia was considered a significant histologic result. The data were organized into 4 age groups, 45 to 49, 50 to 54, 55 to 59, and ≥60 years. Results: Among 453,420 Papanicolaou specimens, 1121 cases reported endometrial cells in women ≥45 years. Of these, 588 (52{\%}) had an endometrial biopsy/curettage or hysterectomy. Benign diagnosis was reported for 558 (95{\%}) and 12 (2{\%}) samples were insufficient for diagnosis. Significant histologic findings were present in 18 (3{\%}) of cases, of which all were endometrial carcinoma. The difference was statistically significant between the age groups 45 to 54 and ≥55 (1.5{\%} versus 17{\%} of cases had significant endometrial pathology, P < 0.05). Conclusions: Increasing the current reporting age appears safe and may improve efficiency and cost savings.",
keywords = "Cervical cytology, Endometrial carcinoma, Endometrial cells, Papanicolaou test, The Bethesda System for reporting cervical cytology",
author = "Stacy Hinson and Kyle Molberg and Mariam Mir and Melinda Flores and Wenxin Zheng and Elena Lucas",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.jasc.2018.09.002",
language = "English (US)",
journal = "Journal of the American Society of Cytopathology",
issn = "2213-2945",
publisher = "Elsevier BV",

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TY - JOUR

T1 - Age cutoff for reporting of benign-appearing endometrial cells in Papanicolaou specimens; should it be raised? A 10-year retrospective study from a large county hospital

AU - Hinson, Stacy

AU - Molberg, Kyle

AU - Mir, Mariam

AU - Flores, Melinda

AU - Zheng, Wenxin

AU - Lucas, Elena

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Introduction: The recommendation for reporting benign-appearing endometrial cells in Papanicolaou specimens was increased from 40 to 45 years in the 2014 edition of The Bethesda System. Recent studies suggest that increasing the reporting age to 50 years would have no significant negative impact. Reporting of benign endometrial cells may trigger unnecessary procedures and increase the cost of patient care. The goal of our study was to perform cytohistologic correlations and determine an optimal age cutoff for reporting endometrial cells in cervical cytology specimens. Materials and methods: The pathology database was searched between 2006 and 2015 for Papanicolaou tests with benign-appearing endometrial cells that were followed by endometrial sampling within 1 year of the cytology result in women ≥45 years. In cases where more than one follow-up surgical specimen was available, only the most significant result was included. Endometrial carcinoma or atypical hyperplasia was considered a significant histologic result. The data were organized into 4 age groups, 45 to 49, 50 to 54, 55 to 59, and ≥60 years. Results: Among 453,420 Papanicolaou specimens, 1121 cases reported endometrial cells in women ≥45 years. Of these, 588 (52%) had an endometrial biopsy/curettage or hysterectomy. Benign diagnosis was reported for 558 (95%) and 12 (2%) samples were insufficient for diagnosis. Significant histologic findings were present in 18 (3%) of cases, of which all were endometrial carcinoma. The difference was statistically significant between the age groups 45 to 54 and ≥55 (1.5% versus 17% of cases had significant endometrial pathology, P < 0.05). Conclusions: Increasing the current reporting age appears safe and may improve efficiency and cost savings.

AB - Introduction: The recommendation for reporting benign-appearing endometrial cells in Papanicolaou specimens was increased from 40 to 45 years in the 2014 edition of The Bethesda System. Recent studies suggest that increasing the reporting age to 50 years would have no significant negative impact. Reporting of benign endometrial cells may trigger unnecessary procedures and increase the cost of patient care. The goal of our study was to perform cytohistologic correlations and determine an optimal age cutoff for reporting endometrial cells in cervical cytology specimens. Materials and methods: The pathology database was searched between 2006 and 2015 for Papanicolaou tests with benign-appearing endometrial cells that were followed by endometrial sampling within 1 year of the cytology result in women ≥45 years. In cases where more than one follow-up surgical specimen was available, only the most significant result was included. Endometrial carcinoma or atypical hyperplasia was considered a significant histologic result. The data were organized into 4 age groups, 45 to 49, 50 to 54, 55 to 59, and ≥60 years. Results: Among 453,420 Papanicolaou specimens, 1121 cases reported endometrial cells in women ≥45 years. Of these, 588 (52%) had an endometrial biopsy/curettage or hysterectomy. Benign diagnosis was reported for 558 (95%) and 12 (2%) samples were insufficient for diagnosis. Significant histologic findings were present in 18 (3%) of cases, of which all were endometrial carcinoma. The difference was statistically significant between the age groups 45 to 54 and ≥55 (1.5% versus 17% of cases had significant endometrial pathology, P < 0.05). Conclusions: Increasing the current reporting age appears safe and may improve efficiency and cost savings.

KW - Cervical cytology

KW - Endometrial carcinoma

KW - Endometrial cells

KW - Papanicolaou test

KW - The Bethesda System for reporting cervical cytology

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JO - Journal of the American Society of Cytopathology

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