Pap Smears in Endometrial Adenocarcinoma: Does It Have a Role?

Abstract

<br /> <strong><span style="font-size: small;">Background: </span></strong><span style="font-family: Times New Roman,Times New Roman; font-size: small;"><span style="font-family: Times New Roman,Times New Roman; font-size: small;">Historically the conventional Pap smear has been an effective screening tool for Carcinoma cervix. However the reporting of benign and malignant endometrial cells on Pap smear has remained controversial. There are very few studies addressing the utility of Pap smears in diagnosing endometrial carcinomas. </span></span><strong><span style="font-size: small;">Objective: </span></strong><span style="font-family: Times New Roman,Times New Roman; font-size: small;"><span style="font-family: Times New Roman,Times New Roman; font-size: small;">To rescreen the Pap smears of patients with endometrial adenocarcinoma for the detection of normal/ atypical endometrial cells and to correlate with clinico-pathological parameters. </span></span><strong><span style="font-size: small;">Methods: </span></strong><span style="font-family: Times New Roman,Times New Roman; font-size: small;"><span style="font-family: Times New Roman,Times New Roman; font-size: small;">The present study was carried out at SDM College of Medical Sciences, Dharwad, Karnataka, India for a period of 7 years. Of the 89 endometrial cancers diagnosed, </span></span><span style="font-family: Times New Roman,Times New Roman; font-size: small;"><span style="font-family: Times New Roman,Times New Roman; font-size: small;">Pap smear slides were available in 32 patients, which were reviewed and classified as normal cells/ atypical cells. </span></span><span style="font-family: Times New Roman,Times New Roman; font-size: small;"><span style="font-family: Times New Roman,Times New Roman; font-size: small;">Corresponding biopsy slides were reviewed for tumour type, nuclear grade, myometrial invasion and stage. Statistical tests of independence were applied for selected clinico-pathological parameters. </span></span><strong><span style="font-size: small;">Results: </span></strong><span style="font-family: Times New Roman,Times New Roman; font-size: small;"><span style="font-family: Times New Roman,Times New Roman; font-size: small;">Cervical cytology was normal in nine patients (28.1%) and atypical in 23 patients ( 71.2%). The most common histological type was endometrioid carcinoma in 27 cases (84%). 13 cases(40.5%) had nuclear grade 1 whereas 9 cases(28%) and 10 cases(31.2%) had grades 2 and 3, respectively. Of the 22 cases assessed for invasion and stage, 12 cases had <1/2 of invasion (41.2%) and remaining 10 cases had >1/2 of invasion (58.8%). Early stages (I and II) had 17 cases (77.27%) and advanced </span></span><span style="font-family: Times New Roman,Times New Roman; font-size: small;"><span style="font-family: Times New Roman,Times New Roman; font-size: small;">stage (III and IV )had 5 cases (23.5 %). Significant correlation was found between post-menopausal status and higher </span></span><span style="font-family: Times New Roman,Times New Roman; font-size: small;"><span style="font-family: Times New Roman,Times New Roman; font-size: small;">nuclear grades (p<0.05).</span></span><strong><span style="font-size: small;">Conclusion: </span></strong><span style="font-family: Times New Roman,Times New Roman; font-size: small;"><span style="font-family: Times New Roman,Times New Roman; font-size: small;">Pap smear is primarily a screening test for squamous cell carcinoma cervix. If atypical glandular cells are seen, further investigations are required to rule out neoplasia. All women with atypical endometrial cells on Pap tests need endometrial sampling irrespective of age/menstrual status. </span></span>