title: Reporting endometrial cells in Papanicolaou smears of women age 40 and older: a qualifying educational note could prevent unnecessary follow-up biopsy.
abstract: OBJECTIVE
  To determine the impact of adding a qualifying educational note when exfoliated endometrial cells were present in the first half of the menstrual cycle.
  
  
  METHODS
  We identified all Pap smears that had endometrial cells in women > or = 40 years, between July and November, 2004. When endometrial cells were seen in the first half of menstrual cycle, it was stated that, "endometrial cells correlate with the menstrual history provided." We then attempted to determine if this qualifying comment had an impact on the decision to obtain a follow-up endometrial biopsy.
  
  
  RESULTS
  A total of 325 women were identified. Of these, 51 (15.7%) had follow-up endometrial biopsy without clinical evidence of endometrial pathology, compared to a rate of 36.9% before implementation of the note (p < 0.0001). Biopsies were performed in 21 of 195 (10.8%) when the note indicated that endometrial cells correlated with menstrual history, compared to 30 of 130 (23%) in whom a different note was appended because endometrial cells were out of phase or patients were postmenopausal (p = 0.0032). Biopsies did not reveal significant endometrial pathology in any of the 51 patients.
  
  
  CONCLUSIONS
  Adding an educational note when endometrial cells are reported in the first half of the menstrual cycle in women > or = 40 years may help reduce unnecessary biopsies.
authors.affiliation: Department of Pathology, St. John Hospital and Medical Center, Detroit, Michigan, USA.
authors.forename: Mohamed
authors.initials: M
authors.lastname: El-Fakharany
authors.forename: Chady
authors.initials: C
authors.lastname: Meroueh
authors.forename: Sreedevi
authors.initials: S
authors.lastname: Kurella
authors.forename: Paul
authors.initials: P
authors.lastname: Mazzara
mesh_terms: D000328:Adult; D000367:Age Factors; D001706:Biopsy / Q000592:standards / Q000706:statistics & numerical data; D003951:Diagnostic Errors / Q000517:prevention & control*; D004717:Endometrium / Q000166:cytology* / Q000187:drug effects / Q000502:physiology; D015914:Estrogen Replacement Therapy / Q000009:adverse effects; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D008597:Menstrual Cycle / Q000502:physiology; D065006:Papanicolaou Test; D010336:Pathology / Q000193:education* / Q000592:standards; D017698:Postmenopause / Q000502:physiology; D011237:Predictive Value of Tests; D017697:Premenopause / Q000502:physiology; D014626:Vaginal Smears / Q000706:statistics & numerical data*