Ask An Expert: Endometrial Tissue in Pap Smear
Content provided by the Faculty of the Harvard Medical School
Ask An Expert: Endometrial Tissue in Pap Smear
Question:
My wife's latest Pap smear showed endometrial tissue in the sample. The OB/GYN has ordered an ultrasound to diagnose the cause. Is this a normal next step?
Answer:
Pap smears are performed to screen for precancerous cells in the cervix. Occasionally cells from the endometrium, or uterine lining, are detected in the Pap smear. The presence of endometrial cells on a Pap smear raises the possibility of a uterine abnormality, and in some circumstances indicates the need for additional testing.
If the endometrial cells are atypical in appearance, additional testing of the uterus is always recommended to exclude the possibility of precancerous cells or cancer. If normal endometrial cells are detected on a Pap smear, the need for further evaluation is based on the patient's age. If the patient is 40 years or older, biopsy of the endometrium is usually recommended. Uterine biopsy is a very reliable test for detecting uterine cancer.
Some physicians will use ultrasound as an alternative to uterine biopsy because it is less invasive. If the endometrium as measured by ultrasound is thin (less than 4 mm) and uniform in appearance, the risk of uterine cancer is small, though not completely excluded. If the endometrium is thicker, the risk of precancerous cells or cancer increases and biopsy should then be performed.
No diagnostic test is perfect, and accuracy depends on the presence of other risk factors. Risk factors that increase the likelihood of uterine cancer, such as obesity, family history, and abnormal bleeding should be considered when deciding the best way to proceed when evaluating the presence of endometrial cells on a Pap smear.
Joan Bengtson, M.D., is assistant professor of obstetrics, gynecology and reproductive biology at Harvard Medical School and a member of the Department of Obstetrics, Gynecology & Reproduction at Brigham and Women's Hospital.
| Last updated: | January 24, 2007 |
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Medical content reviewed by the Faculty of the Harvard Medical School. Harvard Health Publications, Copyright © 2007 by President and Fellows of Harvard College. All rights reserved. Used with permission of StayWell.
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