The isolated finding of histiocytes in Papanicolaou smears from postmenopausal women

The effectiveness of uncovering uterine disease by drawing special attention to increased histiocytes on Papanicolaou smears from postmenopausal patients was evaluated during a 22-month period. Of the 95,593 screened, 478 had increased histiocytes. Half the patients did not have specific follow-up during the study period. One-third had repeated Papanicolaou smears, which were usually unremarkable and free of increased histiocytes. Seventy-eight patients had subsequent endometrial sampling, hysterectomy or both; 41 of these samples failed to disclose pathology. Thirty-seven cases did yield abnormal tissue. However, when the clinical records of those patients were analyzed, it appeared that most had postmenopausal bleeding or an abnormal physical finding. Of five cases in which the finding of increased histiocytes apparently led to uncovering significant uterine disease, two had endometrial cells reported on the Papanicolaou smear in question. There remained only three cases in which the isolated presence of increased histiocytes led to the discovery of disease; they included one instance of adenomatous endometrial hyperplasia and two of endometrial polyp. We conclude that the isolated finding of increased histiocytes in the absence of postmenopausal bleeding or endometrial cells in a postmenopausal patient is a poor indicator of uterine disease. Such a finding, on its own, is insufficient justification for recommending a diagnostic tissue biopsy.