Cervical cytology in menopausal women at high risk for endometrial disease

The objective of this study was to evaluate the value of cervical cytology in the diagnosis of endometrial disease in women after menopause. In 128 consecutive menopausal women presenting with uterine bleeding (116) or in whom endometrial cells were found on a previous cervical cytology smear (12), an endo- and ectocervical smear was taken before hysteroscopy with curettage. The results of the cervical cytology were compared with the endometrial histology. Mean age was 59 years. The average duration of menopause was 10 years. Endometrial carcinoma was diagnosed by endometrial sampling in six women. In two of these cases cervical smears did not contain endometrial cells. The presence of endometrial cells on ectocervical cytology showed a sensitivity of 67% and a specificity of 78% for endometrial carcinoma vs 80% and 76%, respectively, for endocervical cytology. The positive predictive value for endometrial malignancy of the presence of endometrial cells on cervical cytology ranged between 17% and 13%. The presence of 'atypical' endometrial cells on cervical smear was associated with endometrial malignancy in almost half the cases. Cervical cytology is of limited value in the diagnosis and the management of postmenopausal endometrial disease.