Who needs an endometrial biopsy when cervical cytology finds endometrial cells?

Background Previous studies have suggested that non-menstrual cervical cytology findings of endometrial cells may indicate endometrial lesions. However, no clear guidelines recommend who should undergo endometrial biopsy. This study aimed to identify which patients should undergo endometrial biopsy among those whose cervical cytology showed endometrial cells. Methods We retrospectively analyzed 173 patients with cervical cytology to find endometrial cells in our department. Hysteroscopic diagnostic curettage obtained histological evidence in all patients. Results From January 1, 2020, to October 27, 2023, 173 patients underwent hysteroscopic surgery in our department due to endometrial cells found in cervical cytology. Five patients (2.89%) had endometrioid carcinoma, and two patients (1.16%) had endometrial atypical hyperplasia. All 7 had abnormal uterine bleeding/postmenopausal bleeding. Endometrial thickness was 22.9 mm and 20.9 mm in 2 premenopausal patients, median endometrial thickness was 34 mm (8.2-41.4mm) in 5 postmenopausal patients, and heterogeneous endometrial echo in 7 patients. There were 54 patients without abnormal uterine bleeding/postmenopausal bleeding, endometrial thickening, and endometrial echo homogeneity. None of them had endometrial atypical hyperplasia/endometrial cancer. Univariate and multivariate logistic regression analysis showed that diabetes and endometrial thickening were independent risk factors for endometrial atypical hyperplasia/endometrial cancer. Conclusions Patients with endometrial atypical hyperplasia/endometrial cancer often have abnormal bleeding and thickening of the endometrium. If the patient's cervical cytology shows endometrial cells without abnormal bleeding and endometrial thickening, the probability of endometrial atypical hyperplasia/endometrial cancer is minimal. Univariate and multifactorial logistic regression analysis showed that diabetes and endometrial thickening were independent risk factors for endometrial atypical hyperplasia/endometrial cancer.