Background: Endometrial cells are rarely seen in pap smears. Their presence in postmenopausal women > 45 years may suggest endometrial pathology. Aims: To evaluate the pap smears of cases with significant endometrial histopathology for the presence of endometrial cells; its association with age and menopausal status and its sensitivity in detection of endometrial pathology. Settings & Design: Cross sectional retrospective case control study. Meterials and Methods: Endometrial biopsies grouped as cases (significant endometrial pathology hyperplasia, carcinoma, polyps, carcinoma) and control (basal, proliferative, secretory) were collected for a period of two years. Their pap smears were evaluated for the presence of endometrial cells. Statistical Analysis: Descriptive statistics was used. Results: Among the 58 cases and 58 controls, endometrial cells were present in 31% (18/58) of cases and 17% (10/58) of controls. Age >45 years, menopausal status and postmenopausal bleeding had no association. 25% of simple hyperplasia, 50% of complex hyperplasia, 37.5% of endometrial polyp and 50% of endometrial carcinoma cases had endometrial cells. The sensitivity of detection of significant endometrial pathology by endometrial cells was 31%; specificity 82%; positive predictive value 64% and negative predictive value 54%. The average number of clusters were >2 in the cases and <2 in the control. The clusters had papillae/club like/swirl morphology or atypical in cases. Conclusion: We conclude from our study that we should document the presence of endometrial cells in patients with any symptom of irregular bleeding irrespective of age and menopausal status especially when there are more than two clusters with distinct morphologies like papillae/ club/swirls.

Keywords: Endometrial Cells; Pap Smears; Significant Endometrial Pathology.