From the Guidelines
The presence of endocervical and/or squamous metaplastic cells in a cervical sample is a normal finding and does not require any specific treatment or intervention, as it indicates adequate sampling of the transformation zone during a Pap smear or cervical cytology test. This is supported by the 2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests, which focus on the management of abnormal glandular cells, such as atypical glandular cells (AGC) and adenocarcinoma in situ (AIS) 1. The guidelines recommend initial workup with colposcopy and endocervical sampling for women with all subcategories of AGC and AIS, but do not address the presence of normal endocervical and squamous metaplastic cells specifically.
- Key points to consider:
- Endocervical cells line the cervical canal, while squamous metaplastic cells represent the normal process of cellular transformation that occurs at the junction between the endocervical canal and the outer cervix.
- The transformation zone is particularly important to sample during cervical cancer screening because it's the most common site for development of cervical dysplasia and cancer.
- The presence of these cells in a Pap test report indicates that the specimen was adequate and included cells from the clinically relevant areas of the cervix, as noted in the guidelines for managing women with abnormal cervical cancer screening tests 1.
- In terms of management, the guidelines recommend specific follow-up and testing for women with abnormal glandular cells, but the presence of normal endocervical and squamous metaplastic cells does not require additional testing or intervention beyond routine cervical cancer screening, as supported by the guidelines 1.
From the Research
Presence of Endo Cervical and/or Squamous Metaplastic Cells
- The presence of endo cervical and/or squamous metaplastic cells in a Pap test can be an indication of various conditions, including cervical intraepithelial neoplasia (CIN) or other benign changes 2.
- A study published in 2000 found that benign glandular cells and squamous metaplastic-like cells can be seen in vaginal Pap smears of post-hysterectomy patients, with an incidence of 2% 2.
- The presence of these cells does not necessarily indicate imminent neoplasia or dysplasia, and may be related to vaginal adenosis or a metaplastic phenomenon 2.
Diagnostic and Treatment Procedures
- Colposcopy is the accepted diagnostic test for evaluating an abnormal Pap test to determine the location and extent of CIN 3.
- Loop electrosurgical excision procedure (LEEP) is the preferred procedure for advanced diagnosis and treatment of CIN following colposcopy 3, 4, 5, 6.
- LEEP has been compared to cold-knife conization (CKC) in several studies, with results showing that LEEP is an acceptable alternative to CKC in women with CIN and unsatisfactory colposcopic examinations 5, 6.
Concordance between Diagnostic Procedures
- A study published in 2021 found that the concordance between colposcopic biopsy and LEEP was 41.9%, with underestimation and overestimation of lesions occurring in 28 and 113 patients, respectively 4.
- The study also found that parity was the only associated factor that affected the final diagnosis for high-grade lesions in univariate logistic regression analysis 4.