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How important are endocervical cells when doing a Pap smear? #435/9
How important are endocervical cells when doing a Pap smear? During a chart review, I observed that all abnormal paps had endocervical cells present. The last two normal paps had no endocervical cells.

Any information would be appreciated.

Dr. Lisa Flowers, could you please answer this for her and for me? I would be most appreciative.


Endocervical cells along with squamous cells on a pap assures the physician that the transformation zone or transition zone (the area most at risk for cervical disease) has been sampled. Occasionally a woman will have a pap especially postmenopausal women, where no endocervical cells are seen only normal squamous cells. If the woman has had a record of normal paps every year with endocervical cells present and has one normal pap without endocervical cells there is no need to repeat the pap until 1 year.

However, if the woman has had several yearly paps with no endocervical cells, then this woman should have an endocervical curettage to assure that the area most at risk for cervical cancer, the transformation zone has been sampled. The accuracy of the pap is only as good as how often it has been repeated and if the area at risk is sampled on a regular basis (annually if appropriate). Also squamous metaplastic cells on a pap indicates that the TZ has been sampled.


Lisa C. Flowers, MD, FACOG

Associate Professor

Department of Gynecology and Obstetrics

Division of Gynecologic Oncology


If you are ever able to hear Dr. Flowers speak, she is simply brilliant.

His reply on 5-26: “Thank you!  I enjoy your website; refer both colleagues and clients to the site.  I’m sure I’ll be asking more questions in the future.  Thanks again for having the site available!”


Key Words:  endocervical cells, Pap smears, transition zone, risk, cervical disease, postmenopausal, curettage, cervical cancer, squamous metaplastic cells

Posted 5-24-2009, Updated 5-26-2009, Updated 5-31-2009

Robert A. Hatcher MD, MPH
Emeritus Professor of Gynecology and Obstetrics
Emory University School of Medicine
Atlanta, GA

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