Indications Abnormal uterine bleeding: postmenopausal bleeding, malignancy/hyperplasia Monitoring adjuvant hormonal treatment (tamoxifen) Endometrial dating Presence of endometrial cell in PAP smear in women 40 years of age Abnormal Pap smear with atypical cells favoring endometrial origin (AGUS) Follow-up of previously diagnosed endometrial hyperplasia Cancer screening (e.g.
HNPCC/Lynch syndrome, Cowden syndrome) Inappropriately thick endometrial stripe found on USG 3 Sampling of the Endometrium Office biopsy procedures (Pipelle, Vabra aspirator, Karman cannula) agree with a D&C performed in 95% of the time Office biopsy has a 16% false negative rate when the lesion is a polyp or cancer Patients with persistent PMB after a negative office biopsy should have D&C ( /- hysteroscopy) D&C is the gold standard sampling method preoperative D&C will agree with diagnosis at hysterectomy 94% of the time 5 Adequacy criteria Clinical history e.g.
Defining and updating the American Cancer Society Guidelines for the cancer-related check-up: prostate and endometrial cancers. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.
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Diagnosis of Endometrial Biopsies and Curettings Second Edition Michael T. (1994), describe the morphologic features and classiﬁcation of benign and malignant endometrial lesions, but little attention is given to the subtle differences between physiologic changes and pathologic conditions and the artifacts of biopsy and processing.
Mazur, MD Clinical Professor of Pathology, State University of New York, Upstate Medical University, Syracuse, New York, and Clear Path Diagnostics, Syracuse, New York Robert J. Te Linde Distinguished Professor, Departments of Gynecology, Obstetrics and Pathology, The Johns Hopkins Hospital, and The Johns Hopkins University School of Medicine, Baltimore, Maryland Diagnosis of Endometrial Biopsies and Curettings A Practical Approach Second Edition With 230 Illustrations, 77 in Full Color Michael T. In addition, micro-scopic ﬁndings that can be safely ignored because they have no clinical bearing are generally not discussed in standard texts.
Most importantly, however, the text continues its focus on those aspects of endometrial biopsy interpretation that can be especially vexing, such as the diagnosis of atypical hyperplasia, grading of endome-trial carcinoma, and the myriad of benign changes and artifacts that can be confusing to the pathologist.
Considerable disagreement among gynecological pathologists: Inadequate if no endometrial tissue is present “Unassessable” if suboptimal endometrial tissue is present 8 Six morphological patterns Proliferations composed of glands & supportive non neoplastic stroma Biphasic proliferations composed of glands & abundant (possible neoplastic) stroma Predominantly monophasic spindle cell proliferation Sheet like proliferations composed of large, round undifferentiated cells Sample that feature extensive necrosis, inflammation, or disintegration Scanty samples that raise the question of sampling adequacy 14 Endometrial metaplasias Epithelial Mullerian: -Squamous -Tubal -Mucinous -Secretory Non Mullerian -Eosinophilic -Papillary syncytial -Micropapillary hobnail -Clear cell Non epithelial Osteoid Endometrial extamedullary hemopoiesis 32 Endometrial polyp Pathological diagnosis is straightforward if the gynecologist is aware of this & has conveyed this information to the pathologist & has removed polyp intact Possibility of polyp should always be considered in abnormal uterine bleeding Mixture of polypoidal & non polypoidal endometrium helpful in difficult cases Carcinoma, EIN or EIC can arise in or involve endometrial polyp 37 Endometrial hyperplasia (WHO 1994 & 2003) Non-atypical hyperplasias Simple hyperplasia Complex hyperplasia without atypia (adenomatous without atypia) Atypical hyperplasias Simple atypical hyperplasia Complex atypical hyperplasia (adenomatous with atypia) : Problems and alternative approaches Problems with this classification Definition of atypia Reproducibility of atypia Reproducibility of carcinoma Alternative approaches and concepts Simplified Classification for Biopsies Molecular and morphometric studies and EIN concept(Mutter, Baak et al.The technique is fairly easy to learn and may be performed without assistance.The biopsy is obtained through the use of an endometrial suction catheter that is inserted through the cervix into the uterine cavity.Contraindications to the procedure include pregnancy, acute pelvic inflammatory disease, and acute cervical or vaginal infections.Postoperative infection is rare but may be further prevented through the use of prophylactic antibiotic therapy.