Endometrial biopsy

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Endometrial biopsy
Simple endometrial hyperplasia - intermed mag.jpg
Micrograph showing an endometrial biopsy with simple endometrial hyperplasia, where the gland-to-stroma ratio is preserved but the glands have an irregular shape and/or are dilated. H&E stain.
ICD-10-PCS 0UDB
ICD-9-CM 68.13, 68.16
MedlinePlus 003917

The endometrial biopsy is a medical procedure that involves taking a tissue sample of the lining of the uterus. The tissue subsequently undergoes a histologic evaluation which aids the physician in forming a diagnosis.[ citation needed ]

Contents

Medical uses

There are a number of indications for obtaining an endometrial biopsy from a non-pregnant woman:[ citation needed ]

Transvaginal ultrasonography is generally done before obtaining an endometrial biopsy as it may help in the gynecologic diagnosis, or even make the taking of a biopsy superfluous if the lining is thin. If the endometrial lining is less than 5 mm thick on sonography, it is highly unusual to encounter endometrial cancer. [1]

The test is usually done in women over age 35. [2] A more thorough histologic evaluation can be obtained by a dilatation and curettage, which requires anesthesia.

Contraindications

The procedure is contraindicated in pregnancy. [1] Therefore, women in the reproductive years may need a pregnancy test before a biopsy is taken to assure that the test is not done during a pregnancy. Other contraindications are pelvic inflammatory disease and coagulopathies. [1]

An endometrial biopsy usually cannot be done as an office procedure in children, young women, women with vaginismus, or women with cervical stenosis. If necessary, an examination under anesthesia could be performed at which time a biopsy could be taken.[ citation needed ]

Risks

While procedure is generally considered safe, cramps or pelvic pain is a common if short-lived side effect. After the procedure, the patient may experience some bleeding. A uterine perforation or an infection are rare complications. [2]

Pain

Endometrial biopsy pain [3] is quite common. The reason that doctors spray the lidocain is to help to deal with some of the pain from the procedure. The lidocain spray can burn when it is sprayed into the area. The clamp that is put onto the cervix may be another cause of pain and the procedure itself, with the doctor procuring a piece of the lining with the tube potentially being painful. Most of the time, this will only be required once, but sometimes the procedure can entail two or three instances of procuring a piece of the endometrium.[ citation needed ]

Procedure

Gray1167.svg

Generally, an endometrial biopsy follows this process:

  1. The patient is asked to lie on the table with her feet in the stirrups for a pelvic examination. She may or may not be given localized anesthesia.
  2. A speculum will be inserted into the vagina to spread the walls of the vagina apart to expose the cervix. The cervix will then be cleansed with an antiseptic solution.
  3. A tenaculum, a type of forceps, will hold the cervix steady for the biopsy.
  4. The biopsy curette will be inserted into the uterine fundus and with a scraping and rotating motion some tissue will be removed.
  5. The removed tissue will be placed in formalin or equivalent for preservation.
  6. The tissue will be sent to a laboratory, where it will be processed and tested. It will then be read microscopically by a pathologist who will provide a histologic diagnosis. [4]

Both the application of the tenaculum as well as the removal of tissue by the biopsy may cause pain. Patients, in general, may want to take some pain medication (such as ibuprofen) before the procedure and inquire about local anesthesia.[ citation needed ]

Instruments

A number of biopsy instruments are in use. The Novak curette is a thin metallic tube with a side opening at the tip; suction with attached syringe can be applied to help to remove tissue. The Pipelle is a more flexible plastic tube with a side opening at the tip. A smaller tube (internal piston) inside the Pipelle is withdrawn to create suction. Meanwhile, the pipelle is rotated and moved outwards from the fundus to the internal os to collect small pieces of endometrial tissue. [5]

Recently, the TruTest has been introduced as an alternative method of endometrial biopsy. Rather than using a suction tube, this method uses the Tao Brush to gently brush the lining of the uterus. Generally, this method has been found to be less painful than the traditional suction method.[ citation needed ]

Related Research Articles

Dilationand curettage (D&C) refers to the dilation (widening/opening) of the cervix and surgical removal of part of the lining of the uterus and/or contents of the uterus by scraping and scooping (curettage). It is a gynecologic procedure used for diagnostic and therapeutic purposes, and is the most commonly used method for first-trimester miscarriage or abortion.

Endometrium Inner mucous membrane of the mammalian uterus

The endometrium is the inner epithelial layer, along with its mucous membrane, of the mammalian uterus. It has a basal layer and a functional layer: the basal layer contains stem cells which regenerate the functional layer. The functional layer thickens and then is shed during menstruation in humans and some other mammals, including apes, Old World monkeys, some species of bat, the elephant shrew and the Cairo spiny mouse. In most other mammals, the endometrium is reabsorbed in the estrous cycle. During pregnancy, the glands and blood vessels in the endometrium further increase in size and number. Vascular spaces fuse and become interconnected, forming the placenta, which supplies oxygen and nutrition to the embryo and fetus. The speculated presence of an endometrial microbiota has been argued against.

Uterus Female sex organ in mammals

The uterus or womb is the main hormone-responsive, secondary sex organ of the female reproductive system in humans, and most other mammals. Events occurring within the uterus are described with the term in utero. In the human, the lower end of the uterus, the cervix, opens into the vagina, while the upper end, the fundus, is connected to the fallopian tubes. It is within the uterus that the embryo and later fetus develops during gestation. In the human embryo, the uterus develops from the paramesonephric ducts which fuse into the single organ known as a simplex uterus. The uterus has different forms in many other animals and in some it exists as two separate uteri known as a duplex uterus.

Colposcopy

Colposcopy is a medical diagnostic procedure to visually examine the cervix as well as the vagina and vulva using a colposcope.

Hysterectomy Surgical removal of the uterus

Hysterectomy is the surgical removal of the uterus. It may also involve removal of the cervix, ovaries (oophorectomy), Fallopian tubes (salpingectomy), and other surrounding structures.

Uterine cancer Medical condition

Uterine cancer, also known as womb cancer, includes two types of cancer that develop from the tissues of the uterus. Endometrial cancer forms from the lining of the uterus, and uterine sarcoma forms from the muscles or support tissue of the uterus. Endometrial cancer accounts for approximately 90% of all uterine cancers in the United States. Symptoms of endometrial cancer include changes in vaginal bleeding or pain in the pelvis. Symptoms of uterine sarcoma include unusual vaginal bleeding or a mass in the vagina.

Endometrial cancer Uterine cancer that is located in tissues lining the uterus

Endometrial cancer is a cancer that arises from the endometrium. It is the result of the abnormal growth of cells that have the ability to invade or spread to other parts of the body. The first sign is most often vaginal bleeding not associated with a menstrual period. Other symptoms include pain with urination, pain during sexual intercourse, or pelvic pain. Endometrial cancer occurs most commonly after menopause.

Ashermans syndrome Medical condition

Asherman's syndrome (AS) is an acquired uterine condition that occurs when scar tissue (adhesions) form inside the uterus and/or the cervix. It is characterized by variable scarring inside the uterine cavity, where in many cases the front and back walls of the uterus stick to one another. AS can be the cause of menstrual disturbances, infertility, and placental abnormalities. Although the first case of intrauterine adhesion was published in 1894 by Heinrich Fritsch, it was only after 54 years that a full description of Asherman syndrome was carried out by Joseph Asherman. A number of other terms have been used to describe the condition and related conditions including: uterine/cervical atresia, traumatic uterine atrophy, sclerotic endometrium, and endometrial sclerosis.

Adenomyosis Extension of endometrial tissue into the myometrium

Adenomyosis is a medical condition characterized by the growth of cells that proliferate on the inside of the uterus (endometrium) atypically located among the cells of the uterine wall (myometrium), as a result, thickening of the uterus occurs. As well as being misplaced in patients with this condition, endometrial tissue is completely functional. The tissue thickens, sheds and bleeds during every menstrual cycle.

Vaginal bleeding is any expulsion of blood from the vagina. This bleeding may originate from the uterus, vaginal wall, or cervix. Generally, it is either part of a normal menstrual cycle or is caused by hormonal or other problems of the reproductive system, such as abnormal uterine bleeding.

Hysteroscopy Medical procedure

Hysteroscopy is the inspection of the uterine cavity by endoscopy with access through the cervix. It allows for the diagnosis of intrauterine pathology and serves as a method for surgical intervention.

Vacuum aspiration Gynaecological procedure

Vacuum or suction aspiration is a procedure that uses a vacuum source to remove an embryo or fetus through the cervix. The procedure is performed to induce abortion, as a treatment for incomplete spontaneous abortion or retained fetal and placental tissue, or to obtain a sample of uterine lining. It is generally safe, and serious complications rarely occur.

Endometritis Medical condition

Endometritis is inflammation of the inner lining of the uterus (endometrium). Symptoms may include fever, lower abdominal pain, and abnormal vaginal bleeding or discharge. It is the most common cause of infection after childbirth. It is also part of spectrum of diseases that make up pelvic inflammatory disease.

Endometrial ablation

Endometrial ablation is a surgical procedure that is used to remove (ablate) or destroy the endometrial lining of the uterus in women who have heavy menstrual bleeding. Endometrial ablation is not recommended for women who wish to have children, since complications can occur.

The uterine sarcomas form a group of malignant tumors that arises from the smooth muscle or connective tissue of the uterus.

Hematometra Medical condition

Hematometra is a medical condition involving collection or retention of blood in the uterus. It is most commonly caused by an imperforate hymen or a transverse vaginal septum.

The Tao brush is a medical instrument used to perform an alternative method of endometrial biopsy, for the purpose of detecting endometrial cancer.

Uterine clear-cell carcinoma (CC) is a rare form of endometrial cancer with distinct morphological features on pathology; it is aggressive and has high recurrence rate. Like uterine papillary serous carcinoma CC does not develop from endometrial hyperplasia and is not hormone sensitive, rather it arises from an atrophic endometrium. Such lesions belong to the type II endometrial cancers.

Villoglandular adenocarcinoma of the cervix Medical condition

Villoglandular adenocarcinoma of the cervix is a rare type of cervical cancer that, in relation to other cervical cancers, is typically found in younger women and has a better prognosis.

Thoracic endometriosis is a rare form of endometriosis where endometrial-like tissue is found in the lung parenchyma and/or the pleura. It can be classified as either pulmonary, or pleural, respectively. Endometriosis is characterized by the presence of tissue similar to the lining of the uterus forming abnormal growths elsewhere in the body. Usually these growths are found in the pelvis, between the rectum and the uterus, the ligaments of the pelvis, the bladder, the ovaries, and the sigmoid colon. The cause is not known. The most common symptom of thoracic endometriosis is chest pain occurring right before or during menstruation. Diagnosis is based on clinical history and examination, augmented with X-ray, CT scan, and magnetic resonance imaging of the chest. Treatment options include surgery and hormones.

References

  1. 1 2 3 Christiane Kuntz (January 2007). "Endometrial biopsy". Can Fam Physician. 53 (1): 43–44. PMC   1952554 . PMID   17872607.
  2. 1 2 "Endometrial biopsy". The New York Times. Retrieved March 11, 2010.
  3. ↑ "Endometrial biopsy pain". Endometrial Biopsy. Archived from the original on March 27, 2012. Retrieved June 4, 2011.
  4. ↑ Archived 2007-09-28 at the Wayback Machine St. Joseph’s Mercy Health Center – Diagnostic and Surgical Tests and Procedures – Endometrial Biopsy (accessed 7-10-07)
  5. ↑ Endometrial Biopsy, A Review of Sampling Techniques Archived 2014-02-22 at the Wayback Machine , Product bulletin from CooperSurgical, the producer of Pipelle. April 2012.
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