Endometrial Aspiration Biopsy Research Articles

Chinese guidelines on the management of endometrial hyperplasia

• Endometrial hyperplasia can be classified as either hyperplasia without atypia or atypical hyperplasia.• Abnormal uterine bleeding is the most common symptom of endometrial hyperplasia. Transvaginal ultrasound is recommended for initial imaging to evaluate endometrial hyperplasia (evidence level 2+), while transrectal ultrasound is recommended for virgo patients (evidence level 3).• Endometrial biopsy should be used to confirm diagnosis in patients where endometrial lesions are suspected. Effective histological approaches to make definite diagnoses include diagnostic curettage (evidence level 2++), hysteroscopic-guided biopsy (evidence level 2+) and endometrial aspiration biopsy (evidence level 2-).• Progesterone is the preferred medication for the treatment of endometrial hyperplasia without atypia. Compared to oral progestins, placement of a levonorgestrel-releasing intrauterine system (LNG-IUS) has been associated with higher regression rates, lower recurrence rates and fewer adverse events which can be the initial treatment method. (Meta evidence level 1-, RCT evidence level 2+). Ultrasound and endometrial biopsies should be performed every 6 months during treatment to evaluate its effect and treatment should continue until no pathological changes are observed in two consecutive endometrial biopsies. Hysterectomy is not the preferred choice of treatment for patients with endometrial hyperplasia without atypia.• Minimally invasive hysterectomy is indicated for patients with endometrial atypical hyperplasia (evidence level 1+), bilateral fallopian tubes should also be removed (evidence level 2+). In cases where surgery cannot be tolerated, fertility is desired or the patient is younger than 45 years old, medical therapy is recommended (evidence level 3). LNG-IUS is the preferred medical therapy method (evidence level 2+). Endometrial pathologic evaluation should be performed every 3 months during conservative treatments, with adjustments made to dosages or approaches based on observed response to medication. Treatment should continue until no pathological changes are detected in two consecutive endometrial biopsies (evidence level 2++). There is no indication of sentinel lymph nodes biopsy and/or lymphadenectomy for hyperplasia with or without atypia.• Total hysterectomy is recommended to treat patients with recurrent endometrial atypical hyperplasia (evidence level 3); however, medical conservative therapy may be considered for patients hoping to become pregnant in the future.• Patients with fully regressed disease who would like to become pregnant should be advised to seek assistance through assisted reproductive technologies (evidence level 3).• Long-term follow-up is suggested for patients after endometrial hyperplasia treatment (evidence level 2+). Patient education is imperative for improving medication adherence, increasing regression rates and lowering recurrence rates (evidence level 3).

Hysteroscopy with Endometrial Vacuum Aspiration in Repeated Implantation Failure: Diagnostic Significance and the Effect on IVF Success

Introduction. This study raises the issue of diagnostic and therapeutic value of hysteroscopy with endometrial vacuum aspiration in patients with recurrent implantation failure (RIF) in IVF programs.The purpose of the study is to determine the structure of uterine pathology in women with RIF according to hysteroscopy with endometrial aspiration biopsy and to study the effect of hysteroscopy with subsequent endometrial vacuum aspiration in patients with a history of repeated implantation failures on clinical pregnancy rate.Materials and methods. In this retrospective cohort study we investigated a sample of 143 patients who passed the program of IVF at the Clinical Institute of Reproductive Medicine (Ekaterinburg, Russia). We studied the frequency of detection of uterine pathology using hysteroscopy and endometrial vacuum aspiration in patients with RIF (n = 36) and in the control group without RIF (n = 89). We analyzed the differences in the chance of clinical pregnancy aſter embryo transfer (s) in the IVF program in patients with RIF aſter hysteroscopy with endometrial vacuum aspiration (n = 30) and in the control group (n = 18).Results. The structure of intrauterine pathology was not statistically different in patients with RIF and without this condition (p > 0.05 for all pathologies). Hysteroscopy with endometrial vacuum aspiration significantly increased the incidence of clinical pregnancies in patients with RIF compared with the control group (23/30 (77.0 %) and 8/18 (44.0 %), p = 0.032).Discussion. The obtained data on the structure of the pathology of the uterus correlate with the results of similar studies. The therapeutic effect of hysteroscopy in infertility remains a matter of controversy.Conclusion. Hysteroscopy with pathomorphological examination of the aspirated endometrium is the same intervention in terms of diagnostic efficiency for patients without identified uterine pathology on ultrasound, regardless of RIF status. Hysteroscopic examination with curative endometrial injury may increase the success rate of embryo transfer implants in patients with RIF.

The Holy Grail of endometriosis biomarkers in the diagnostic process – How much would it be worth and what does it look like?

Previously, the gold standard for the diagnosis of endometriosis involved the performance of laparoscopic surgery, which allows the visualization and histological examination of the endometrial tissue. According to the latest guidelines published by the European Society of Human Reproduction and Embryology (ESHRE) in 2022, surgery is recommended only in patients with diagnostic difficulties associated with the use of non-invasive methods or in case of inappropriate or unsuccessful empirical treatment. At the same time, it is not recommended to use the measurement of biomarkers in the endometrial tissue, blood, menstrual or uterine fluids to diagnose endometriosis as the ESHRE guideline development group indicated the need of larger, multi-center prospective studies on this matter. The aim of this narrative review is to present advances in knowledge on non-invasive endometriosis diagnostic opportunities with emphasis on proteomics, the use of endometrial aspiration biopsy, iron metabolism, vitamin D-binding protein, extracellular matrix signaling pathways, epithelial−mesenchymal transformation, and other molecular pathways, together with a critical analysis of studies cited in the recent ESHRE guidelines.

Differential possibilities of determination of molecular markers in uterine aspirate in endometrial and non-endometrial cancer of uterine body

Objective. To evaluate the diagnostic informativeness of determining the concentration of the MCM5 proliferation marker in the uterine aspirate for the detection of uterine body cancer (UBC) and the differential identifiation of the risk group for patients with suspected non-endometrioid endometrial cancer.Materials and methods. 104 patients diagnosed with UBC and 32 healthy patients of the control group were examined. According to the histological type, 79 (76 %) patients had endometrial cancer, 16 (15 %) had serous and 9 (9 %) clear cell cancer. Endometrial aspiration biopsy was obtained by Pipel biopsy using a two-channel Pipelle catheter. Direct quantitative determination of the concentration of MCM5 in the uterine aspirate cell homogenate was carried out by enzyme-linked immunosorbent assay using specifi MCM5 ELISA test systems.Results. It was found that when the concentration of MCM5 in the uterine aspirate exceeds 11.38 pg/ml, the detection of early-stage UBC is possible with a diagnostic sensitivity of 96.12 % and a specifiity of 78.79 %. When the concentration of MCM5 in the uterine aspirate exceeds 56.9 pg/ml, the relative risk of detecting rare forms of UBC increases (p < 0.0001) by 59.7 times.Conclusions. Determination of the concentration of the protein of the minichromosomal protection family MCM5 in the aspirate of the uterine cavity is informative for the early detection of UBC.

Uterine blood flow assessment by colour Doppler for prediction of malignant endometrial pathologies in women with abnormal uterine bleeding

Introduction: Colour Doppler has emerged as useful adjunct to transvaginal sonography in evaluation of women with AUB. This study was carried out to evaluate the role of measurement of the Resistance index (RI) and Pulsatility index (PI) of the uterine arteries by Colour Doppler sonography to discriminate between benign and malignant endometrial condition in women with abnormal bleeding.Material and Methods: This prospective analytical study was performed to evaluate 70 women (30-60 years) with AUB. Spiral arterioles flow patterns, Resistance index (with 0.81 as cut off) and Pulsatility index (with 1.83 as cut off) of uterine arteries were analysed by colour Doppler after detailed TVS. They were compared with Histopathological report of Endometrial Aspiration biopsy. Results: 10 patients (14.3%) had RI in malignancy range (> 0.81) and 9 patients (12.9%) had PI in malignancy range (< 1.83). Out of these 8 had both RI and PI in malignancy range. Thus 11 cases (15.7%) having either RI/PI or RI and PI both, in malignancy range were considered to be suspected of malignancy. Out of these 11 cases, 5 patients were diagnosed to have Hyperplasia/Malignancy on histopathology. There were no False Negative cases, making the sensitivity 100% and specificity 90.7% of TVS with colour Doppler. For the vascular patterns, both cases of hyperplasia had scattered vessel pattern and all 3 cases of carcinoma had multiple vessel pattern, making the association of vascular pattern with AUB diagnosis significant (p<0.001).Conclusion: Colour Doppler of the uterine artery and endometrial spiral arteries, improves the diagnostic accuracy of TVS for the prediction of endometrial pathologies and facilitates in screening for malignant and premalignant lesions. Therefore, it is recommended that CDTU with TVS should be used as screening modality in all AUB patient.

Endometrial Thickness (ET) by TVS and its Correlation with HPE by Endometrial Aspiration Biopsy in Postmenopausal Bleeding

Endometrial Thickness (ET) by TVS and its Correlation with HPE by Endometrial Aspiration Biopsy in Postmenopausal Bleeding

A Novel Xeno-Free Method to Isolate Human Endometrial Mesenchymal Stromal Cells (E-MSCs) in Good Manufacturing Practice (GMP) Conditions.

The cyclic regeneration of human endometrium is guaranteed by the proliferative capacity of endometrial mesenchymal stromal cells (E-MSCs). Due to this, the autologous infusion of E-MSCs has been proposed to support endometrial growth in a wide range of gynecological diseases. We aimed to compare two different endometrial sampling methods, surgical curettage and vacuum aspiration biopsy random assay (VABRA), and to validate a novel xeno-free method to culture human E-MSCs. Six E-MSCs cell samples were isolated after mechanical tissue homogenization and cultured using human platelet lysate. E-MSCs were characterized for the colony formation capacity, proliferative potential, and multilineage differentiation. The expression of mesenchymal and stemness markers were tested by FACS analysis and real-time PCR, respectively. Chromosomal alterations were evaluated by karyotype analysis, whereas tumorigenic capacity and invasiveness were tested by soft agar assay. Both endometrial sampling techniques allowed efficient isolation and expansion of E-MSCs using a xeno-free method, preserving their mesenchymal and stemness phenotype, proliferative potential, and limited multi-lineage differentiation ability during the culture. No chromosomal alterations and invasive/tumorigenic capacity were observed. Herein, we report the first evidence of efficient E-MSCs isolation and culture in Good Manufacturing Practice compliance conditions, suggesting VABRA endometrial sampling as alternative to surgical curettage.

Endometrial polyps with increased plasma cells are associated with chronic endometritis in infertility patients: Hysteroscopic findings and post-polypectomy pregnancy rates.

PurposeThe relationship between endometrial polyps (EPs), chronic endometritis (CE), hysteroscopic findings, and antimicrobial in infertility patients was determined.MethodsWe retrospectively enrolled 115 infertility patients with suspected EPs who underwent office hysteroscopy. Patients were divided into 3 groups: 38 with increased plasma cells in EPs (group 1); 31 without increased plasma cells in EPs (group 2); and 46 without EPs (group 3). The 3 groups underwent hysteroscopy with or without polypectomies, and immediately thereafter, an endometrial aspiration biopsy (EAB) was performed. CE was diagnosed based on plasma cell infiltration in the non‐polypoid endometrium obtained by EAB.ResultsThe percentage of CE was 68.4%, 32.2%, and 28.3% in groups 1, 2, and 3, respectively. CE was more frequent in group 1 than group 2 or 3 (P = .01 and P = .002, respectively). The number of polyps was higher in group 1 than group 2. After adjustment for age and assisted reproductive technology, antibiotic therapy was not associated with pregnancy (adjusted odds ratio, 0.44; 95% confidence interval, 0.05‐3.57) in patients with EPs and CE.ConclusionsGroup 1 was associated with CE, and hysteroscopic findings were different from group 2. Antibiotic therapy after polypectomy for EPs with CE may not always be necessary.

Traditional and liquid-based cytology in the diagnosis of non-tumor lesions and endometrial tumors

BACKGROUND: Morphological examination of materials obtained during endometrial aspiration biopsy or diagnostic curettage is an integral part in the diagnosis of endometrial pathologies; however, these manipulations are invasive and have additional surgical and anesthetic risks. Therefore, the improvement of endometrial cytological examination is of great interest to minimize associated risks with high diagnostic potential. Currently, traditional cytology (TC) and liquid-based cytology (LBC) are employed for the morphological diagnosis of diseases of various localizations, but the possibilities of their combined use are insufficiently explored.&#x0D; AIMS: To improve the cytological diagnosis of endometrial tumors and non-tumor lesions.&#x0D; MATERIALS AND METHODS: The study enrolled 101 patients aged 2279 years with endometrial pathologies and indications for surgical treatment and routine histological examination of operative specimen. Endometrial surface scrapings obtained during hysteroscopy (n=73) and postoperative specimen (n=28) were used for cytological examination. A portion of the obtained specimen was immediately applied to a TC slide, and the rest was placed in a vial with preserving medium for LBC. Statistical processing of the results was performed according to conventional methods using StatTech v. 2.8.8 (Stattech LLC, Russia).&#x0D; RESULTS: Uninformative data were obtained in 9.9% of the cases in the TC and in 14.9% of cases in LC of uterine cavity specimens. The combined use of TC and LC reduced the number of observations with inadequate specimen to 6.9%. The presence of atypia in the cytological specimen (threshold value of atypical hyperplasia) correlated with the results of the histological examination (p0.001).&#x0D; CONCLUSIONS: The combined use of TC and LC allows increasing the number of observations with adequate specimens, improving the accessible and minimally invasive diagnosis of proliferative conditions and tumors.

Endometrial changes in estrogen and progesterone receptor expression during implantation in an oocyte donation program.

Implantation is the final and most important stage of embryogenesis and is of paramount importance in achieving a successful pregnancy. Progesterone and estrogen are steroid hormones responsible for the regulation of the implantation window and the current study hypothesised that their receptors may be implicated in women undergoing oocyte donation. A total of 15 women aged 25-32 years old (mean ± SD, 28.9±2.89) undergoing oocyte donation were recruited into the present study. Participants underwent ovarian stimulation with gonadotrophin-releasing hormone antagonist and recombinant follicle-stimulating hormone. Endometrial aspiration biopsy was performed on the day of oocyte retrieval and after 5 days (on days 0 and 5, respectively). Endometrial histology and evaluation of estrogen receptor (ER)α and progesterone receptor (PR)-B were performed on days 0 and 5. The ER nodal staining percentage on day 0 was age-associated, with patients aged <30 years demonstrating 100% staining and those aged >30 years exhibiting 90% staining. Pathological staining revealed statistically significant differences between days 0 and 5 following all staining procedures. Wilcoxon signed-rank test resulted in the following P-values, for ER (nodes % and stromal %) day 0/5, P=0.0001; for PR (nodes % and stromal %) day 0/5, P=0.0001 and P=0.035, respectively; for ER (grade nodes and stromal %) day 0/5, P=0.0001; and PR (grade nodes and stromal %) day 0/5 P=0.0001 and P=0.016, respectively. Synchronization between blastocyst development and the acquisition of endometrial receptivity is a prerequisite for the success of in vitro fertilisation (IVF). Aside from the recent discovery of molecules that are considered crucial for successful embryo implantation, assessing the functional characteristics of the endometrium may offer unique insights into this process, thus improving IVF results.

Endometrial expression of e-cadherin in relation to estrogen-progesterone receptor characteristics of the endometrium

Aim: to evaluate the endometrial expression of e-cadherin in relation to the estrogen-progesterone-receptor status of the endometrium.Materials and methods. In total 137 women were examined including 81 patients with infertility and 40 with a history of early pregnancy loss (main group); for comparison, 16 healthy fertile women (control group) were also examined. Endometrial aspiration biopsy was performed on 6–8 days after ovulation; in parallel, a peripheral blood sample was taken to determine the levels of estradiol and progesterone. A histological and immunohistochemical study of the endometrium with determination of estrogen (ER) and progesterone (PR) receptors and e-cadherin expression was carried out.Results. All fertile women (n = 16) and only 44 % (n = 53) of patients in the main group had the normal pattern of hormonereceptor endometrial interactions, i. e., low expression of ER and PR in the endometrial glands as well as reduced expression of ER and high expression of PR in the endometrial stroma. The endometrial e-cadherin expression was assessed in the following cohorts: a) women with normal hormone-receptor interactions (16 women in the control group and 53 women in the main group); b) with abnormal variants of hormone-receptor interactions in the endometrium (68 patients in the main group). The frequency of reduced e-cadherin expression was significantly lower in the cohort of women with normal estrogenprogesterone-receptor endometrial status (a) than in the cohort of women with abnormal variants of the endometrial “response” (b): in the luminal epithelium – in 5 % (3 out of 63) (а) vs. 17 % (8 out of 47) (b) (p &lt; 0.05); in the glands – in 13 % (9 out of 69) (a) vs. 37 % (25 out of 68) (b) (p &lt; 0.05).Conclusion. The estrogen-progesterone-receptor status of the endometrium is significant for the e-cadherin expression in the luminal epithelium and glands of the endometrium.

The value of the expression of endometrial receptors for steroid hormones in patients with endometriosis

Aim: To elucidate the nature of the expression of progesterone receptors (PR) and estrogen receptors (ER) of the endometrium in patients with endometriosis in order to study the effect of endometriosis therapy on endometrial receptors while taking progestogens and agonists of gonadotropin-releasing hormones (a-GnRH).Materials and Methods. A total of 119 women were examined, including 69 patients with small-sized endometrioma with adenomyosis, who were divided into two subgroups during the study: 35 women received Dienogest therapy, other 34 patients received Diferelin. To study the expression of endometrial steroid receptors, the patients underwent endometrial aspiration biopsy from different points of the uterine cavity before the treatment and after 3 months against the background of the therapy for endometriosis.ResultsEndometriosis therapy affects the expression pattern of endometrial steroid receptors. While taking Dienogest, the sensitivity of the endometrium to estrogens increases, and the number of cells with a positive response to progesterone receptors is partially reduced. When using gonadotropin-releasing hormone agonists (Dipherelin), the sensitivity of the uterine mucosa to ovarian hormones decreases, which is confirmed by the adequate expression of ER and PR. There is a need for more research on estrogen beta receptors, as well as progesterone receptors A and B, and the related ratios.

Comparison of diagnostic accuracy between endometrial curettage and aspiration biopsy in patients treated with progestin for endometrial hyperplasia: a Korean Gynecologic Oncology Group study.

ObjectiveTo compare the diagnostic accuracy of dilatation and curettage (D&C) versus endometrial aspiration biopsy in follow-up evaluation of patients treated with progestin for endometrial hyperplasia (EH)MethodsA prospective multicenter study was conducted from 2015 to 2018. Patients with EH were treated with progestin, one of the following three treatment regimens: oral medroxyprogesterone acetate (MPA) 10 mg/day for 14 days per cycle, continuous MPA 10 mg/day or the levonorgestrel-releasing intrauterine system (LNG-IUS). At 3 or 6 months of treatment, endometrial tissues were obtained via 2 methods in each patient: aspiration biopsy, followed by D&C. The primary outcome was the consistency of the histologic results between the 2 methods. The secondary outcome was the regression rate at 6 months of treatment.ResultsThe study population comprised 65 patients (55 with non-atypical hyperplasia, 10 with atypical hyperplasia). During the follow-up, a comparison of the pathologic results from aspiration biopsy and D&C was carried out for the 65 cases. Thirty-eight cases were diagnosed as EH by D&C. Among these, only 24 were diagnosed with EH from aspiration biopsy, for a diagnostic concordance of 63.2% (ĸ=0.59). Forty-four patients were followed up at 6 months, and the regression rate was 31.8% (14/44). Responses were obtained for 41.7% (5/12) of the cyclic MPA group, 58.3% (7/12) of the continuous MPA group and 10% (2/20) of the LNG-IUS group.ConclusionAs a follow-up evaluation of patients treated with progestin for EH, aspiration biopsy is less accurate than D&C and might not be a reliable method.Trial RegistrationClinicalTrials.gov Identifier: NCT02412072

New in a diagnosis and treatment of chronic endometritis at infertility

Background. Chronic endometritis is one of the causes of infertility, miscarriage, failed in vitro fertilization and embryo transfer attempts. Treatment of chronic endometritis is quite complicated due to a multifactorial nature of endometrium morpho-functional disorders. There are lots of approaches to a comprehensive treatment of chronic endometritis which indicates a lack of a single algorithm for a management of such patients to date. One of the modern, perspective and high-tech methods for treatment of chronic endometritis is photodynamic therapy (PDT). Aim. To study chronic endometritis treatment efficacy in patients with infertility when using the method of PDT and low doses of 17b-estradiol. Materials and methods. 85 female patients of reproductive age with chronic endometritis were examined and treated. All patients were divided into 2 groups: group 1 (43 patients) got treated by a method of intravenous PDT with low-dose transdermal 17b-estradiol; group 2 (42 patients) received low-dose transdermal therapy with 17b-estradiol. Clinical examination and laboratory tests, pelvic ultrasound, endometrial aspiration biopsy followed by pathomorphlogical and immunohistochemical examination were carried out to all patient. Results. Ultrasound examination revealed an increase in endometrium thickness at 12th day following PDT session in group 1 and following transdermal therapy with 17b-estradiol in group 2 resulting in endometrium state improvement almost 2 times compared with baseline values before treatment. Conclusions. PDT is a minimally invasive, gentle and safe treatment method. Due to a diffuser design laser radiation is evenly distributed in the uterine cavity. PDT reliably restores receptor function to progesterone in the endometrial glands.

Effects of lidocaine spray for reducing pain during endometrial aspiration biopsy: A randomized controlled trial.

To examine the effect of lidocaine spray for reducing pain during endometrial aspiration biopsy by comparing it with placebo and no intervention. Women undergoing endometrial aspiration biopsy from March 2017 to January 2018 were invited to participate. The participants were randomly assigned into three groups. In group 1 (lidocaine spray), eight puffs (80 mg, 10 mg/puff, 0.8 mL) of 10% lidocaine spray was applied thoroughly to the cervix, 3 min before starting the procedure. For group 2 (placebo spray), 0.8 mL of normal saline spray was applied to the cervix, 3 min before starting the procedure. For group 3 (no intervention), no anesthesia was given. The patients rated their pain according to a 10-cm visual analog scale at different points including baseline, immediately after the procedure (biopsy pain), and 10 min after the procedure. The 10-cm visual analog scale on satisfaction was also rated before hospital discharge. Comparison of continuous variables was made by using Kruskal-Wallis test. Chi squared test was used for comparison of categorical variables. Two hundred and forty patients (80 in each group) participated. The mean baseline, biopsy and postprocedural pain scores were not significantly different among the study groups. Similarly, the mean difference between the biopsy and the baseline pain scores were comparable among the groups. In addition, there was no difference on the satisfaction scores among the groups. Lidocaine spray applied to the cervix is not effective for reducing pain associated with pipelle endometrial aspiration biopsy.

Pipelle Endometrial Biopsy vs Dilatation and Curettage to Diagnose Endometrial Diseases in Abnormal Uterine Bleeding

ABSTRACT Aim The objective of this study was to assess the adequacy of the sample aspirated in order to make a definite diagnosis of endometrial disease in abnormal uterine bleeding (AUB) and to draw comparisons between the histopathological findings of Pipelle endometrial aspiration biopsy and dilatation and curettage (D&amp;C). Materials and methods Pipelle endometrial biopsy and D&amp;C samples were collected from 100 patients with AUB in the Department of the Obstetrics and Gynecology and sent to the Department of Pathology of a tertiary care hospital for adequacy of the sample and for histopathological analysis. Results The Pipelle sample was adequate in 73% of the cases and inadequate in 27% compared with D&amp;C, which showed 85% and 15%, respectively. About 53% of cases were comparable between D&amp;C and Pipelle and 37% were discordant. For endometrial hyperplasia using Pipelle aspirator, the sensitivity was 58.8%, specificity was 91.6%, positive predictive value (PPV) was 58.8%, negative predictive value (NPV) was 91.6%, and concordance was 86%. For detection of endometrial carcinoma using Pipelle, the sensitivity was 50%, specificity was 99%, PPV was 50%, NPV was 99%, and concordance rate was 98%. Conclusion It is more convenient and cost-effective for patients to undergo pipelle biopsy to confirm normalcy and rule out endometrial hyperplasia rather than undergoing D&amp;C initially. Out of the 27% of inadequate samples, 14.8% had fibroids and 11.1% had polyps, thus showing that tumors localized to a polyp or a small area of endometrium went undetected with Pipelle. Clinical significance Due to the high specificity and NPV and low sensitivity and PPV in diagnosing endometrial lesions and carcinomas, pipelle is suitable for women with a low risk of cancer. In cases where the diagnosis is hyperplasia on Pipelle, the patients are advised to undergo hysteroscopic-guided D&amp;C following pipelle to confirm the diagnosis. This is also applicable for cases of polyps and fibroids. How to cite this article Chandrashekar N, Jyothi GS, Shetty P. Pipelle Endometrial Biopsy vs Dilatation and Curettage to Diagnose Endometrial Diseases in Abnormal Uterine Bleeding. J South Asian Feder Menopause Soc 2017;5(2):123-128.

Особливості гормонального гемостазу у хворих з доброякісними гіперпластичними процесами грудних залоз

The objective: to study the incidence of gynecological diseases, clinical and hormonal parameters of the menstrual cycle in patients with benign hyper-plastic processes of breasts. Patients and methods. 65 women with various forms of mastitis were investigated. The following investigations were conducted: mammologistic and gynecological investigation, mommologistic X-ray investigation, ultrasound of breasts and of the pelvic organs, endometrial aspiration biopsy that was followed by cytology; when it was necessary the diagnostic laparoscopy, colposcopy, hysteroscope with curettage and morphological investigation of the endometrium, hormone research and rectal temperature measurements were conducted. Results. The frequency of the benign breast diseases was set: fibrocystic disease of breast – 32 women (49.2±6.20%), fibrous of breast – 16 women (24.6±5.34%), nodular of breasts – 8 women (12.3±4.07%), fibroadenoma – 6 women (9.2±3.59%), nodular disease of breasts on the background of fibroid changes – 3 women (4.6±2.60%). All in all, 96.9±2.14% of the patients had any gynecological diseases. Thus, the average age of the ‘debut’ of mastitis was 31.4±1.09 years; the hyper-plastic processes in the uterus was 35.2±1.17 years. Anovulation was detected in 17 (47.2±8.3%) patients, the lack of the luteal phase (NLF) was detected in 11 (30.6±7.6) patients. Conclusions. Identified hormonal changes are typical for patients with the hyper-plastic processes of the reproductive organs with different localization (breasts, uterus, ovaries). Due to the commonality of the hormone changes in most cases mastitis is combined with the various gynecological diseases (96.9±2.14%). Key words: gynecological pathology, hormonal changes, breast, factors of risk.

Availability of Hysteroscopy-Guided Resection of Endometrial Polyp

Endometrial polyp is a common disease that is often found in adult women. When malignancy is not pointed out pathologically in specimens of the blind endometrial aspiration biopsy or curettage biopsy and obvious lesion that needs to be treated is not observed by transvaginal ultrasonography, observation for periods depending on each case is usually indicated. To confirm the adequacy of such a management, we investigated past cases in which hysteroscopy-guided resection of endometrial polyp and pathological investigation in our hospital are underwent.

Management of Endometrial Hyperplasia With a Levonorgestrel-Releasing Intrauterine System: A Korean Gynecologic-Oncology Group Study.

The aim of the study was to evaluate the efficacy of the levonorgestrel intrauterine system (LNG-IUS) for treatment of endometrial hyperplasia (EH). A prospective multicenter study was conducted from November 2010 to March 2014. Patients with histologically confirmed EH were treated with LNG-IUS. At 3, 6, and 9 months after LNG-IUS insertion, follow-up endometrial aspiration biopsies with the LNG-IUS in the uterus were undertaken. At the 12th month of follow-up, endometrial tissues were obtained via 2 methods: endometrial aspiration biopsy with the LNG-IUS in the uterus, followed by dilatation and curettage (D&C) after LNG-IUS removal. The primary outcome was the regression rate at 12 months after LNG-IUS insertion, and the secondary outcome was the consistency of the results between the endometrial aspiration biopsy and the D&C. The study population comprised 75 patients, including 37 with simple hyperplasia without atypia; 3 with atypical simple hyperplasia; 23 with complex hyperplasia without atypia, and 12 with atypical complex hyperplasia. Of these patients treated with the LNG-IUS, 38 (50.7%) were followed up at 12 months after LNG-IUS insertion. The complete regression rate at 12 months was 94.7% (36/38): 100% (6/6) of patients with atypical EH and 93.7% (30/32) with EH without atypia. In all of the cases (100%, 36/36), patients achieved complete regression within 3 months of LNG-IUS insertion. A comparison of the pathologic results from endometrial aspiration biopsy and D&C was carried out for 15 patients. In the histologic results by endometrial aspiration biopsy, 14 patients were diagnosed as "normal endometrium" and 1 as "insufficient tissue for pathologic evaluation." Among the 14 cases of normal endometrium by endometrial aspiration biopsy, 1 was diagnosed as "residual EH" by D&C, and the 1 case with insufficient tissue was diagnosed as normal endometrium by D&C. Levonorgestrel intrauterine system is an effective and favorable method for treatment of EH.

Role of Chromo-hysteroscopy with Toluidine Blue in Diagnosing Endometrial Pathology after 40 years of Age

Objective: To evaluate diagnostic accuracy of Chromo hysteroscopy with Toluidine Blue for endometrial pathology in women with AUB after 40 years of age. Material and Methods: This cross-sectional interventional study was conducted in 50 cases with menorrhagia, metrorrhagia, polymenorrhagia or postmenopausal bleeding. After excluding thyroid disorders, coagulation disorders and cervical & vaginal causes, diagnostic hysteroscopy was done and findings recorded. Chromohysteroscopy was done by instillation of 1% toluidine blue dye. Hysteroscopic biopsy was taken from stained area & unstained area separately followed by endometrial aspiration biopsy. The histopathological results of these three samples were compared for each participant. Results: The ability of hysteroscopy to diagnose endometrial pathology was significantly higher (p=0.013) in comparison to TVS. 24% cases showed endometrial hyperplasia/carcinoma. 75% cases of endometrial hyperplasia/ carcinoma showed >50% endometrial surface staining while only 52.63% of cases with normal HPE showed similar staining but the difference was not statistically significant. The sensitivity, NPV and diagnostic accuracy of Stained biopsy (83.3%, 95% & 96%), unstained biopsy (83.3%, 95% & 96%) and endometrial aspiration (75%, 92.6% & 94%) did not show any statistically significant difference. Conclusions: Toluidine blue dye does not specifically stain endometrial hyperplasia or endometrial carcinoma and hence is NOT a useful stain for Chromo hysteroscopy guided biopsy in diagnostic evaluation of cases of AUB.