Endometrial Biopsy In Women Research Articles

Histopathological patterns of abnormal uterine bleeding in endometrial biopsies: a retrospective study in Najran Region, Saudi Arabia

Objective: This retrospective study aimed to elucidate the histopathological patterns of endometrial biopsies in women presented with abnormal uterine bleeding (AUB) across various age groups in Najran, Saudi Arabia. Methods: A total of 365 subjects, spanning perimenarchal to perimenopausal stages, were included in the study, conducted at the Maternity and Children Hospital in Najran, Saudi Arabia. The study period extended from October, 2020 to September, 2022. Histopathological patterns were analyzed in relation to age, parity, bleeding patterns, cause, and management of AUB. Results: The predominant age group was 40-50 years (40.5%), with proliferative endometrium being the most prevalent histopathological pattern. Menorrhagia was the most common bleeding pattern (34.0%), and functional causes accounted for 46.0% AUB cases. Surgical treatment was the primary management approach (50.7%). Multinomial logistic regression highlighted the unique contributions of age, parity, bleeding patterns, cause, and management of AUB to endometrial histopathology (p < 0.001). Conclusion: The current study findings provided a comprehensive understanding of the complex interplay between demographic and clinical factors in shaping endometrial histopathology in women with AUB in Najran, Saudi Arabia. Tailoring diagnostic and management strategies based on these factors can enhance personalized care for this diverse patient population.

Correlation between Manual Vacuum Aspiration and Endometrial Cell Sampler in Abnormal Uterine Bleeding

Objective: Office endometrial biopsy using an endometrial cell sampler is an accepted method of obtaining endometrial tissue for histopathologic evaluation in women with abnormal uterine bleeding (AUB). Manual vacuum aspiration (MVA) is considered an alternative method, but data specific to the use of MVA is limited. This study aimed to evaluate the efficacy of MVA compared to endometrial cell sampler for diagnosing causes of AUB. Materials and Methods: This prospective study enrolled women aged ≥35 years who presented with AUB during August 2015 to June 2016. For each patient, endometrial biopsy using an endometrial cell sampler was first performed followed by MVA. Correlation of endometrial histopathology between methods were analyzed using Kappa statistic. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were evaluated. Results: Of the 162 patients enrolled, the data from 151 women were analyzed. Correspondence of histopathologic finding between tissue obtained from endometrial cell sampler and MVA was 72.8% (Kappa: 0.51). Correspondence of histopathologic finding between tissue obtained from MVA and the final most severe pathology used for treatment decision was 84.1% (Kappa: 0.72). MVA diagnosed all cases of malignancy, but endometrial cell sampler missed one case of malignancy. The overall sensitivity, specificity, PPV, and NPV of MVA was 84.5%, 100%, 100%, and 91.2%, respectively. Conclusion: The histopathologic findings of MVA were in good agreement with those of endometrial cell sampler, and MVA had high accuracy for diagnosing endometrial pathology. MVA is suggested as a reliable alternative procedure for endometrial biopsy in women with AUB.

Микросателлитная нестабильность и гиперпластические процессы слизистой оболочки матки

Introduction. Microsatellite instability is historically closely associated with the development of oncological processes. Early diagnosis of microsatellite instability as a marker for premalignancy, including in the case of endometrial hyperplasia (EH), which is recognized as a premalignancy lesion, is of interest. Identification of the mutational profile characteristic of malignant tumors in benign disease makes it possible to improve prognostic models and therapeutic tactics. Aim. Determination of clinical and anamnestic features of patients with EH and endometrioid adenocarcinoma in a comparative aspect, as well as structural features of microsatellite instability in the endometrium in patients with this pathology. Materials and methods. The study involved 120 women who were divided into 4 groups: group I – EH patients without atypia (n = 30); group II – patients with atypical EH (n = 30); group III – patients with endometrioid adenocarcinoma (n = 30); group IV – healthy women without somatic and gynecological pathology (n = 30). A comparative morphological study of endometrial samples was performed and levels of MLH-1, MSH-2, MSH-6 and PMS-2 expression were assessed. Results. It was revealed that most EH patients without atypia, patients with atypical EH, endometrioid adenocarcinoma complained of abnormal uterine bleeding; the history of patients of these groups is characterized by the presence of cardiovascular and endocrine diseases, and the gynecological history is characterized by the presence of uterine fibroids, benign breast diseases and pelvic inflammatory diseases. There was found a decrease in the MLH-1, PMS-2, MSH-2 and MSH-6 expression in endometrial biopsies of women with EH. Conclusion. Decreased expression of MLH-1, PMS-2, MSH-2 and MSH-6 in endometrial biopsies can probably be considered as a predictor of premalignant transformation, which requires further study in order to develop a program of malignancy risk assessment.

POST MENOPAUSAL BLEEDING PATTERNS IN PREDICTION OF ENDOMETRIAL CARCINOMA

Objective: To determine the demographic profile, patterns of bleeding and histopathological patterns of endometrial biopsy in women presenting with postmenopausal bleeding. Study Design: Descriptive cross-sectional study. Place and Duration of Study: Department of Obstetrics and Gynaecology, CAIMS, Karimnagar from October 2020 to April 2022. Material and Methods: This descriptive cross-sectional study included women of any parity and age >45 years who had spontaneous cessation of menstruation for the last one year and who presented with abnormal uterine bleeding. Premenopausal women, drug or irradiation induced, or iatrogenic menopause cases were excluded. All patients were admitted, transvaginal ultrasound done (cut off endometrial thickness >4mm) and subjected to dilatation and curettage under anesthesia and endometrial biopsies obtained. Samples were sent for histopathology and followed. Results: A total of 70 women were included. Commonest age group was 61-70 years, and was seen in 38 (54.3%) women, followed by the 52-60 years age group where 18 (25.7%) subjects were observed. Mean age was 62 ± 2.54 years. Twenty-four (35%) women were hypertensive while Type 2 Diabetes Mellitus (T2DM) was seen in 14 (20%). forty (57%) women complained of streaks of blood on the sanitary pad, and in 56 (80%) (P=0.032) there were recurrent episodes. Forty-eight (68.57%) women were multiparous. Atrophic endometrium was the most common benign histopathological pattern, seen in 18 (26%) followed by 16 (23%) chronic endometritis. Endometrial carcinoma was seen in 16 (23%). (p=0.041) Conclusion: Postmenopausal bleeding is an alarming symptom and should be thoroughly investigated with transvaginal ultrasound followed by endometrial biopsy for timely diagnosis and treatment.

ORIGINAL RESEARCH ARTICLE: HISTOPATHOLOGICAL EVALUATION OF ENDOMETRIAL BIOPSIES IN WOMEN WITH GYNECOLOGICAL COMPLAINTS

Objectives: The objectives of the study were to study histopathological evaluation of endometrial biopsies in women with gynecological complaints. Methods: The present study included 100 patients who attended gynecology department of Dhiraj General Hospital, SBKS MI and RC with the complaints of abnormal uterine bleeding. Endometrial biopsy or curettage done by clinician as part of diagnosis and management. Samples sent to the department of pathology for histopathological evaluation. Tissue after appropriate fixation and processing was embedded in paraffin block. After that, 4 micron tissue sections were cut and they were stained with H and E stain. The sections were evaluated on microscopy and an appropriate histopathological diagnosis was made. Results: Out of 100 cases studied, 37% were found out to be secretory endometrium, 20% proliferative endometrium, 6% disordered endometrial glands, 3% simple hyperplasia without atypia, 5% complex hyperplasia without atypia, 1% endometrial hyperplasia with atypia, 2% endometrial polyp, 7% chronic nonspecific endometritis, 1% tuberculous endometritis, 3% Arias-Stella reaction, 6% products of conception, 3% deciduitis, 1% complete hydatidiform mole, 2% endometrial carcinoma, and 3% squamous cell carcinoma of cervix. Conclusion: Abnormal uterine bleeding is a leading cause of morbidity in patients with gynecological complaints. It not just impairing health but psychologically also affects the patients. Endometrial biopsy is a safe, reliable, and less time-consuming outpatient procedure which can be used as an initial diagnostic tool in the patients with abnormal uterine bleeding.

A study on histomorphological patterns of endometrial biopsies in women with infertility

Background: Infertility is a global health problem. Cyclical histological changes in the endometrium reflect the fluctuating hormone levels and enables histological appearance of endometrium to be a reliable parameter to evaluate the cause of infertility. The aim was to study histomorphological patterns of endometrial tissue in cases of infertility. Materials and methods: A cross sectional study on 250 endometrial samples of infertile women both primary and secondary was carried out to find the histomorphological patterns of endometrium in infertile women. Results: 250 endometrial biopsies of patients presenting with infertility were studied. The age ranged from 20 to 45 years, with mean age of 31.47+3.15 years. Majority of the cases were of primary infertility 165 cases (66%) and secondary infertility 85 cases (34%). The various patterns include proliferative phase 76 cases (30.4%), early secretory phase 15 cases (6%), mid secretory phase 15 cases (6%) and late secretory phase 36 cases (14.4%), endometrial polyp 40 cases (16%), endometrial hyperplasia without atypia 52 cases (20.8%), atypical endometrial hyperplasia 2 cases (0.8%), nonspecific endometritis 12 cases (4.8%) and tuberculous endometritis 2 cases (0.8%). Conclusion: Endometrial biopsies provide an insight into the hormonal response of endometrium as well as the local factors of endometrium. Hence the histological examination of endometrial biopsy is the most confirmatory tool for the diagnosis of infertility.

P-415 Study of the incidence of herpes viruses in the endometrium of women with evidence of chronic endometritis and reproductive problems

Abstract Study question What is the prevalence of herpes viruses in endometrial mucosa in women with chronic endometritis and without bacterial causative agents and reproductive problems. Summary answer In our study in 12.5% were found to be positive for herpes viruses in endometrial sample. What is known already Herpes viruses affect the genital tract and can lead to chronic inflammation of the genital system. They are represented by over 100 different species, 8 of which affect humans. After the initial infection, they usually enter a latent stage as integrated DNA or as an extrachromosomal form. There are various causes that lead to reactivation of herpes viruses in the genital tract, such as decreased immune reactivity, cyclic hormonal changes associated with the menstrual cycle, hypothermia or hyperthermia, infections, invasive gynecological interventions, disturbed psychoemotional status. This can lead to the development of persistent chronic infections in the endometrial lining. Study design, size, duration Prospective cohort study at a Medical Center Institute for Reproductive Medicine, Pleven, Bulgaria. Data collection took place between June 2020 to January 2022. Participants/materials, setting, methods Of all the patients who underwent the Medical Center “Institute of Reproductive Medicine”, we found that in 24 of them (mean age 35.56±3.86 years) there was no evidence of pathogenic microorganisms in the endometrial biopsy. The results of flow cytometric analysis showed a high percentage of CD138+ plasma cells. These were included for further investigation of herpesviruses by Multiplex Real-Time PCR. The endometrial biopsy study was performed mandatorily after negative microbiological result of vaginal swab. Main results and the role of chance The results of this study indicate that 12.5% of women with reproductive problems have herpes virus found in the endometrial mucosa. Demonstration of herpes viruses in endometrial biopsy in women with reproductive problems directs the assisted reproduction specialist to the possible cause of pregnancy loss and helps to prepare and adopt the right strategy for subsequent pregnancies. Endometrial biopsy testing may facilitate the choice of antibacterial or antiviral therapy, which helps to limit the antibiotic effect on the balance of microorganisms forming the genital microbiome. Limitations, reasons for caution The insufficient number of patients. Wider implications of the findings Developing a diagnostic and treatment plan for patients with evidence of chronic endometritis. Trial registration number 1

O-144 Endometrial production of 17β-estradiol in relation to pregnancy outcome in women undergoing IVF/ICSI

Abstract Study question Does the endometrial synthesis and inactivation of 17β- estradiol differ between receptive and non-receptive endometrium in women undergoing IVF/ICSI? Summary answer The synthesis and inactivation of 17β-estradiol is similar in the endometrium of women who did and did not achieve a clinical pregnancy through IVF/ICSI. What is known already Implantation failure of high-quality embryos is a main concern in IVF/ICSI treatment. Blood sex-steroid concentrations do not reflect their corresponding concentrations in endometrial tissue. This is in line with the concept that blood steroids (and precursors) are locally converted to bioactive metabolites and vice versa, by expressing steroid-metabolising enzymes, such as 17β-hydroxy steroid dehydrogenase (17β-HSD). Studies indicate that alterations in intracrinology might modulate endometrial receptivity. We hypothesize that the local 17β-HSD activity during the window of implantation (WOI) differs between pregnant and non-pregnant IVF/ICSI patients. Study design, size, duration Case-control study of 40 patients that were recruited in the SCRaTCH study (NL5193/NTR5342), a randomised trial exploring whether ‘endometrial scratching’ in patients with a previous IVF/ICSI cycle failure affects pregnancy outcome in a subsequent IVF/ICSI cycle. For the present investigation, 20 endometrial biopsies from women who achieved clinical pregnancy after fresh embryo transfer (ET) were compared with 20 endometrial biopsies of women that did not conceive after fresh ET. Participants/materials, setting, methods Endometrial biopsies and serum were obtained at LH + 5-8 days (urinary test) in a natural cycle, prior to the fresh ET cycle. Cases (negative pregnancy test, n = 20) and controls (clinically pregnant, n = 20) were matched for primary vs. secondary infertility, embryo quality and age. Reduction of estrone to 17β-estradiol (synthesizing 17β-HSDs) and oxidation of 17β-estradiol to estrone (inactivating 17β-HSDs) were determined by high-performance liquid chromatography (HPLC). Results were compared with the Wilcoxon-Mann-Whitney Rank Sum Test. Main results and the role of chance Activity of 17β-HSDs responsible for the reduction of estrone to 17β-estradiol (mainly 17β-HSD type 1) was detected in all samples and ranged from 55 to 1864 pmol 17β-estradiol formed/mg protein/24 h. The values obtained from pregnant women (median: 1054) were not significantly different to those obtained from non-pregnant women (median: 997), p = 0.97. The activity of enzymes responsible for the oxidation of 17β-­ estradiol (mainly 17β-HSD type 2) into the less active estrone ranged from 32 to 1731 estrone formed/mg protein/24 h. The values obtained from pregnant women (median: 737) were not significantly different to those obtained from non-pregnant women (median: 624), p = 0.90. The ratio of 17β-HSD type 1:17β-HSD type 2 had a median of 1.63 in the pregnant woman compared to 1.95 in the group of non-pregnant woman (p = 0.57). Limitations, reasons for caution The study is pilot in nature and study population is small. Primary and secondary infertility patients were analysed together. A chance phenomenon could have occurred as included women were included after their first IVF/ICSI cycle, hence not every included study person met the criteria for repeated implantation failure (RIF). Wider implications of the findings 17β-estradiol metabolism takes place during the WOI, controlling the final 17β-estradiol level. Although the present investigation did not show differences between pregnant and non-pregnant women, it remains important to explore if estrogen balance deviations, e.g. in other cycle phases plays a role in clinical conditions such as primary infertility/RIF. Trial registration number NL5193/NTR5342

Morphological Pattern of Endometrial Biopsy in Women with Clinical Diagnosis of Abnormal Uterine Bleeding

Objectives: This study was carried out to determine the underlying gynecological pathology with help of morphological pattern of the endometrial histology in women of different age groups with clinical diagnosis of abnormal uterine bleeding. Methods: This is a retrospective study of a series of one hundred and twenty cases of women with presenting complaint of abnormal uterine bleeding. This study was done in the Department of Pathology, Rashid Latif Medical College, in collaboration with Gynecology departments of Arif Memorial Hospital and Hameed Latif Hospital over period of one year. (July 2018 to June 2019). One hundred and twenty cases of endometrial curettage, with clinical impression of abnormal uterine bleeding were analyzed and reported by two histopathologists. Patients with complications of pregnancy were excluded from present study. Results: Histopathological examination of endometrial curetting revealed spectrum of morphology from physiological changes to malignancy. Endometrium with normal cyclical changes were seen in 64 (53.33%) cases, followed by endometrial polyp 18 (15%) cases, endometrial hyperplasia 15 (12.5%), and disordered proliferative of endometrium 10 (8.33%) cases. Malignancy was noticed in 3 (2.5%) cases. Malignancy was diagnosed mostly in the postmenopausal age group. Conclusion: The present study proves that on routine basis endometrial histopathological evaluation is a useful diagnostic measure to determine the underlying cause of abnormal uterine bleeding which ultimately help in accurate treatment. Key Words: Abnormal uterine bleeding, polyp, hyperplasia, disordered proliferation, malignancy How to Cite: Khurram N, Aslam N, G. Wasim N.Y. Morphological pattern of endometrial biopsy in women with clinical diagnosis of abnormal uterine bleeding. Esculapio.2020;16(04):3-7.

Detection of Endometrial Nerve Fibres in the Diagnosis of Endometriosis: A Case-control Study

Introduction: Due to non-availability of a good non-invasive or semi-invasive test for diagnosing endometriosis, there is a substantial time delay between the onset of symptoms and surgically confirmed endometriosis. Development of a simple non-invasive or semi-invasive diagnostic method can greatly help to reduce this delay and prevent severe morbidity in minimal to mild endometriosis which cannot be diagnosed clinically or by ultrasonography. Aim: To evaluate the role of nerve fibre detection in endometrial biopsy for diagnosing endometriosis Materials and Methods: In this observational study, detection of endometrial nerve fibres in endometrial biopsy in women undergoing laparoscopy/laparotomy for pelvic pain or infertility was done using polyclonal rabbit anti-protein gene product 9.5 (Dako, Australia). The results were compared between women who has laparoscopic/laparotomy visualisation of endometriotic lesions with those who don't have endometriotic lesions. Women with visual evidence of endometriosis in laparoscopy/laparotomy were taken as cases (n=32). Women without evidence of endometriosis in laparoscopy/laparotomy were taken as controls (n=29). Presence of endometrial nerve fibre was compared between women with and without evidence of endometriosis. Presence of endometrial nerve fibres and its association with painful symptoms, history of hormonal therapy, endometrial histopathology and stages of endometriosis was analysed. Results: Endometrial nerve fibres were detected in the functional layer in 21.8% of the endometriosis patients and no nerve fibres were detected in the control group. There was no significant association between endometrial nerve fibres in endometriosis and presentation of painful symptoms, history of hormonal therapy, endometrial histopathology and stages of endometriosis. Sensitivity of detecting endometriosis by the presence of nerve fibres in endometrial nerve biopsy specimen was 21.8% and specificity was 100%. Conclusion: Endometrial nerve fibre assessment for identifying endometriosis in women undergoing laparoscopy/laparotomy using routine endometrial sampling and immunohistochemical analysis was found not to be sensitive for the diagnosis of endometriosis.

Long-Term Outcome of Postmenopausal Women With Proliferative Endometrium on Endometrial Sampling

Background Proliferative endometrium has been reported in 15% of endometrial biopsies of women aged 50 years and older. Contrary to endometrial hyperplasia, proliferative endometrium has not been associated with the risk of endometrial cancer. Objective This study aimed to report on the long-term outcome of postmenopausal women who received a diagnosis of proliferative endometrium. Study Design This is a retrospective cohort study of 1808 women aged 55 years and older who underwent endometrial sampling between January 1997 and December 2008. Outcome data were available through February 2018. Women with a proliferative endometrium were compared with those with an atrophic endometrium for future development of endometrial hyperplasia or cancer. A subanalysis was performed for those who presented with postmenopausal bleeding. Uni- and multivariable logistic regression analyses were used to assess for confounders. Results In this study, 297 women (16.4%) received a diagnosis of proliferative endometrium. Furthermore, 962 women met the inclusion criteria. Among those women, 278 had a proliferative endometrium, and 684 had an atrophic endometrium. Women with a proliferative endometrium were younger (61.2 vs 64.5 years; P 60 years (odds ratio, 1.98; 95% confidence interval, 1.03–3.82; P=.04), and body mass index >35 kg/m2 (odds ratio, 2.3; 95% confidence interval, 1.09–4.83; P Conclusion One of the 6 postmenopausal women who underwent endometrial sampling had a proliferative endometrium. Furthermore, 11.9% of women developed endometrial hyperplasia or cancer, a 4-fold greater incidence than women with an atrophic endometrium. The findings of this study suggest that long-term monitoring is warranted for women with postmenopausal bleeding and a proliferative endometrium histology. Further studies are needed to examine if a treatment is required to negate the risk of unopposed estrogen.

Histopathological study of endometrial biopsies in women presenting with abnormal uterine bleeding

Histopathological study of endometrial biopsies in women presenting with abnormal uterine bleeding

Histological Pattern of Endometrial Biopsies in Women with Abnormal Uterine Bleeding in a Hospital in North Central Nigeria.

The study is a retrospective cross-sectional study carried out in the Department of Pathology of Premier Hospital, Abuja, on specimens received over a one-year period. Four hundred and eighty-six samples of endometrial biopsies and curettings from women presenting with abnormal uterine bleeding sent to the histopathology laboratory were analyzed. The most common biopsies were those of product of conception which accounted for 304 cases (62.6%). Most of the cases of endometrial hyperplasia were typical. Endometritis and chorioamnionitis were the inflammatory conditions seen. Twenty-three women had molar pregnancies. The most common cause of abnormal uterine bleeding in this population is retained products of conception. There may be need to retrain some of the staff involved in the management of pregnancy related complications. There is need to further evaluate pregnancy related complications to ascertain the causes and circumstances responsible for them so as to appropriately direct interventional protocols.

Endometrial Biopsy in an Outpatient Gynaecological Setting: Overinvestigation.

We reviewed the indications for endometrial biopsy at the general gynaecology outpatient clinic of the Université de Montréal Hospital Center and measured their compliance with the Society of Obstetricians and Gynaecologists of Canada and other international guidelines. Three hundred and seventy-one files of patients who had an endometrial biopsy between January and October 2015 were reviewed. Indication for endometrial biopsy and pathology results were noted. Files were separated into four categories. In the postmenopausal bleeding category, all files complied with the SOGC. We found hyperplasia or neoplasia in 13% of patients. In the asymptomatic endometrial thickening category, 9% of the files did not show sufficient indication for biopsy. None of the patients presented hyperplasia or neoplasia. In the abnormal uterine bleeding (AUB) - under 41 years old category, there was no indication for biopsy in 23% of the files. We found hyperplasia or neoplasia in 13% of patients, but only in patients with an indication for biopsy. In patients with AUB - over 40, non-compliance with SOGC was 3%. But according to international guidelines, 42% of patients with AUB between 41 and 45 years old did not have an indication for biopsy and none showed hyperplasia or neoplasia. We demonstrated clinically significant overinvestigation in patients with AUB. Indications should be reviewed carefully before performing an endometrial biopsy in women under 41. In addition, the value of endometrial biopsies in patients between 41 and 45 years old with menorrhagia and no additional risk factor should be reevaluated.

The effects of the Bethesda System 2014 on endometrial cell reporting and follow-up endometrial biopsies in women 45 years of age and over

The Bethesda System (TBS) guidelines for reporting the presence of endometrial cells on Papanicolaou tests increased the reporting age from 40 (TBS 2001) to 45 (TBS 2014) years. Exfoliated endometrial cells (EMC) are usually a normal finding. Nevertheless, benign-appearing EMC occasionally correspond to endometrial hyperplasia or malignancy, especially in older, postmenopausal women. This study assesses the impact of this age cutoff change. This retrospective review compares endometrial biopsies following TBS 2001 and TBS 2014. Papanicolaou tests with EMC reported in women older than age 40 or 45 years were correlated with follow-up endometrial biopsies performed between May 25, 2014, to May 26, 2015, and May 27, 2015, to May 26, 2016, respectively. The number of reported EMC declined from 770 to 492 (a 36.1% decrease). The follow-up endometrial biopsy rate for Papanicolaou tests reporting EMC using TBS 2001 was 13.6% (105 of 770) versus TBS 2014 at 13.8% (68 of 492; P = 0.92). For TBS 2001, 15% of women aged 45 and older had follow-up biopsies (65 of 434; P = 0.62). Most follow-up biopsies showed benign endometrium. In the TBS 2001 group, 1 biopsy showed malignancy and another showed complex hyperplasia with atypia. Both patients were older than 45 years. The TBS 2014 group contained 1 biopsy of malignancy and 1 with simple hyperplasia with focal atypia. The implementation of TBS 2014 reduced the frequency of reporting benign-appearing endometrial cells. The follow-up biopsy rate has remained essentially the same, but the total number of biopsies performed decreased, with a similar low yield of significant abnormalities.

Endometrial Biopsy: American College of Nurse-Midwives.

Endometrial biopsy can be used to diagnose endometrial hyperplasia, endometrial cancer, and uterine infections. This cost-effective procedure has minimal side effects, and complications are rare. The purpose of this clinical bulletin is to provide clinicians with guidance about endometrial biopsy including the procedure's advantages and disadvantages, indications and contraindications, and side effects. In addition, step-by-step instructions for performing endometrial biopsy, the equipment required, selection of sampling devices, and care before and after the procedure are discussed.

Management of Proliferative Endometrium on Biopsy in Post-Menopausal Women

Post-menopausal bleeding (PMB) is usually caused by several endometrial conditions (hyperplasia and carcinoma) for which there are evidence-based treatments. However, there is little literature and no evidence-based treatments for a finding of proliferative endometrium without atypia on Pipelle endometrial biopsy in women presenting with PMB. Our aim is to explore management and treatment options for this subset of women. This is a retrospective, observational case series review of women presenting with PMB to a gynaecology rapid access clinic at a District General Hospital in Manchester, UK over a period of three weeks. Four women who were found to have a proliferative or secretory endometrium on endometrial Pipelle biopsy were chosen. Their history, examination findings, investigations, treatment and follow-up findings were then analysed. This case series has identified the management dilemma posed by patients with proliferative endometrium with no atypia on endometrial sampling. The four patients were followed-up with a repeat Pipelle endometrial biopsy six weeks after presentation to the specialist gynaecology unit. They were subsequently counselled or treated with oral progesterone therapy for six to eight weeks. The management options included the Mirena intrauterine system (IUS), oral progesterone therapy and discharging the patient back to primary care. There is no consensus on the importance of oral progesterone or the duration of follow up necessary to monitor for the development of endometrial hyperplasia or cancer in this subset of patients. Further research is needed to develop evidence-based, management guidelines for proliferative endometrium in women with PMB.

A Structured Assessment to Decrease the Amount of Inconclusive Endometrial Biopsies in Women with Postmenopausal Bleeding.

Objective. To determine whether structured assessment of outpatient endometrial biopsies decreases the number of inconclusive samples. Design. Retrospective cohort study. Setting. Single hospital pathology laboratory. Population. Endometrial biopsy samples of 66 women with postmenopausal bleeding, collected during the usual diagnostic work-up and assessed as insufficient for a reliable histological diagnosis. Methods. Endometrial biopsy samples were requested from the pathology laboratories. The retrieved samples were systematically reassessed by a single pathologist specialized in gynecology. Main Outcome Measure. Disagreement between initial assessment and conclusion after structured reassessment. Results. We retrieved 36 of 66 endometrial biopsy samples from six different pathology laboratories. Structured reassessment of the retrieved samples by a single pathologist specialized in gynecology did not change the conclusion in 35 of the 36 samples. The remaining sample contained a large amount of endometrial tissue and the diagnosis at reassessment was endometrial hyperplasia without atypia. All other samples contained insufficient material for a reliable diagnosis. Conclusion. A structured reassessment of endometrial biopsies samples, which were classified as inconclusive due to insufficient material, did not change the conclusion. Although it might be helpful for pathologists to have diagnostic criteria for adequacy and/or inadequacy of an endometrial biopsy sample, the gain in efficiency is likely to be small.

Pregnancy outcomes in women with chronic endometritis and recurrent pregnancy loss

To evaluate the prevalence of chronic endometritis (CE) in women with recurrent pregnancy loss (RPL) and compare pregnancy outcomes in women with and without CE. Case-control observational study. Academic fertility practice. Women with two or more pregnancy losses. Hematoxylin and eosin (H & E) staining was performed on all endometrial biopsies and plasma cells were identified by morphology. Immunohistochemical (IHC) staining for CD138 was later applied to all tissue samples. Charts were reviewed to evaluate the outcome of the next clinical intrauterine pregnancy. Miscarriage rate and live birth rate. A total of 107 women met inclusion criteria. The use of CD138 IHC staining resulted in a significantly higher prevalence of CE compared with the use of H & E staining and morphological assessment alone (56% [60/107] vs. 13% [14/107]). The 51 women with untreated CE were compared with the 45 women without CE by CD138 staining. Among those women with a subsequent pregnancy, the live birth rate in the next clinical intrauterine pregnancy after endometrial evaluation was 67.6% (23/34) in women with untreated CE and 87.1% (27/31) in women without CE. Age, body mass index (BMI), results of RPL evaluation, and number of prior losses were not significantly different between the two groups. CD138 IHC staining of endometrial biopsies in women with RPL provides increased sensitivity when screening for CE compared with H & E staining and morphological assessment alone. Untreated CE may contribute to poor pregnancy outcomes and deserves further investigation in a larger cohort.

Management of "Atypical Endocervical Cells" Compared to "Atypical Glandular Cells".

To assess adherence to management guidelines based on the terminology used to describe atypical glandular cells (AGC) on cytology reports. We analyzed AGC pathology reports from Hartford Hospital, 2004-2007, and identified cases of AGC with the terminology atypical glandular cells or atypical endocervical cells (AEC). We calculated rates of clinical evaluations based on the terminology used to describe the AGC. Statistical analysis was performed using the χ test. Seventy-eight reports contained the terminology AEC and 97 reports contained the terminology AGC. The rate of histologic sampling in women with AEC was lower than in women with AGC (52.6% vs 83.5%; p < .01). Similarly, the rate of comprehensive evaluations was lower (33.3% vs 71.1%; p < .01). Fewer endocervical curettages (47.4% vs 77.3%; p < .01) and fewer endometrial biopsies in women 35 years or older were performed (26.9% vs 69.1%; p < .01) in women with AEC than in women with AGC. Women with AGC reports containing the term AEC were managed less optimally than those with AGC. These results suggest that the terminology used to describe the finding of atypical glandular cells may influence the clinical evaluation. Clinicians may not recognize AEC as AGCs. Ours results suggest that the terminology atypical endocervical cells should be avoided or accompanied by the terminology atypical glandular cells.