Endometrial Sampling In Women Research Articles

Routine endometrial sampling of asymptomatic premenopausal women shedding normal endometrial cells in papanicolaou tests is not cost effective

Following The Bethesda System 2001 (TBS 2001) recommendation to report normal endometrial cells (nEMC) in women ages >or=40 years, studies have shown that endometrial (EM) sampling has increased, but detection of significant EM pathology has not increased. The cost implications of this increased EM sampling have not been specifically addressed. The aim of this study was to assess the cost effectiveness of EM sampling in women ages >or=40 years with nEMC in their Papanicolaou tests. The authors reviewed 499 cases at a large academic women's hospital where nEMC had been reported in Papanicolaou tests followed by EM tissue sampling. Relevant clinical information was obtained from cytopathology and surgical pathology reports. Data on costs of EM sampling were obtained from business offices. Of 1049 women ages >or=40 years who were shedding nEMC, 499 (48%) had follow-up EM sampling. In follow-up EM sampling, 6 cases of significant pathology (atypical complex EM hyperplasia or adenocarcinoma) were detected. Asymptomatic women totaled 350, and the total cost for EM sampling of asymptomatic patients shedding nEMC was estimated at 107,272 dollars. Three of the asymptomatic patients had significant EM pathology, but all 3 were postmenopausal. Three additional premenopausal patients with significant pathology were symptomatic with vaginal bleeding. No asymptomatic premenopausal patients shedding nEMC either before or after Day 12 of their menstrual cycle were found to have significant EM pathology in this large study of almost 500 women with nEMC in their Papanicolaou tests. The total costs, when projected nationally, for EM sampling in asymptomatic premenopausal women were highly significant. Educational discussions with clinicians in this community are underway to reduce the number of women who undergo EM sampling after Papanicolaou test findings of nEMC. Routine EM sampling of asymptomatic premenopausal women with nEMC in Papanicolaou tests is not cost-effective.

Expression of interleukin-8 and monocyte chemotactic protein-1 in adenomyosis

To clarify the inflammatory nature of adenomyosis, we aimed to investigate the expression of interleukin-8 (IL-8) and monocyte chemotactic protein-1 (MCP-1) by immunohistochemistry to determine their putative role in pathophysiology of adenomyosis. Adenomyosis samples, with their eutopic endometrium, were collected from 30 women undergoing hysterectomy. Endometrium from 27 women without adenomyosis were also collected as a control group. Samples were grouped according to the menstrual cycle phase and examined by immunohistochemistry for IL-8 and MCP-1. In normal endometrium, secretory phase samples expressed higher levels of epithelial IL-8 than in proliferative phase samples (P = 0.01), and we observed a trend for an increased epithelial MCP-1 expression in the secretory phase samples compared with the proliferative phase samples (P = 0.07). Endometrial samples of women with adenomyosis did not show the same cyclic variation. In the secretory phase, eutopic endometrium of women with adenomyosis expressed lower levels of epithelial IL-8 and MCP-1 compared with normal endometrium (P < 0.05). The expression of epithelial IL-8 and MCP-1 was higher in the adenomyosis foci than the eutopic endometrium (P < 0.05). These findings may indicate that an intrinsic abnormality of inflammatory response may be present in eutopic endometrium of women with adenomyosis, and IL-8 and MCP-1 may contribute to the pathophysiology of adenomyosis.

A prospective evaluation of pain and acceptability during outpatient flexible hysteroscopy and endometrial biopsy

AbstractObjective To compare the pain of outpatient flexible hysteroscopy and endometrial sampling in women who have abnormal uterine bleeding.Design A prospective cohort study.Setting A minimal access gynaecological training unit within a district general hospital in north‐east England.Subjects 100 women referred consecutively for assessment of abnormal uterine bleeding.Main outcome measures Pain experienced with hysteroscopy and endometrial biopsy, as assessed by visual analogue score, and patient acceptability assessed by questionnaire.Results Endometrial biopsy was found to be the most painful part of the assessment and was significantly more painful than either hysteroscopy or insertion of the speculum (P &lt; 0.0001). The overall success of outpatient hysteroscopy in this series was 93%. On an intention‐to‐treat basis, procedure acceptability was 92% and only 9% of women required additional oral analgesia following the procedures. Of the women, 51% found the experience of outpatient hysteroscopy less painful than a cervical smear.Conclusion Outpatient flexible hysteroscopy is a viable first‐line investigation for abnormal uterine bleeding. Endometrial biopsy should be used selectively.

Granulocytes in the endometrium of post-partum women.

Endometrial samples of women at various stages of gonadal activity after parturition were examined for the presence and numbers of endometrial granulocytes. Although samples at all the stages contained significant numbers of the granulocytes (i.e. greater than 7/high-power field), the 100% values for late-proliferative and adaptation hyperplasia were significantly higher than the values for the resting (81.8%), early (82.4%) and mid- (87.9%) proliferative and secretory (83.3%) phases. We suggest that this correlates with the suggestion that the granulocytes constitute a receptor system for oestrogens.