DIAGNOSIS OF ENDOMETRIAL BIOPSIES AND CURETTINGS PDF

Abstract A major proportion of the workload in many histopathology laboratories is accounted for by endometrial biopsies, either curettage specimens or outpatient biopsy specimens. The increasing use of pipelle and other methods of biopsy not necessitating general anaesthesia has resulted in greater numbers of specimens with scant tissue, resulting in problems in assessing adequacy and in interpreting artefactual changes, some of which appear more common with outpatient biopsies. In this review, the criteria for adequacy and common artefacts in endometrial biopsies, as well as the interpretation of endometrial biopsies in general, are discussed, concentrating on areas that cause problems for pathologists. An adequate clinical history, including knowledge of the age, menstrual history and menopausal status, and information on the use of exogenous hormones and tamoxifen, is necessary for the pathologist to critically evaluate endometrial biopsies. Topics such as endometritis, endometrial polyps, changes that are induced by hormones and tamoxifen within the endometrium, endometrial metaplasias and hyperplasias, atypical polypoid adenomyoma, adenofibroma, adenosarcoma, histological types of endometrial carcinoma and grading of endometrial carcinomas are discussed with regard to endometrial biopsy specimens rather than hysterectomy specimens.

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Abstract A major proportion of the workload in many histopathology laboratories is accounted for by endometrial biopsies, either curettage specimens or outpatient biopsy specimens.

The increasing use of pipelle and other methods of biopsy not necessitating general anaesthesia has resulted in greater numbers of specimens with scant tissue, resulting in problems in assessing adequacy and in interpreting artefactual changes, some of which appear more common with outpatient biopsies. In this review, the criteria for adequacy and common artefacts in endometrial biopsies, as well as the interpretation of endometrial biopsies in general, are discussed, concentrating on areas that cause problems for pathologists.

An adequate clinical history, including knowledge of the age, menstrual history and menopausal status, and information on the use of exogenous hormones and tamoxifen, is necessary for the pathologist to critically evaluate endometrial biopsies.

Topics such as endometritis, endometrial polyps, changes that are induced by hormones and tamoxifen within the endometrium, endometrial metaplasias and hyperplasias, atypical polypoid adenomyoma, adenofibroma, adenosarcoma, histological types of endometrial carcinoma and grading of endometrial carcinomas are discussed with regard to endometrial biopsy specimens rather than hysterectomy specimens. The value of ancillary techniques, especially immunohistochemistry, is discussed where appropriate.

In many histopathology laboratories, endometrial specimens account for a major proportion of the workload.

Most specimens are taken because of abnormal uterine bleeding or other related symptoms, and the pathologist is expected to exclude an endometrial cancer or a precancerous lesion. In some cases, a benign cause for abnormal uterine bleeding is identified, such as endometritis or endometrial polyp.

In this review, I will outline my approach to the interpretation of endometrial biopsy specimens, especially concentrating on areas which, in my experience, create difficulties for pathologists.

Endometrial biopsy specimens are now rarely taken to date the endometrium and to assess whether ovulation has occurred, as serum measurements of various hormones give equivalent or more information. In this review, dating of the endometrium will not be discussed, as this has been dealt with in detail recently.

Clinical history In evaluating an endometrial biopsy specimen, an adequate clinical history is important, including the age of the patient and the reason for the biopsy. The menopausal status as well as the date of onset of the last menstrual period and the length of the menstrual cycle in premenopausal women should be provided.

In many cases of postmenopausal bleeding, the patient is not actually postmenopausal but rather is perimenopausal, with a prolonged interval between periods.

This results in the clinician and the patient assuming that the woman is postmenopausal. Before biopsy, many women with abnormal uterine bleeding are already taking exogenous hormones, especially progestogenic compounds, to control the bleeding, and this information is not always conveyed to the pathologist.

Other women may be taking hormone replacement therapy or contraceptives. These hormonal compounds may alter the morphological appearance of the endometrium and a knowledge that these, and other relevant drugs such as tamoxifen, are being taken is of paramount importance to the pathologist. Criteria for adequacy of endometrial biopsy specimens Previously, endometrial biopsy specimens were largely obtained by dilatation and curettage carried out under general anaesthesia.

Most endometrial specimens are now taken at outpatients by pipelle or other techniques, with the result that many biopsy specimens contain scant, or even no, endometrial tissue. Paradoxically, superficial endometrial biopsy specimens with scant tissue often take longer to assess than intact biopsy specimens with an appreciable amount of tissue. The pathologist is faced with making a decision on whether the biopsy specimen is adequate. A recent study showed that there is considerable disagreement among specialist gynaecological pathologists about what constitutes an adequate endometrial biopsy specimen.

For example, some clinicians routinely conduct a repeat biopsy when an endometrial specimen has been classified as inadequate. It is my policy in reporting endometrial specimens that a biopsy specimen from either outpatient clinic or curettage is classified as inadequate only if no endometrial tissue is present.

If there is any endometrial tissue, no matter how little, I do not categorise the specimen as inadequate. If intact tissue, comprising glands and stroma, is present then this can be typed, although with a comment that only a limited amount of tissue is available for examination. Open in a separate window Figure 1 Typical endometrial biopsy specimen from an outpatient, which is scant and is composed of only superficial strips of endometrial glands with a pseudopapillary architecture.

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My approach to the interpretation of endometrial biopsies and curettings

A review from Modern Pathology touts it as being "extremely useful for the practicing pathologist because it outlines criteria for diagnosis, helps in solving diagnostic dilemmas, and clarifies controversial issues. More than illustrations complement the text, with 70 of them in full color throughout. Each chapter includes a section on "Clinical Queries and Reporting", which summarizes the features that must be discussed in the final pathology report. The authors are two prominent gynecologic pathologists, and this book is derived from their long-running Short Course presented at the International Academy of Pathology.

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Diagnosis of Endometrial Biopsies and Curettings

The final prices may differ from the prices shown due to specifics of VAT rules About this book The 3rd edition of this text entails a comprehensive review of endometrial pathophysiology, including the recognition of physiologic conditions i. The book will maintain a compact size with numerous illustrations and tables. The complicated subject of hyperplasia and cancer precursors will include expanded commentary on the application of endometrial intraepithelial neoplasia EIN and how it relates to the traditional classification of endometrial hyperplasia. Additionally, a substantial number of new, all color images, some of which will be available in electronic format, will aid readers to fully understand and confidently classify such complex specimens. This text will continue to serve as a useful resource not only for pathologists in training and practicing pathologists, but also to experienced physicians, other health care providers and researchers dealing with, and interested in endometrial pathology.

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