Diagnostic Endometrial Pathology 2E

Yee Khong, Annie NY Cheung, Wenxin Zheng

• Publisher: CRC Press
• Year: 2019
• ISBN:
  9781351856850
• Edition: 2
• Topic: Medizin
• Subtopic: Medizinische Theorie, Praxis & Referenz

Endometrial cancer remains the most frequent gynaecological cancer in first world countries.This bench book on endometrial pathology distils the current literature to provide a practical text on endometrial pathology. Differential diagnosis is emphasised, and the clinical correlates of pathology are also stressed to make this a clinically useful book.Fully updated and including over 400 colour images, this book provides a valuable resource for the practising pathologist in general and community hospitals as well as in teaching hospitals.

1

Sampling the endometrium

Indications for sampling the endometrium

Sampling of the endometrium

When is the endometrial tissue sufficient?

Tissue artifacts

References

Indications for sampling the endometrium

Among the many indications for sampling the endometrium, abnormal uterine bleeding is the commonest (Table 1.1). When used in conjunction with other techniques, histological examination of an endometrial sample may help to exclude significant endometrial pathology such as endometritis, hyperplasia or carcinoma. Age over 45 years as a cut-off has previously been a guideline for sampling the endometrium in order to detect atypical hyperplasia and cancer in premenopausal women with abnormal uterine bleeding. This may no longer be appropriate as obesity, resulting in relative unopposed estrogen, increases the risk of atypical hyperplasia or carcinoma and the cut-off may place women at risk of delayed or missed diagnosis.1–3

Table 1.1 Indications for sampling the endometrium

Premenopausal abnormal uterine bleeding

Postmenopausal bleeding

Screening

Infertility

Abnormal pregnancy

Transvaginal ultrasonography and hysteroscopy are increasingly being used in conjunction with endometrial biopsy for the evaluation of women with abnormal uterine bleeding. Transvaginal ultrasonography with assessment of endometrial thickness may determine which women would benefit from an endometrial biopsy; thresholds for endometrial thickness in relation to risk of endometrial hyperplasia and cancer appear to differ between symptomatic and asymptomatic women.4,5 Under certain circumstances, hysteroscopy may help identify pathological lesions missed by blind endometrial biopsy and enable a directed biopsy of abnormal areas. Both transvaginal ultrasonography and hysteroscopy used together with endometrial biopsy can reassure the patient or physician that a negative biopsy is the result of an atrophic mucosa.

Endometrial sampling is carried out periodically in order to rule out malignancy and premalignant changes in the endometrium of asymptomatic women receiving postmenopausal hormone replacement or tamoxifen for breast cancer. Women at high risk of developing endometrial cancer, such as those with Lynch syndrome, may benefit from screening, although there is a lack of consensus as to optimal screening technique, and whether endometrial sampling should be included, frequency and age at which to commence screening.6 Women with polycystic ovary syndrome are also monitored because of an increased risk of endometrial hyperplasia and cancer. The finding that asymptomatic, morbidly obese patients have a high prevalence of occult hyperplasia, associated with a relatively high hormone receptor expression, suggests that those women would also benefit from screening.7

Histological evaluation of endometrial biopsy is also carried out in the investigation of infertility.

Endometrial sampling, in addition to clinical history, examination and other tests, may be necessary for the detection of an intrauterine pregnancy when the diagnosis of an ectopic pregnancy is in doubt.8

Sampling of the endometrium

Dilatation and curettage

The introduction of antiseptics allowed the procedure of cervical dilatation and endometrial curettage to become widespread. It is used also for the treatment of early pregnancy loss and for investigation of abnormal uterine bleeding.

Between 77% and 94% of such procedures have been reported to yield specimens deemed adequate for histological interpretation.9 At a time when it was the practice to perform curettage prior to hysterectomy for ruling out unsuspected endometrial cancer, in 16% of 50 consecutive pre-hysterectomy curettage specimens, less than one-fourth of the cavity had been curetted, and in 60%, less than half of the uterine cavity was sampled. However, recent appraisals support a high sensitivity of the method to detecting endometrial cancer in premenopausal and postmenopausal women.1...