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endometrial biopsy

Sunday 12 May 2013

Method

To ensure a good specimen for morphologic interpretation, a biopsy sample should be taken from both the anterior and the posterior endometrium and fixed immediately in 10% buffered formalin.

In current practice, the device that is most often used is the Pipelle endometrial aspirator.

To ensure a maximum amount of tissue for morphological reading, the specimen should be placed on a piece of lens paper or some other adhesive tissue and then immersed in the fixative. By this means, all of the tissue fragments remain tightly attached to the lens paper, rather than floating in the fixative, and no tissue will be lost for histologic examination.

In premenopausal women with regular menstrual cycles, histological preparations include the upper portion of the functional layer of the endometrium.

This is necessary, for in most instances morphological changes occur in the functionalis as opposed to the basalis layer, and, by inference, provide a clinically useful diagnosis.

In cases in which little or no tissue is obtained but the endometrium was penetrated with the aspirator, a repeat procedure should be performed.

If the repeat aspiration still yields little tissue, one can assume severe endometrial atrophy or obstructing endometrial polyp.

Taking an endovaginal ultrasonography of the uterus may solve this dilemma.

If the aspirator is ’blocked’ at the lower uterine segment (internal os), traction may be applied on the uterus with either a single-toothed tenaculum or preferably an Emmet tenaculum placed about half a centimetre into the anterior endocervical canal. This will help pass over the area of resistance.

The pathology requisition should contain all pertinent information, including date of last menstrual period.

Links

- The endometrial cycle at GLOW