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Introduction

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Diagnosis of Endometrial Biopsies and Curettings

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Abstract

Endometrial biopsies and curettings are among the most common tissue specimens received in the pathology laboratory. In several respects, these specimens present a unique challenge for the surgical pathologist. The normal endometrium undergoes a variety of morphologic changes, especially during the reproductive years, when cyclical hormonal influences and pregnancy affect uterine growth. Biopsy-induced artifacts confound this heterogeneous group of morphologic changes. Endometrial sampling techniques can vary from hysteroscopy with curettage, which is considered the “gold standard,” to a “blind” biopsy with no visualization of the tissue sampled. The final specimen contains multiple, irregularly oriented tissue fragments mixed with blood and contaminating cervical tissue and mucus.

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References

  1. Clark TJ, Voit D, Gupta JK, Hyde C, Song F, Khan KS. Accuracy of hysteroscopy in the diagnosis of endometrial cancer and hyperplasia: a systematic quantitative review. JAMA. 2002;288:1610–21.

    Article  Google Scholar 

  2. Visser NCM, Reijnen C, Massuger LFAG, Nagtegaal ID, Bulten J, Pijnenborg JMA. Accuracy of endometrial sampling in endometrial carcinoma: a systematic review and meta-analysis. Obstet Gynecol. 2017;130:803–13.

    Article  Google Scholar 

  3. Gkrozou F, Dimakopoulos G, Vrekoussis T, Lavasidis L, Koutlas A, Navrozoglou I, Stefos T, Paschopoulos M. Hysteroscopy in women with abnormal uterine bleeding: a meta-analysis on four major endometrial pathologies. Arch Gynecol Obstet. 2015;291:1347–54.

    Article  CAS  Google Scholar 

  4. Svirsky R, Smorgick N, Rozowski U, Sagiv R, Feingold M, Halperin R, Pansky M. Can we rely on blind endometrial biopsy for detection of focal intrauterine pathology? Am J Obstet Gynecol. 2008;199:115.e1–3.

    Article  Google Scholar 

  5. Baitlon D, Hadley JO. Endometrial biopsy. Pathologic findings in 3,600 biopsies from selected patients. Am J Clin Pathol. 1975;63:9–15.

    Article  CAS  Google Scholar 

  6. Nickelsen C. Diagnostic and curative value of uterine curettage. Acta Obstet Gynecol Scand. 1986;65:693–7.

    CAS  Google Scholar 

  7. Van Bogaert LJ, Maldague P, Staquet JP. Endometrial biopsy interpretation. Shortcomings and problems in current gynecologic practice. Obstet Gynecol. 1978;51:25–8.

    PubMed  Google Scholar 

  8. Galle PC, McRae MA. Abnormal uterine bleeding. Finding and treating the cause. Postgrad Med. 1993;93:73–6. 80–81

    Article  CAS  Google Scholar 

  9. Merrill JA. The interpretation of endometrial biopsies. Clin Obstet Gynecol. 1991;34:211–21.

    Article  CAS  Google Scholar 

  10. Goldstein RB, Bree RL, Benson CB, Benacerraf BR, Bloss JD, Carlos R, Fleischer AC, Goldstein SR, Hunt RB, Kurman RJ, Kurtz AB, Laing FC, Parsons AK, Smith-Bindman R, Walker J. Evaluation of the woman with postmenopausal bleeding: society of Radiologists in ultrasound-sponsored consensus conference statement. J Ultrasound Med. 2001;20:1025–36.

    Article  CAS  Google Scholar 

  11. Patel V, Wilkinson EJ, Chamala S, Lu X, Castagno J, Rush D. Endometrial thickness as measured by transvaginal ultrasound and the corresponding histopathologic diagnosis in women with postmenopausal bleeding. Int J Gynecol Pathol. 2017;36:348–55.

    Article  Google Scholar 

  12. Fleischer A, Abramowicz J, Goncalves L, Manning F, Monteagudo A, Timor I, Toy E, editors. Sonographic techniques for early detection of ovarian and endometrial cancers. Fleischer’s sonography in obstetrics and gynecology. 8th ed. New York: McGraw Hill Education; 2018.

    Google Scholar 

  13. Stovall TG, Solomon SK, Ling FW. Endometrial sampling prior to hysterectomy. Obstet Gynecol. 1989;73:405–9.

    CAS  PubMed  Google Scholar 

  14. Ramm O, Gleason JL, Segal S, Antosh DD, Kenton KS. Utility of preoperative endometrial assessment in asymptomatic women undergoing hysterectomy for pelvic floor dysfunction. Int Urogynecol J. 2012;23:913–7.

    Article  Google Scholar 

  15. Archer DF, McIntyre-Seltman K, Wilborn WW, Dowling EA, Cone F, Creasy GW, Kafrissen ME. Endometrial morphology in asymptomatic postmenopausal women. Am J Obstet Gynecol. 1991;165:317–20. discussion 320–322.

    Article  CAS  Google Scholar 

  16. Louie M, Canavan TP, Mansuria S. Threshold for endometrial sampling among postmenopausal patients without vaginal bleeding. Int J Gynaecol Obstet. 2016;132:314–7.

    Article  Google Scholar 

  17. McPencow AM, Erekson EA, Guess MK, Martin DK, Patel DA, Xu X. Cost-effectiveness of endometrial evaluation prior to morcellation in surgical procedures for prolapse. Am J Obstet Gynecol. 2013;209:22.e1–9.

    Article  Google Scholar 

  18. Munro MG, Critchley HOD, Broder MS, Fraser IS. FIGO working group on menstrual disorders: FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet. 2011;113:3–13.

    Article  Google Scholar 

  19. Goldfarb JM, Little AB. Current concepts: abnormal vaginal bleeding. N Engl J Med. 1980;302:666–9.

    Article  CAS  Google Scholar 

  20. Povey WG. Abnormal uterine bleeding at puberty and climacteric. Clin Obstet Gynecol. 1970;13:474–88.

    Article  CAS  Google Scholar 

  21. Kilbourn CL, Richards CS. Abnormal uterine bleeding. Diagnostic considerations, management options. Postgrad Med 2001;109:137–138, 141–144, 147–150.

    Article  CAS  Google Scholar 

  22. Wren BG. Dysfunctional uterine bleeding. Aust Fam Physician. 1998;27:371–7.

    CAS  PubMed  Google Scholar 

  23. Fraser IS, Critchley HOD, Broder M, Munro MG. The FIGO recommendations on terminologies and definitions for normal and abnormal uterine bleeding. Semin Reprod Med. 2011;29:383–90.

    Article  Google Scholar 

  24. Fritz MA, Speroff L. Clinical gynecologic endocrinology and infertility. 8th ed. Philadelphia: LWW; 2010.

    Google Scholar 

  25. Rubin SC. Postmenopausal bleeding: etiology, evaluation, and management. Med Clin North Am. 1987;71:59–69.

    Article  CAS  Google Scholar 

  26. Schindler AE, Schmidt G. Post-menopausal bleeding: a study of more than 1000 cases. Maturitas. 1980;2:269–74.

    Article  CAS  Google Scholar 

  27. Van Bogaert LJ. Clinicopathologic findings in endometrial polyps. Obstet Gynecol. 1988;71:771–3.

    PubMed  Google Scholar 

  28. Choo YC, Mak KC, Hsu C, Wong TS, Ma HK. Postmenopausal uterine bleeding of nonorganic cause. Obstet Gynecol. 1985;66:225–8.

    CAS  PubMed  Google Scholar 

  29. Mencaglia L, Perino A, Hamou J. Hysteroscopy in perimenopausal and postmenopausal women with abnormal uterine bleeding. J Reprod Med. 1987;32:577–82.

    CAS  PubMed  Google Scholar 

  30. Pacheco JC, Kempers RD. Etiology of postmenopausal bleeding. Obstet Gynecol. 1968;32:40–6.

    CAS  PubMed  Google Scholar 

  31. Lidor A, Ismajovich B, Confino E, David MP. Histopathological findings in 226 women with post-menopausal uterine bleeding. Acta Obstet Gynecol Scand. 1986;65:41–3.

    Article  CAS  Google Scholar 

  32. Moghal N. Diagnostic value of endometrial curettage in abnormal uterine bleeding – a histopathological study. J Pak Med Assoc. 1997;47:295–9.

    CAS  PubMed  Google Scholar 

  33. Van den Bosch T, Ameye L, Van Schoubroeck D, Bourne T, Timmerman D. Intra-cavitary uterine pathology in women with abnormal uterine bleeding: a prospective study of 1220 women. Facts Views Vis Obgyn. 2015;7:17–24.

    PubMed  PubMed Central  Google Scholar 

  34. Ricciardi E, Vecchione A, Marci R, Schimberni M, Frega A, Maniglio P, Caserta D, Moscarini M. Clinical factors and malignancy in endometrial polyps. Analysis of 1027 cases. Eur J Obstet Gynecol Reprod Biol. 2014;183:121–4.

    Article  Google Scholar 

  35. Meyer WC, Malkasian GD, Dockerty MB, Decker DG. Postmenopausal bleeding from atrophic endometrium. Obstet Gynecol. 1971;38:731–8.

    CAS  PubMed  Google Scholar 

  36. Gambrell RD. Postmenopausal bleeding. J Am Geriatr Soc. 1974;22:337–43.

    Article  Google Scholar 

  37. Wise MR, Gill P, Lensen S, Thompson JMD, Farquhar CM. Body mass index trumps age in decision for endometrial biopsy: cohort study of symptomatic premenopausal women. Am J Obstet Gynecol. 2016;215:598.e1–8.

    Article  Google Scholar 

  38. Stoffel E, Mukherjee B, Raymond VM, Tayob N, Kastrinos F, Sparr J, Wang F, Bandipalliam P, Syngal S, Gruber SB. Calculation of risk of colorectal and endometrial cancer among patients with lynch syndrome. Gastroenterology. 2009;137:1621–7.

    Article  Google Scholar 

  39. Pennington KP, Walsh T, Lee M, Pennil C, Novetsky AP, Agnew KJ, Thornton A, Garcia R, Mutch D, King M-C, Goodfellow P, Swisher EM. BRCA1, TP53, and CHEK2 germline mutations in uterine serous carcinoma. Cancer. 2013;119:332–8.

    Article  CAS  Google Scholar 

  40. Tan M-H, Mester JL, Ngeow J, Rybicki LA, Orloff MS, Eng C. Lifetime cancer risks in individuals with germline PTEN mutations. Clin Cancer Res. 2012;18:400–7.

    Article  CAS  Google Scholar 

  41. van Lier MGF, Wagner A, Mathus-Vliegen EMH, Kuipers EJ, Steyerberg EW, van Leerdam ME. High cancer risk in Peutz-Jeghers syndrome: a systematic review and surveillance recommendations. Am J Gastroenterol. 2010;105:1258–64. author reply 1265.

    Article  Google Scholar 

  42. Ring KL, Garcia C, Thomas MH, Modesitt SC. Current and future role of genetic screening in gynecologic malignancies. Am J Obstet Gynecol. 2017;217:512–21.

    Article  Google Scholar 

  43. Venn A, Watson L, Lumley J, Giles G, King C, Healy D. Breast and ovarian cancer incidence after infertility and in vitro fertilisation. Lancet. 1995;346:995–1000.

    Article  CAS  Google Scholar 

  44. Harris HR, Terry KL. Polycystic ovary syndrome and risk of endometrial, ovarian, and breast cancer: a systematic review. Fertil Res Pract. 2016;2:14.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD, USA

    Tricia A. Murdock, Emanuela F. T. Veras & Robert J. Kurman

  2. Department of Pathology and Laboratory Medicine, State University of New York Upstate Medical University, Syracuse, NY, USA

    Michael T. Mazur

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  1. Tricia A. Murdock
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  2. Emanuela F. T. Veras
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  3. Robert J. Kurman
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  4. Michael T. Mazur
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Murdock, T.A., Veras, E.F.T., Kurman, R.J., Mazur, M.T. (2019). Introduction. In: Diagnosis of Endometrial Biopsies and Curettings. Springer, Cham. https://doi.org/10.1007/978-3-319-98608-1_1

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  • DOI: https://doi.org/10.1007/978-3-319-98608-1_1

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-98607-4

  • Online ISBN: 978-3-319-98608-1

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