Uterine biopsy is needed for differential diagnosis of abnormal uterine bleeding. Uterus has a inner lining called endometrium. In thick uterine lining and heavy bleeding cases, the underlying pathology can be endometrial cancer or hyperplasia (precursor of endometrium cancer). Endometrial biopsy is needed for an exclusion of endometrium cancer. Endometrial cancer is a type of uterine cancer that involves the lining of the uterus (the endometrium). In the presence of clinical suspicion or risk factors, performing uterine biopsy would be safe for you since early diagnosis can save life in many diseases
Therefore even if you don’t have any complaints having your routine gynelogical examination has great importance in terms of having your endometrial thickness checked on a regular basis. Uterine lining is evaluated and measured with a transvaginal ultrasound. For instance postmenopausal women normally have a thin endometrial lining. If the lining is thicker than 4 or 5 mm, additional evaluation with an endometrial biopsy may be appropriate. Ultrasound cannot distinguish between different types of abnormalities (eg, polyp versus cancer) and further testing may be necessary. It should also be noted that thick endometrium is not always indicative of endometrium cancer. In the existence of thick endometrium proliferative endometrium is surely one of the differential diagnosis.
Proliferative endometrium is a very common non-cancerous change that develops in the tissue lining the inside of the uterus. It is a normal finding in women of reproductive age. Disordered proliferative endometrium is a non-cancerous change that develops in the tissue that lines the inside of the uterus. This diagnosis means that after examining your tissue sample under the microscope, your pathologist saw irregular and dilated endometrial glands in the proliferative phase (growing phase). Disordered proliferative endometrium is a descriptive diagnosis that needs to be considered together with your medical history, physical examination, and any other tests that were performed (blood tests, transvaginal ultrasoun scan etc.).
We will use all of this information in order to determine the final diagnosis and reason for this condition. Another finding may be secretory endometrium which is a non-cancerous change seen in the tissue that lines the inside of the uterus. It is also a normal finding in women of reproductive age. The secretory endometrium produces substances necessary to support the implantation of an egg should conception occur. After ovulation, the endometrium grows under the influence of progesterone. During this phase, the endometrial glands become long and twisted, and the secretion starts. This phase is called the secretory endometrium. These changes occur during the fertile age, which for most women starts at early teens, and lasts until the age of 45-55.
Endometrium Biopsy
For endometrial biopsy, we will take a sample of tissue from inside your uterus. The sample can be viewed under a microscope to look for problems and the differential diagnosis of disordered proliferative, secretory endometrium, hyperplasia and cancer. An endometrial biopsy is often performed in women age 45 or older to rule out abnormal endometrial growths in addition to endometrial cancer. Endometrial biopsy may also be performed in women younger than 45 years if they have risk factors for endometrial cancer or are felt to be at increased risk for an infection of the endometrium.
Risks for endometrial cancer include obesity, chronic anovulation (late periods due to delay in egg release), history of breast cancer, tamoxifen use or a family history of breast cancer or colon cancer. During the biopsy, a thin instrument (a small plastic canula)is inserted through the vagina and cervix into the uterus to obtain a small sample of endometrial tissue. Concomittantly, any fluid or blood trapped in the cavity can be drained out. The biopsy (which often causes temporary severe uterine cramping) can be performed in a office setting without anesthesia. Because only a small portion of the endometrium is sampled, the biopsy may miss some causes of bleeding and other tests are sometimes necessary.
Endometrial tissue is evaluated histopathologically by a biopsy. The endometrial cells, obtained by biopsy, are examined under microscope for diagnosis. Endometrial biopsy is a simple procedure performed in office setting. Endometrial biopsy is performed with a small plastic canula.
Hysteroscopy and endometrial biopsy can be performed simultaneously. Hysteroscopy in accordance with endometrial biopsy will be useful for the diagnosis of uterine bleeding.
