Endometrial dating pathology
Endometrial biopsy is useful in the work-up of abnormal uterine bleeding, cancer screening, endometrial dating and infertility evaluation.Contraindications to the procedure include pregnancy, acute pelvic inflammatory disease, and acute cervical or vaginal infections.The continued use of the endometrial biopsy for the diagnosis of luteal phase defects (LPDs) and in the general evaluation of the infertile couple is based largely on tradition, the absence of a clearly superior diagnostic modality, the absence of studies that have either validated or repudiated its efficacy with certainty, its ability to assess the endometrial response irrespective of endogenous progesterone levels, its ability to monitor the endometrial response to hormonal therapy in fertility treatments, and, finally, its ability to exclude other intrinsic endometrial anomalies that may be detrimental to the implantation of the conceptus, such as chronic endometritis or neoplasia.However, the intra- and interobserver variability inherent in dating the product of the endometrial biopsy-the endometrium-has led to the current situation, in which, in approximately 20% of cases, variability attributed to the pathologist alone is determinant of whether a given biopsy in “in phase” or out of phase (ie, an assigned postovulatory date that is at least 2 days behind the chronologic date).2).(Bergeron C, Ferenczy A, Shyamala G: Distribution of estrogen receptors in various cell types of normal, hyperplastic and neoplastic human endometrial tissues. Copyright by US and Canadian Academy of Pathology)This chapter contains a review of the technical procedures for handling endometrial tissues and a discussion of the morphologic aspects of the endometrium, focusing on the interpretation and understanding of the physiomorphology of the endometrial cycle.
Twirling the catheter while moving it in and out of the uterine cavity enhances uptake of uterine tissue, which is aspirated into the catheter and removed.Thus, studies that clearly delineate which histologic parameters serve as the greatest source of disagreement for pathologists provide a valuable framework for further refinement of the criteria for endometrial dating.Meanwhile, continued use of the criteria of Noyes et al for endometrial dating is recommended until more precise modalities for assessing the adequacy of endometrial maturation are available.Our Pathologists will discuss and review your case by phone or secure e-mail to provide you with the fastest turn-around time and reduce distress to patients and family members anxious for an answer.CPS Pathologists will always contact you immediately to report unusual and/or unexpected results.