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Indications Abnormal uterine bleeding: postmenopausal bleeding, malignancy/hyperplasia Monitoring adjuvant hormonal treatment (tamoxifen) Endometrial dating Presence of endometrial cell in PAP smear in women 40 years of age Abnormal Pap smear with atypical cells favoring endometrial origin (AGUS) Follow-up of previously diagnosed endometrial hyperplasia Cancer screening (e.g.
Nonsterile gloves Lubricating jelly Absorbent pad to place beneath the patient on the examination table Formalin container (for endometrial sample) with the patient's name and the date recorded on the label20 percent benzocaine (Hurricaine) spray with the extended application nozzle Place the following items on a sterile drape covering the Mayo stand with the following items placed on top: Sterile gloves Sterile vaginal speculum Uterine sound Sterile metal basin containing sterile cotton balls soaked in povidone-iodine solution Endometrial suction catheter Cervical tenaculum Ring forceps (for wiping the cervix with the cotton balls)Sterile 4 × 4 gauze (to wipe off gloves or equipment)Sterile scissors (if the physician chooses to cut off the catheter tip to deliver the endometrial sample into the formalin container)Keep sterile cervical dilators available, but do not open the sterile packaging unless the dilators are needed.
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.
Endometrial biopsy is a fairly easy technique to learn.
Physicians are often comfortable performing the procedure unassisted after two to five precepted procedures.
Physicians who perform other gynecologic procedures find that endometrial biopsy is a natural addition to their practice.