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Subject: Endometrial Biopsy
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Unimar PIPELLE (Pipelle de Cornier), which can be ordered from CooperSurgical, Inc., Shelton, CT. Phone: 1-800-243-2974. Web site: http://www.coopersurgical.com/.
Wallach Endocell Endometrial Cell Sampler (20-piece box), which can be ordered from Wallach Surgical Devices, Inc., 235 Edison Road, Orange, CT 06477. Phone: 203-799-2000; fax: 203-799-2002. E-mail: firstname.lastname@example.org. http://email@example.com/.
Examination for abnormal uterine bleeding (to rule out endometrial hyperplasia or cancer)
Workup for atypical glandular endometrial cells seen on the Papanicolaou (Pap) smear
Monitor unopposed estrogen therapy for the development of hyperplasia
Pregnancy or suspected pregnancy
Acute pelvic inflammatory disease
Acute cervical or vaginal infections
Uncooperative patient (relative contraindication)
Clotting disorders (coagulopathy)
Morbid obesity (relative)
Severe pelvic relaxation with uterine descensus (relative)
Severe cervical stenosis (relative)
PITFALL: Check for masses or structural abnormalities, cervical stenosis, or signs of infection that may make the procedure more difficult or impossible.
PITFALL: When inserting a sound, apply firm, steady forward pressure to pass through the tightly closed internal os of the upper cervix. Be prepared to immediately pull back after the internal os is penetrated, or the tip of the sound can be thrust forward against the upper uterus and perforate the opposing wall. Perforations also can occur through the thin lower uterine segment. Placement of a tenaculum in difficult cases and straightening of the uterocervical angle can help reduce perforation after the sound passes through the internal os.
PITFALL: If strong resistance is encountered, consider repeat sounding the uterus. If still unable to enter the endometrial cavity with the EMB catheter, abort the procedure. Forcing the catheter may result in uterine perforation.
PITFALL: If the catheter bends excessively, apply a small amount of torque to the catheter. This causes it to flex less.
PITFALL: Do not allow the hole in the tip to emerge from the cervix, or all of the suction will be lost.
PITFALL: Do not force the tissue out of the sampling hole without cutting the tip off because this may distort the histologic sample.
Pain (especially cramping)
Atrophic endometrium: Hormonal therapy may be considered for patients with atrophic endometrium. Persistent vaginal bleeding should warrant further diagnostic workup.
Cystic or simple hyperplasia: Progresses to cancer in fewer than 5% of patients. Most individuals with simple hyperplasia without atypia can be managed with medroxyprogesterone (Provera), 10 mg daily for 5 days to 3 months, or with close followup.
Atypical hyperplasia: Considered a premalignant lesion that can progress to cancer in 30% to 45% of women. A dilation and curettage (D&C) procedure to exclude the presence of endometrial carcinoma is recommended.
Endometrial carcinoma: Consider referral to a gynecologic oncologist for definitive surgical therapy.