RCPA – Endometrial curettings and biopsies

Dictation Template

Background

A range of fragmented endometrial specimens are received in the laboratory; diagnostic curettings and biopsies, products of conception from simple incomplete or complete abortions and post-partum retained products.^1,2

This protocol includes endometrial curettings and biopsies. A separate protocol is provided for products of conception.

Record the patient identifying information and any clinical information supplied together with the specimen description as designated on the container. See overview page for more detail on identification principles.

• No
  • Non-routine fixation (not formalin), describe.

• Yes
  • Special studies required, describe.
  • Ensure samples are taken prior to fixation.

Large specimens should be strained through a sieve to ensure all tissue is collected.

See general information for more detail on specimen handling procedures.

Inspect the specimen and dictate a macroscopic description.

External Inspection

Describe the following features of the specimen:

Procedure

Describe as stated by the clinician.

• Endometrial curettings
• Endometrial biopsy
• Pipelle
• Other, specify

Specimen volume

¹

• Measure aggregate size in three dimensions (mm)

Biopsy with minimal fragments and/or polyp

• Number of pieces submitted
• Maximum dimension (mm) each fragment
• If intact polyp(s) are present, measure each in three dimensions (mm)

Specimen description, if relevant

• Colour
• Texture

Dissection

Dissection in not required in most circumstances. Large polyps may be bisected longitudinally if required.

Internal Inspection

Not required.

Processing

Submit all tissue, transferring directly into cassettes for processing. Lens paper, biopsy pads or similar are required to prevent loss of tissue during processing.

Check the pot carefully, particularly the lid and around the rim so that all fragments of tissue are found.

Be aware that blood clot and mucus may not survive processing.

Very small specimens may be more successfully processed by centrifugation and cell block preparation.

Record details of each cassette.

An illustrated block key similar to the one provided may be useful.

Block allocation key

Acknowledgements

Drs Kerryn Ireland-Jenkin and Marsali Newman for their contribution in reviewing and editing this protocol.

References

1. Brown L, Andrew A, Hirschowitz L and Millan D. Tissue pathways for gynaecological pathology, The Royal College of Pathologists, London, 2008.

2. Heatley MK. Dissection and reporting of the organs of the female genital tract. J Clin Pathol 2008;61(3):241-257.

Dictation Template

Endometrial curettings

Endometrial curettings for processing

Endometrial curettage in abnormal uterine bleeding and efficacy of progestins for control in cases of hyperplasia

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. 2014;15(8):3737-40.

doi: 10.7314/apjcp.2014.15.8.3737.

Simender Mesci-Haftaci 
¹
, Handan Ankarali, Ali Yavuzcan, Mete Caglar

Affiliations

Affiliation

• ¹ Department of Obstetrics and Gynecology, Duzce Public Hospital, Duzce, Turkey E-mail : [email protected].

• PMID:

  24870785

• DOI:

  10.7314/apjcp.2014.15.8.3737

Free article

Simender Mesci-Haftaci et al.

Asian Pac J Cancer Prev.

2014.

Free article

. 2014;15(8):3737-40.

doi: 10.7314/apjcp.2014.15.8.3737.

Authors

Simender Mesci-Haftaci 
¹
, Handan Ankarali, Ali Yavuzcan, Mete Caglar

Affiliation

• ¹ Department of Obstetrics and Gynecology, Duzce Public Hospital, Duzce, Turkey E-mail : [email protected].

• PMID:

  24870785

• DOI:

  10.7314/apjcp.2014.15.8.3737

Abstract

Background:

Abnormal uterine bleeding (AUB) is the most important symptom of endometrial hyperplasia and endometrial curettage (EC) is the gold standard diagnostic procedure. We present the results of patients who underwent EC for AUB and the efficacy of progestin administration in those with endometrial hyperplasia.

Materials and methods:

A total of 415 female patients who presented to Duzce Public Hospital in 2011-2012 for AUB and who underwent EC were included. We determined the reasons for AUB, and females with hyperplasia were treated with 10 mg/day medroxyprogesterone acetate for 14 days/month or 160 mg/day megestrol acetate continuously for 3 months. We evaluated the efficacy of progestins for periods of three and/or six cycles by repeating EC. A statistical analysis of specific endometrial causes according to age of presentation was conducted using the chi-square test.

Results:

Among the 415 females (average age, 53.5 years) followed for 6 months, 186 had physiological changes (44.8%), 89 had simple hyperplasia (21. 44%), 1 had atypical hyperplasia (0.2%), 6 had (1.44%) complex hyperplasia, 3 had (0.72%) atypical complex hyperplasia, and 5 had adenocarcinoma (1.2%). Regression rates were 72.7-100%, and the optimum results were observed after 6 months of hormonal therapy.

Conclusions:

The main cause of AUB was physiological change. Progestin therapy resulted in significant regression even in females with atypical hyperplasia.

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Curettage of the walls of the uterine cavity

Curettage in gynecology – a type of surgical intervention aimed at removing the endometrial layer (uterine cavity tissues) for therapeutic or diagnostic purposes. As a rule, the procedure is carried out under anesthesia. In modern medicine, hysteroscopes are increasingly used for curettage.

Indications

Endometrial scraping procedure is performed for a number of indications. As a therapeutic technique, it is performed when:

• appearance of polyps and other neoplasms on the uterine mucosa
• endometrial hyperplasia (that is, its excessive thickening)
• uterine bleeding
• endometritis
• incomplete abortions (to remove the remnants of the placenta and other tissues)
• synechiae (endometrial wall adhesions)

Curettage is also a popular screening method (obtaining material for histological studies) and monitoring the state of the female reproductive system, for example, assessing the success of hormone therapy. Diagnostic procedure can be prescribed:

• for clarification of information obtained during ultrasound
• for menstrual disorders (heavy menstruation, etc. )
• before planned “female” surgeries

Specifics of curettage

To minimize the risk of complications and speed up the recovery process, curettage of the walls of the uterus in the Viva clinic is most often performed using a hysteroscope – a special equipment that provides visual control of the procedure on the monitor.

Prior to surgery, the patient undergoes a traditional examination:

• visits a gynecologist
• gives smears and tests of blood, urine
• undergoing ultrasound

Paracervical anesthesia or intravenous anesthesia is used as anesthesia during the procedure. Scraping itself requires a minimum of time. In most cases, the intervention refers to one-day operations, that is, the patient can go home the same day and lead a normal life.

Recovery after surgery

For the first time after the procedure, there may be slight pain in the lower abdomen and spotting.

Doctors of the Viva clinic give recommendations on recovery to patients on an individual basis. The general set of rules includes abstinence for 2-4 weeks after curettage from:

• sexual intercourse
• swimming in pools and open water
• sauna or bath visits
• active physical activity

In addition, medication may be prescribed to eliminate inflammation.

Gynecologists

Departments where the procedure is performed

• Clinic at Vinogradarepr. V. Porika, 9a
• Clinic on Podoleul. Shchekavitskaya, 36
• Clinic on Troyeshchineul. Lavrukhina, 6
• Clinic on Lybidskaya st. Antonovich, 155
• Clinic on Shulyavskaya st. Vadim Hetman, 1-in
• Clinic on Borshchagovkeul. Yakuba Kolas, 2-d
• Clinic on Troyeshchineul. Honoré de Balzac, 85a

Still have questions?

Hysteroscopy – curettage of the uterine cavity in Moscow

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Diagnostic curettage with hysteroscopy

Separate curettage of the uterine cavity and cervical canal with subsequent sampling of mucous fragments for analysis is a traditional and highly accurate method for diagnosing endometrial pathologies. However, it has disadvantages – insufficient accuracy due to blind manipulation and the risk of complications for the same reason. If separate diagnostic curettage is supplemented with hysteroscopy, the accuracy of the procedure and its safety for the patient increase significantly.

all services

Cost

Primary appointment with an obstetrician-gynecologist

3,700 ₽

Indications for use

infertility;

irregular menstruation;

miscarriage;

uterine bleeding;

miscarriages;

suspected endometrial tissue tuberculosis;

the need to remove polyps;

myoma;

endometrial hyperplasia;

endometriosis.

Cost

Primary appointment with obstetrician-gynecologist

3 700 ₽

Today, hysteroscopy with separate diagnostic curettage (abbreviated as WFD) has been introduced in the leading reproductive centers of Europe as an informative and safe way to find out the causes of female infertility and miscarriage. The technique is widely used for the diagnosis and treatment of various diseases of the uterus. According to recent studies, this operation can increase the success rate of in vitro fertilization, and sometimes – physiological conception.

More about therapeutic and diagnostic curettage with hysteroscopy

Cleaning the uterine cavity is a method that has long been introduced into medical practice. It consists in the following: the doctor removes the upper functional layer of the uterine mucosa with special tools, then the scraped material is examined. If there are indications, RFE can also be carried out for therapeutic purposes – for example, to remove pathological formations of the uterine mucosa.

For a long time, doctors performed the manipulation “blindly”, without visual control. This increased the risk of complications and made diagnosis difficult. The problem was solved by combining diagnostic cleaning with hysteroscopy – examining an organ using a hysteroscope that displays a picture on a monitor. The procedure involves inserting an optical device directly into the uterine cavity. The new approach gave doctors the ability to visually control their actions.

In the Life Line Reproduction Center, the method is used both for diagnostics – the material obtained during curettage is examined using a biopsy, and for therapeutic purposes – surgical removal of polyps, separation of intrauterine adhesions, etc.

Where to do curettage of the uterus with hysteroscopy in Moscow?

Separate diagnostic curettage hysteroscopy is a high-tech surgical procedure. Its introduction into the practice of a medical institution is associated with stringent requirements for the qualifications of specialists, conditions in the operating unit, and equipment. In the clinic “Line of Life” manipulation is carried out according to international standards. This explains the high accuracy of diagnosis and therapeutic efficacy of curettage.

• We perform gynecological cleaning with visual control using modern diagnostic and endoscopic equipment.
• Highly qualified gynecologists with extensive experience and special training specifically in this area are engaged in the “Line of Life” RVD.
• A modern operating unit is assigned for the operation, after which we transfer the patient to a comfortable rest room under the supervision of doctors.

Indications for hysteroscopy with WFD:

• infertility;
• menstrual irregularities;
• miscarriage;
• uterine bleeding;
• miscarriages;
• suspected endometrial tissue tuberculosis;
• the need to remove polyps;
• myoma;
• endometrial hyperplasia;
• endometriosis.

Contraindications:

• malformations of the genital organs;
• acute inflammatory diseases of the reproductive organs;
• diseases of the heart, liver and kidneys in the acute stage.

Stages of diagnostic curettage under hysteroscopy control

In Liniya Zhizni clinics, the cleaning procedure using a hysteroscope is carried out in several stages.

1. Preparation

Preparation for the intervention consists in a thorough examination of the patient. It includes:

• visual examination by a gynecologist;
• hemostasiogram;
• biochemical and clinical blood tests;
• determination of the Rh factor;
• tests for hepatitis, HIV, syphilis;
• cervical cytology;
• cervical and vaginal swab;
• electrocardiography;
• fluorography.

In addition, for the EFD, a standard conclusion of the therapist is required that there are no contraindications for surgical intervention under anesthesia. Patients are not allowed to eat for 12 hours before surgery.

2. WFD with hysteroscopy

Surgical intervention lasts about 30 minutes. First, the gynecologist inserts a hysteroscope into the uterine cavity – a device in the form of a thin tube with a camera at the end. The optical system allows the doctor to examine the walls of the uterine cavity and identify pathological formations, if any. To improve visibility, a sterile fluid is sent into the uterine cavity, stretching the walls of the organ. Then, gradually expanding the cervix, the specialist introduces a scraping instrument (curette) into the cervical canal. The doctor places the fragments of the endometrium in a separate container and sends it for histology. If necessary, polyps and other pathological formations are removed.

3. Recovery of the patient after diagnostic cleaning

A correctly performed procedure rarely causes complications. The vast majority of our patients tolerate it well. The first 2-3 hours after the operation, constant medical supervision is necessary, the woman spends this time in the ward. For 3-10 days after the intervention, spotting spotting is noted. Sometimes they are accompanied by discomfort and heaviness in the lower abdomen. 2 weeks postoperative period, we recommend to refrain from sexual activity and the use of tampons.

To minimize the risks of surgery, it is important to choose the right doctor. Behind the shoulders of the gynecologists of the clinic “Line of Life” is a great experience in carrying out medical and diagnostic curettage with hysteroscopy. For them, this is a routine manipulation, doctors act confidently and accurately. The health of our patients is always our top priority. The price of RDD with hysteroscopy at the Life Line Reproduction Center is lower than in most private medical clinics in Moscow. A preliminary appointment with a specialist is not included in the cost of a comprehensive medical and diagnostic curettage.

To make an appointment with the Line of Life gynecologist, please contact us by phone or leave a request in a special form on the website.

You may also like the procedure

Cervical biopsy

Minimally invasive surgical intervention, which consists in cutting or pinching off a tissue fragment, the material obtained as a result of the procedure is sent for examination.

Diagnosis and treatment of obstruction of the fallopian tubes

Fallopian tubes are a very important part of the female reproductive system. When the path through them is blocked, there are difficulties with conception, the risks of ectopic pregnancy increase. A fallopian tube patency test is performed when it is necessary to identify the cause of infertility. If an obstruction is diagnosed, doctors have ways to deal with the problem.

IVF programs

IVF is used to overcome infertility. The essence of the method is the fertilization of the egg outside the female body. The reproductologist transfers the embryo obtained in the laboratory into the patient’s uterine cavity to achieve pregnancy.