Results of endo biopsy11/8/2023 ![]() Most individuals with simple hyperplasia without any atypia can be managed with hormonal manipulation (medroxyprogesterone, 10 mg daily for five days to three months) or with close follow-up. Persistent vaginal bleeding should warrant further diagnostic work-up.Ĭystic or simple hyperplasia progresses to cancer in less than 5 percent of patients. Hormonal therapy may be considered for patients with atrophic endometrium. Excess blood and povidone-iodine solution are wiped from the vagina, and the vaginal speculum is removed.Ītrophic endometrium generally yields scant or insufficient tissue for diagnosis. Pressure can be applied with cotton swabs if the tenaculum sites bleed following removal of the tenaculum. If a second pass is to be made, the catheter should not be contaminated when being emptied of the first specimen. Some physicians prefer to make a second pass into the uterus with the catheter to optimize tissue sampling. To remove the sample from the endometrial catheter, the piston can be gently reinserted, forcing the tissue out of the catheter tip. Once the catheter fills with tissue, it is withdrawn, and the sample is placed in the formalin container. Make at least four up and down excursions to ensure that adequate tissue is in the catheter. Use a 360-degree twisting motion to move the catheter between the uterine fundus and the internal cervical os ( Figure 1). The catheter tip is moved with an in-and-out motion, but the tip does not exit the endometrial cavity through the cervix, which maintains the vacuum effect. Once the catheter is in the uterine cavity, the internal piston on the catheter is fully withdrawn, creating suction at the catheter tip. The catheter tip is then inserted into the uterine fundus or until resistance is felt. The endometrial biopsy catheter tip is inserted into the cervix, avoiding contamination from the nearby tissues. The distance from the fundus to the external cervical os can be measured by the gradations on the uterine sound and generally will be 6 to 8 cm. The smallest size is inserted, followed by insertion of successively larger dilators until the sound passes easily to the fundus. If the uterine sound will not pass through the internal os, consider placement of small Pratt uterine dilators. Occasionally, steady, moderate pressure is required to insert the sound through the closed internal cervical os. Attempt to insert the uterine sound to the fundus. Pull outward on the tenaculum gently, straightening the uterocervical angle to reduce the chance of posterior perforation. The author prefers placement of the tenaculum in most cases, for increased safety, and grasps the anterior lip of the cervix with the tenaculum teeth in the horizontal plane. The tenaculum is placed on the anterior lip of the cervix, grabbing enough tissue that the cervix will not lacerate when traction is applied. The cervix often is too mobile to allow for passage of the sound but can be stabilized with the tenaculum. The cervix is gently probed with the uterine sound. The nurse can then spray the cervix with the 20 percent benzocaine spray for 5 seconds, avoiding contamination of the sterile speculum with the extended spray nozzle. The gloves can be washed with povidone-iodine solution if contaminated. The cervix is centered in the speculum and cleansed with povidone-iodine solution. The physician should minimize contact of the sterile gloves with the nonsterile vulvar tissues. Once the cervix is centered in the speculum, the cervix can be anesthetized by spraying 20 percent benzocaine spray for 5 seconds and then cleansing it with povidone-iodine solution.Īlternately, the physician can apply sterile gloves, and insert the sterile speculum into the patient's vagina. Avoid contaminating the sterile instruments on the tray. Still wearing the nonsterile gloves, the physician can pick up the sterile speculum from the sterile tray and place it in the patient's vagina. The patient is placed in the lithotomy position and bimanual examination is performed (with nonsterile gloves) to determine the uterine size and position, and whether marked uterocervical angulation exists. ![]()
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