Dating the endometrial biopsy noyes speed dating barcelona
To ensure a maximum amount of tissue for morphological reading, the specimen should be placed on a piece of lens paper or some other adhesive tissue and then immersed in the fixative.
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 contrast, secretory-phase endometrium often demonstrates subtle changes and, in many cases, combinations of morphologic changes, resulting in most instances in errors of 4–5 days.
The pathologist can improve this to 2–3 days, however, by acquiring expertise in endometrial dating (all cases of normal endometria are to be dated regardless of reasons for sampling), and by basing the dating on those endometrial morphologic alterations that represent the most advanced phase of the menstrual cycle.
Also, during the period of bleeding, both the external os and the isthmus (lower uterine segment) are widened, facilitating penetration of the biopsy forceps into the endometrial cavity.
The final argument in favor of taking samples at the onset of bleeding is that endometrium of the first 2 days of menstruation is relatively easy to recognize histologically.
Steroid hormone control of endometrial, epithelial, stromal, and presumably endothelial cells is mediated by estrogen receptors and progesterone receptors. They have high affinity to bind estradiol and progesterone, respectively.
If the repeat aspiration still yields little tissue, one can assume severe endometrial atrophy or obstructing endometrial polyp.
Method To ensure a good specimen for morphologic interpretation, a biopsy sample should be taken from both the anterior and the posterior endometrium and fixed immediately in 10% buffered formalin.
In current practice, the device that is most often used is the Pipelle endometrial aspirator.
Also, because proliferation precedes the ovulatory period, dating proliferative endometrium gives the clinician no relevant information on whether ovulation is occurring.
The daily changes in the endometrium during the postovulatory period were, in the past, considered significant enough from one day to another to provide accurate evaluation of the endometrial cycle.
The major morphologic criteria useful for dating the endometrium throughout the cycle are presented in Fig. In routine dating, the pathologist should avoid bias by evaluating the histologic section before reading the clinical information.