WordNet

examination of tissues or liquids from the living body to determine the existence or cause of a disease
of or relating to the endometrium

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/02/11 19:37:27」(JST)

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The endometrial biopsy is a medical procedure that involves taking a tissue sample of the lining of the uterus. The tissue subsequently undergoes a histologic evaluation which aids the physician in forming a diagnosis.

Medical uses

There are a number of indications for obtaining an endometrial biopsy in a non-pregnant woman:

Women with chronic anovulation such as the polycystic ovary syndrome are at increased risk for endometrial problems and an endometrial biopsy may be useful to assess their lining specifically to rule out endometrial hyperplasia or cancer.
In women with abnormal vaginal bleeding the biopsy may indicate the presence of abnormal lining such as endometrial hyperplasia or cancer.
In patients with suspected uterine cancer, the biopsy may discover the presence of cancer cells in the endometrium or cervix.
In female infertility the assessment of the lining can determine, if properly timed, that the patient ovulated, however, the same information can be obtained by a blood test of the progesterone level.

Transvaginal ultrasonography is generally done before obtaining an endometrial biopsy as it may help in the gynecologic diagnosis, or even make the taking of a biospy superfluous if the lining is thin. If the endometrial lining is less than 5 mm thick on sonography, it is highly unusual to encounter endometrial cancer.^[1]

The test is usually done in women over age 35.^[2] A more thorough histologic evaluation can be obtained by a dilatation and curettage, which requires anesthesia.

Contraindications

The procedure is contraindicated in pregnancy.^[1] Therefore, women in the reproductive years may need a pregnancy test before a biopsy is taken to assure that the test is not done during a pregnancy. Other contraindications are pelvic inflammatory disease and coagulopathies.^[1]

An endometrial biopsy usually cannot be done as an office procedure in children, young women, women with vaginismus, or women with cervical stenosis. If necessary, an examination under anesthesia could be performed at which time a biopsy could be taken.

Risks

While procedure is generally considered safe, cramps or pelvic pain is a common if short-lived side effect. After the procedure, the patient may experience some bleeding. A uterine perforation or an infection are rare complications.^[2]

Pain

Endometrial biopsy pain ^[3] is quite common. The reason that doctors spray the lidocain is to help to deal with some of the pain from the procedure. The lidocain spray can burn when it is sprayed into the area. The clamp that is put onto the cervix may be another cause of pain and the procedure itself, where the doctor has to procure a piece of the lining with the tube can be painful. Most of the time, this will only be required once, but sometimes the procedure can entain two or three instances of procuring a piece of the endometrium.

Procedure

Generally, an endometrial biopsy follows this process:

The patient is asked to lie on the table with her feet in the stirrups for a pelvic examination. She may or may not be given localized anesthesia.
A speculum will be inserted into the vagina to spread the walls of the vagina apart to expose the cervix.The cervix will then be cleansed with an antiseptic solution.
A tenaculum, a type of forceps, will hold the cervix steady for the biopsy.
The biopsy curette will be inserted into the uterine fundus and with a scraping and rotating motion some tissue will be removed.
The removed tissue will be placed in formalin or equivalent for preservation.
The tissue will be sent to a laboratory, where it will be processed and tested. It will then be read microscopically by a pathologist who will provide a histologic diagnosis.^[4]

Both the application of the tenaculum as well as the removal of tissue by the biopsy may cause pain. Patients, in general, may want to take some pain medication (such as ibuprofen) before the procedure and inquire about local anesthesia.

Instruments

A number of biopsy instruments are in use. The Novak curette is a thin metallic tube with a side opening at the tip; suction with attached syringe can be applied to help to remove tissue. The Pipelle is a more flexible plastic tube with a side opening at the tip. A smaller tube (internal piston) inside the Pipelle is withdrawn to create suction. Meanwhile, the pipelle is rotated and moved outwards from the fundus to the internal os to collect small pieces of endometrial tissue.^[5]

Recently, the TruTest has been introduced as an alternative method of endometrial biopsy. Rather than using a suction tube, this method uses the Tao Brush to gently brush the lining of the uterus. Generally, this method has been found to be less painful than the traditional suction method.^{[citation needed]}

References

^ ^a ^b ^c Christiane Kuntz (January 2007). "Endometrial biopsy". Can Fam Physician 53 (1): 43–44. PMC 1952554. PMID 17872607. Retrieved March 11, 2010.
^ ^a ^b "Endometrial biopsy". The New York Times. Retrieved March 11, 2010.
^ "Endometrial biopsy pain". Endometrial Biopsy. Retrieved June 4, 2011.
^ [1] St. Joseph’s Mercy Health Center – Diagnostic and Surgical Tests and Procedures – Endometrial Biopsy (accessed 7-10-07)
^ Endometrial Biopsy, A Review of Sampling Techniques, Product bulletin from CooperSurgical, the producer of Pipelle. April 2012.

External links

[2]: Truth about Endometrial Biopsy Procedure Pain

UpToDate Contents

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1. 子宮内膜サンプリング手順 endometrial sampling procedures
2. 悪性または前癌疾患に関する子宮内膜の評価 evaluation of the endometrium for malignant or premalignant disease
3. 妊娠していない生殖可能年齢の女性における不正子宮出血に対するアプローチ approach to abnormal uterine bleeding in nonpregnant reproductive age women
4. 子宮内膜増殖症の分類および診断 classification and diagnosis of endometrial hyperplasia
5. 子宮内膜アブレーションの概要 an overview of endometrial ablation

English Journal

Transplantation of bone marrow mesenchymal stem cells on collagen scaffolds for the functional regeneration of injured rat uterus.

Ding L1, Li X2, Sun H3, Su J2, Lin N2, Péault B4, Song T2, Yang J5, Dai J6, Hu Y7.Author information 1Center for Reproductive Medicine, Department of Obstetrics and Gynecology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Rd., Nanjing 210008, China; Nanjing Center for Stem Cells and Biomaterials, The Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Rd., Nanjing 210008, China.2Department of Obstetrics and Gynecology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Rd., Nanjing 210008, China.3Center for Reproductive Medicine, Department of Obstetrics and Gynecology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Rd., Nanjing 210008, China.4Center for Regenerative Medicine, University of Edinburgh, Edinburgh, EH16 4UU, UK.5Department of Pathology, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School, 321 Zhongshan Rd. Nanjing 210008, China.6Nanjing Center for Stem Cells and Biomaterials, The Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Rd., Nanjing 210008, China; Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, 3 Nanyitiao, Zhongguancun, Beijing 100190, China. Electronic address: jwdai@genetics.ac.cn.7Center for Reproductive Medicine, Department of Obstetrics and Gynecology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Rd., Nanjing 210008, China; Nanjing Center for Stem Cells and Biomaterials, The Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Rd., Nanjing 210008, China; Department of Obstetrics and Gynecology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Rd., Nanjing 210008, China. Electronic address: yalihu@nju.edu.cn.AbstractSerious injuries of endometrium in women of reproductive age are often followed by uterine scar formation and a lack of functional endometrium predisposing to infertility or miscarriage. Bone marrow-derived mesenchymal stem cells (BM-MSCs) have shown great promise in clinical applications. In the present study, BM-MSCs loaded onto degradable collagen membranes were constructed. Collagen membranes provided 3-dimmensional architecture for the attachment, growth and migration of rat BM-MSCs and did not impair the expression of the stemness genes. We then investigated the effect of collagen/BM-MSCs constructs in the healing of severe uterine injury in rats (partial full thickness uterine excision). At four weeks after the transplantation of collagen/BM-MSCs constructs, BM-MSCs were mainly located to the basal membrane of regenerative endometrium. The wounded tissue adjacent to collagen/BM-MSCs constructs expressed higher level of bFGF, IGF-1, TGFβ1 and VEGF than the corresponding tissue in rats receiving collagen construct alone or in spontaneous regeneration group. Moreover, the collagen/BM-MSCs system increased proliferative abilities of uterine endometrial and muscular cells, facilitated microvasculature regeneration, and restored the ability of endometrium to receive the embryo and support its development to a viable stage. Our findings indicate that BM-MSCs may support uterine tissue regeneration.
Biomaterials.Biomaterials.2014 Jun;35(18):4888-900. doi: 10.1016/j.biomaterials.2014.02.046. Epub 2014 Mar 27.
Serious injuries of endometrium in women of reproductive age are often followed by uterine scar formation and a lack of functional endometrium predisposing to infertility or miscarriage. Bone marrow-derived mesenchymal stem cells (BM-MSCs) have shown great promise in clinical applications. In the pr
PMID 24680661

Ovarian steroid-dependent tumor necrosis factor-α production and its action on the equine endometrium in vitro.

Szóstek AZ1, Adamowski M2, Galvão AM3, Ferreira-Dias GM2, Skarzynski DJ4.Author information 1Department of Reproductive Immunology and Pathology, Institute of Animal Reproduction and Food Research, Olsztyn, Poland.2C.I.I.S.A., Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal.3Department of Reproductive Immunology and Pathology, Institute of Animal Reproduction and Food Research, Olsztyn, Poland; C.I.I.S.A., Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal.4Department of Reproductive Immunology and Pathology, Institute of Animal Reproduction and Food Research, Olsztyn, Poland. Electronic address: d.skarzynski@pan.olsztyn.pl.AbstractTumor necrosis factor-α (TNF) is a cytokine that plays important roles in functions of the endometrium. The aims of this study were to determine whether (i) ovarian steroids modulate TNF production by endometrial cells (Experiment 1); (ii) TNF effects on prostaglandin (PG) production in cultured equine endometrial cells and tissue (Experiment 2). Epithelial and stromal cells were isolated from equine endometrium (Days 2-5 of the estrous cycle; n=20) and treated after passage 1. In Experiment 1, epithelial and stromal cells were exposed to progesterone (P4; 10(-7)M), 17-β estradiol (E2; 10(-9)M) or P4+E2 (10(-7)/10(-9)M) for 24h. Then, TNF mRNA transcription was determined using Real-time PCR. Additionally, TNF protein production was investigated in response to ovarian steroids for 24h using Enzyme-Linked Immunosorbent Spot (EliSpot). In Experiment 2, epithelial and stromal cells and endometrial explants (mid-luteal phase of the estrous cycle; n=5) were exposed in vitro to TNF (10ng/ml) and to oxytocin (OT; positive control; 10(-7)M) for 24h. The concentrations of PGE2 and PGF2α were determined using a direct enzyme immunoassay (EIA) method. The transcription of prostaglandin-endoperoxide synthase-2 (PTGS-2), prostaglandin E2 synthase (PGES) and PGF2α synthase (PGFS) mRNAs in the endometrial explants was determined using Real-time PCR. Results showed that TNF is produced by two types of equine endometrial cells and its production is up-regulated by ovarian steroids (P<0.05) in stromal cells and by P4 (P<0.05) and E2 (P<0.01) in epithelial cells. Epithelial and stromal cells can also produce PG in response to TNF. In endometrial explants, TNF stimulated PGE2 production to a large extent and PGF2α secretion to a lesser extent. These actions are mediated by up-regulation of PG synthases mRNA transcription. The study indicates that TNF production is closely related to ovarian steroid actions and that the interaction between TNF and PG regulates physiologic processes in the equine endometrium.
Cytokine.Cytokine.2014 Jun;67(2):85-91. doi: 10.1016/j.cyto.2014.02.005. Epub 2014 Mar 15.
Tumor necrosis factor-α (TNF) is a cytokine that plays important roles in functions of the endometrium. The aims of this study were to determine whether (i) ovarian steroids modulate TNF production by endometrial cells (Experiment 1); (ii) TNF effects on prostaglandin (PG) production in cultured eq
PMID 24642167

Japanese Journal

症例子宮内膜細胞診と組織診に腺癌細胞集塊を認めた卵管癌の2例

産科と婦人科 83(1), 105-111, 2016-01
NAID 40020697336

当科における術前子宮体癌ⅠA期（FIGO 2008）相当に対する腹腔鏡下リンパ節郭清術の郭清範囲の縮小：傍大動脈リンパ節レベルから骨盤リンパ節レベルまでへ

日本産科婦人科内視鏡学会雑誌 31(1), 146-154, 2015
NAID 130005117767

腹腔鏡下子宮腟上部切断術・仙骨腟固定術後に子宮体癌が発覚した1例

日本産科婦人科内視鏡学会雑誌 31(1), 178-181, 2015
NAID 130005117751

Related Pictures

★リンクテーブル★

リンク元	「子宮内膜組織診」
関連記事	「endometrial」「endometria」

「子宮内膜組織診」

Endometrial biopsy
	Diagnostics
	Micrograph showing an endometrial biopsy with simple endometrial hyperplasia, where the gland-to-stroma ratio is preserved but the glands have an irregular shape and/or are dilated. H&E stain.
ICD-10-PCS	0UDB
ICD-9-CM	68.13, 68.16
MedlinePlus	003917
	[edit on Wikidata]

　　[★]

英: endometrial biopsy, endometrial histological diagnosis, endometrial histological examination, histological examination of the endometrium
関: 子宮内膜

「endometrial」

　　[★]

adj.

子宮内膜の

関: endometria、endometrium

「endometria」

　　[★]

子宮内膜

関: endometrial、endometrium

[cfp-1] Christiane Kuntz (January 2007). "Endometrial biopsy". Can Fam Physician 53 (1): 43–44. PMC 1952554. PMID 17872607. Retrieved March 11, 2010.

[nyt-2] "Endometrial biopsy". The New York Times. Retrieved March 11, 2010.

[org-3] "Endometrial biopsy pain". Endometrial Biopsy. Retrieved June 4, 2011.

[4] [1] St. Joseph’s Mercy Health Center – Diagnostic and Surgical Tests and Procedures – Endometrial Biopsy (accessed 7-10-07)

[5] Endometrial Biopsy, A Review of Sampling Techniques, Product bulletin from CooperSurgical, the producer of Pipelle. April 2012.

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endometrial biopsy