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Hysteroscopy biopsy (review) - JS Afonso | hysteroscopy | histeroscopia

Hysteroscopy biopsy (review) - JS Afonso

This link was last updated on October 01, 2000 and review on July 20, 2005.

This article should be cited as:

Afonso JS. Hyteroscopy biopsy (review). In: http://www.histeroscopia.med.br/. Access in:

keywords: hysteroscopy, biopsy.

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The morphological patterns in the light of hysteroscopy, of the endometrial pathologies  have been very well defined by Prof. Jacques E. Hamou. This study used to be carried out through direct visualization usually magnified 20 times, and biopsy was carried out only in case of doubt. He has determined visual parameters to classify menstrual cycle phases (proliferation, ovulation, lutean and pre-menstrual), inflammatory processes, adherences, congenital alterations processes, benign tumors (polyps and myomas), hyperplasia (simple, polypoid, glandular, cystic,  adenomyosis with and without atypia) and adenocarcinoma (1). Currently, hyperplasias receive a different classification (simple and complex with or without atypia). Nowadays, as the method has spread, there seems to have appeared a large number of cases presenting a clear discrepancy between diagnostic hysteroscopy and hystologic study. As a result, a series of authors started recommending biopsy for every morphological alteration found during the mentioned examination.(2) Prof. Ramón Labastida mentions the subtleties of morphological alterations in the endometrial adenocarcinoma  with no relation with hyperplasia and recommends endometrial biopsy to confirm visual diagnosis. (3) Recent studies show the similar sensitivity between hysteroscopy with biopsy and dilation and curettage. (4) Prof. Larry J. Copeland recommends outpatient biopsy (Novak or Randall), when carried out properly, with a sensitivity similar to that of dilation and curettage. (5)

There are not enough comparative scientific studies between hysteroscopic biopsy under constant visualization (direct) and biopsy with suction curette in an area  previously determined by diagnosis hysteroscopy (oriented), to determe whether there is a significant difference of accuracy in the methods for the diagnosis of pathologic alterations of the endometrium. How easy a technical method is should not be discussed once the oriented technique has proved to be the easiest of them all.

Studies should be divided into two groups:

1)    Cases where only one type of focal pathology associated with an  area of difficult access, for example, polyp of the endometrium superposing a focal endometrium hyperplasia.

2)      Cases where the cervical of the endometrium adenocarcinoma  is affected.

The routine would be simple: hysteroscopic biopsy under  constant visualization (direct) followed by a new biopsy carried out with a suction curette (Novak or Randall). In the cases where hysterectomy is indicated, data would be added (gold standard). All that is left to be done is to standardise the diameters of the instruments used. As for group 1, since we thought it would be difficult for only one author to collect a number of cases enough to show any significance, we believe an interesting proposal  would be to carry out these studies in different centres. The result of the cases, no matter if the contribution is of only one case, would be added to the others thus fulfilling our aim.

We are looking forward to the acceptance of this proposal for our study to go ahead. 

References

(1) Hamou, Jacques E.. Hysteroscopy and Microcolpohysteroscopy: Text and Atlas. Conn., USA: Appleton Lange, 1991

(2) Mencaglia L.. Hysteroscopy and adenocarcinoma. Obstet Gynecol Clin North Am 1995 Sep;22(3):573-9

(3) Gordon, Alan G., Lewis, B. Victor, Decherney, Alan H.. Atlas Colorido de Endoscopia Ginecológica.  Rio de Janeiro: Livraria e Editora Revinter Ltda., 1997.

(4) Ben-Yehuda O.M., Kim Y.B., Leuchter R.S.. Does hysteroscopy improve upon the sensitivity of dilatation  and curettage in the diagnosis of endometrial hyperplasia or carcinoma? Gynecol Oncol; 68(1):4-7 1998 UI: 98123053

(5) Copeland, Larry J..Tratado de Ginecologia. Rio de Janeiro: Guanabara Koogan S.A., 1996.