The glandular epithelium of a polyp is often dyssynchronous from the adjacent endometrium.Īn EMB revealing plasma cells within the endometrial stroma suggests chronic endometritis which can cause AUB whereas, lymphocytes are commonly found in normal endometrial tissue. For patients not yet menopausal, observation may be an option but removal is usually preferred in the setting of AUB or in patients with risk factors for EIN. Removal is recommended for postmenopausal patients. This can result from several sources including exogenous hormones taken as hormone replacement therapy, dietary supplements, peripheral conversion of normal levels of androgens by adipose tissue or an ovarian lesion that stimulates ovarian androgen production.Įndometrial polyps can be diagnosed by an EMB revealing endometrial glands and stroma with a central vascular channel. A benign, proliferative EMB result in a postmenopausal patient suggests excess estrogen. Secretory endometrium in a patient reporting menopausal symptoms would suggest she is not yet menopausal. Use of contraceptive steroids or other hormones can cause alterations, such as decidual change or endometrial gland atrophy. A result of disordered or crowded glands is common with anovulatory cycles due to prolonged estrogen stimulation without postovulatory progesterone exposure. Disordered or dyssynchronous endometrium suggests ovulatory dysfunction. The last menstrual period should be correlated with EMB results.

Proliferative endometrium indicates the follicular phase whereas, secretory endometrium indicates luteal phase. History, physical findings, and clinical suspicion must be correlated with the EMB result, especially when an unexpected benign result is reported.ĮMB results can reveal important information regarding the menstrual cycle. Scar tissue or synechiae (post-ablation or curettage) or fibroids that distort or enlarge the endometrial cavity may make obtaining a representative endometrial sample more difficult. Endometrial lesions that are diffuse, multiple, and larger are more likely to be detected than a smaller, isolated lesion, such as a polyp. The sensitivity of EMB is influenced by the lesion type and size, presence of uterine malformation or scarring, endometrial surface area, and number of lesions present. Approximately 20% of postmenopausal patients have endometrial pathology discovered during a secondary investigation following an insufficient or non-diagnostic initial EMB with as many as 3% of those patients having cancer. An “insufficient” EMB result should always be viewed cautiously, especially in the setting of persistent postmenopausal bleeding. The detection rate for endometrial cancer is approximately 99.6% in postmenopausal patients, 91% in premenopausal patients, and 81% for EIN. Endometrial biopsy (EMB) is recommended for AUB in patients >45 years of age, younger patients with significant risk factors for endometrial intra-epithelial neoplasia (EIN) or cancer, and patients with postmenopausal bleeding.Īn adequate endometrial biopsy specimen contains both glandular and stromal tissue and has a high accuracy for detecting diffuse endometrial processes, even though only a small portion of the endometrium is sampled. The primary role of endometrial sampling is to ascertain existence of premalignant or malignant intrauterine pathology however, further information can be gained from reviewing pathology results in the clinical setting of abnormal uterine bleeding (AUB).

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