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?Endometrial biopsy


?Endometrial biopsy

المعلومة

What are the indications of endometrial biopsy?

المرجع

Uterus 2005

by


-نزف رحمي شاذ
-نزف بعد سن اليأس
-لطاخة بابا نيكيولا مع خلايا شاذة من بطانة الرحم
-نزوف رحمية وظيفية
-العقم

qusei


Indications for Endometrial Biopsy(EMB)

1-Assist in identification of causes of abnormal uterine bleeding (AUB)

2-Evaluate dysfunctional uterine bleeding (DUB)

3-Rule out endometrial carcinoma and precancerous lesions

4-Identify causes of postmenopausal bleeding

5-Evaluate infertility (specifically short luteal phase)

6-Follow up presence of endometrial cells on Pap smear
(especially if they occur within the last 18 days of the cycle or anytime in a postmenopausal woman)

7-Assess effects of hormone replacement therapy (HRT)*

8-Assess impact of tamoxifen on endometrium*
~~
*Indication is controversial.

prettyflower's picture
prettyflower
بعد التخرج


صورة :

qusei


ما هو اشيع سبب للنزف في

1- adolescence
2- reproductive years
3- perimenopausal years
4- postmenopausal years

khalaf77

Quote:
postmenopausal years

المعالجة الهرمونية المعيضة

qusei


common cause of abnormal postmenopausal bleeding

endometrial atrophy

khalaf77


ممممممممممم
شكرا

qusei

Quote:
ما هو اشيع سبب للنزف في

1- adolescence
2- reproductive years
3- perimenopausal years
4- postmenopausal years

in adolescence and perimenopausal
dysfunctional uterine bleeding

reproductive years
pregnancy complications

khalaf77


طيب واللاباضة وين محلها من الاعراب ..

qusei

Quote:
Evaluate infertility (specifically short luteal phase)

ما فائدة هذا الاجراء من الناحية العملية

وما هي اهمية تشخيص luteal phase defect

khalaf77

Quote:
طيب واللاباضة وين محلها من الاعراب ..

اشيع سبب ل DUB هي اللاباضة anovulation

khalaf77

Quote:
Assess impact of tamoxifen on endometrium*

tamoxifen هو SERM تاثيره الاساسي ANTAGONIST

ليش لازم نعمل endometrial biopsy عند المعالجة بهذا الدواء في مريضات سرطان الثدي

khalaf77

Quote:
ليش لازم نعمل endometrial biopsy عند المعالجة بهذا الدواء في مريضات سرطان الثدي

خوفا من سرطان بطانة الرحم ..

qusei


عند مريضة سرطان ثدي معالجة بالتاموكسيفين

ما هي المراقبة المطلوبة لها

ما هي الفواصل الزمنية لاجراء ال endometrial biopsy عند هذه المريضة

هل نجري biopsy من اجل كل المرضى المعالجين ب tamoxifen

khalaf77


يلي بعرفو انو الرالوكسيفين احسن من التاموكسيفين من حيث التأثير على باطن الرحم Rolling Eyes

qusei


raloxifene vs tamoxifene

خطر endometrial carcinoma اقل مع استخدام ال raloxifene والسبب هو الاختلاف في estrogen receptor agonist activity على مستوى الرحم والتي هي اقل في ال raloxifene

khalaf77


لكن raloxifene لم يعتمد بشكل واسع كمعالجة عند مريضات سرطان الثدي

khalaf77


ما هي الفواصل الزمنية لاجراء ال endometrial biopsy عند هذه المريضة
am not sure, after 4 years?

هل نجري biopsy من اجل كل المرضى المعالجين ب tamoxifen
we stop using Tamoxifen after 4-5 years, so we don't need to do the biopsy for every pt

DAM's picture
DAM

after searching:

Endometrial Cancer in Women Receiving Tamoxifen

Tamoxifen has become standard adjuvant therapy in patients with breast cancer because it reduces the risk for a second case of contralateral primary breast cancer by up to 50 percent. The current recommended dosage is 20 mg per day for five years. More recently, tamoxifen has been approved as a chemopreventive agent in women who are at high risk for breast cancer. Tamoxifen acts as an estrogen antagonist in the breast and as an estrogen agonist in other tissues, increasing the thickness of the vaginal epithelium, reducing serum cholesterol levels and preserving bone density. Estrogen-like effects have been found on steroid hormone receptors in the endometrium, and growth-promoting effects have been found on endometrial carcinoma cells. Tamoxifen is associated with a variety of endometrial abnormalities, ranging from polyps to cancer, although it is difficult to calculate the importance of other epidemiologic and genetic risk factors that cause breast cancer in the overall risk for other gynecologic cancers. Suh-Burgmann and Goodman reviewed the literature in an attempt to develop a strategy for gynecologic surveillance in patients taking tamoxifen.

Endometrial cancer is the most common gynecologic cancer in the United States. Consistently identified risk factors such as nulliparity, late onset of menopause, unopposed estrogen hormone therapy, obesity and estrogen-producing ovarian neoplasms, generally increase risk by increasing estrogen exposure. Pelvic radiation and a family history of hereditary nonpolyposis colorectal cancer are also risk factors. Fortunately, morbidity from endometrial cancer is low because most patients present with abnormal bleeding at an early stage.

Effective screening to detect early endometrial cancer is not yet available. Papanicolaou (Pap) smears can help detect endometrial cancer when atypical glandular cells are present. Transvaginal ultrasonography can evaluate the thickness of the endometrial lining and is useful in high-risk patients. Endometrial biopsy is recommended in patients with specific abnormalities, including (1) abnormal bleeding, (2) the presence of endometrial cells on Pap smear in postmenopausal women and atypical glandular cells of undetermined origin, and (3) for screening high-risk syndromes such as hereditary nonpolyposis colon cancer syndrome.

Women Taking Tamoxifen

FIGURE. Suggested algorithm for surveillance of endometrial cancer in women receiving tamoxifen. (Pap = Papanicolaou)
Adapted with permission from Suh-Burgmann EJ, Goodman A. Surveillance for endometrial cancer in women receiving tamoxifen. Ann Intern Med 1999; 131:127-35.

Because tamoxifen confers an increased risk (perhaps two- to threefold) for endometrial cancer among postmenopausal women, surveillance may be desirable. For the authors' recommendations for a surveillance strategy, see the accompanying figure. Endometrial biopsy has not been demonstrated to be cost-effective for this use. Ultrasonography showing an endometrial thickness of less than 8 mm is a strong indication of the absence of tamoxifen-associated endometrial cancer. Pretreatment evaluation using ultrasonography with or without endometrial biopsy remains controversial, although normal findings on pelvic examination and Pap smear and absence of abnormal bleeding or discharge should be documented before tamoxifen therapy is begun. The presence of risk factors or any other detected abnormality suggests the need for further individualized study, including ultrasonography, endometrial biopsy or endometrial curettage.

The authors conclude that because tamoxifen causes a dose-related and duration-related increase in endometrial cancer, women should be advised about the risk and evaluated for risk factors. Certain specific findings, as shown in the accompanying figure, should prompt a thorough evaluation of the endometrium. If there are no symptoms, but an adequate pelvic examination is not possible or the patient has additional risk factors, transvaginal ultrasonography should be used to screen for endometrial cancer.

RICHARD SADOVSKY, M.D.

Suh-Burgmann EJ, Goodman A. Surveillance for endometrial cancer in women receiving tamoxifen. Ann Intern Med July 20, 1999;131:127-35

.

DAM's picture
DAM


شكرا dam

فقط بعض الاضافات البسيطة

توصيات الجمعيةالامريكية لامراض النساء والتوليد 2006

1- كل النساء بعد سن الياس المعالجات بالتاموكسيفين يحتجن لمراقبة جيدة

2- النساء ما قبل سن الياس المعالجات بالتاموكسيفين لا يحتجن لمراقبة بسبب عدم ازدياد الخطر لديهم لذلك لا يحتجن الى مراقبة اضافية

3- يجب تنبيه المريضة الى الاثار الجانبية للعلاج بالتاموكسفين

4- اي نزف مهبلي او ضائعات او SPOTTING يجب ان يقيم بشكل جيد

5- قبل البدء بالتاموكسفين من الافضل اجراء مسح بالايكو للرحم لبحث عن اي موجودات غير طبيعية

6- اذا لم تكن المريضة عالية الخطورة لسرطان بطانة الرحم فان مراقبة بطانة الرحم غير ضرورية وذلك لانها تزيد التكلفة بدون زيادة نسبة تشخيص سرطلن بطانة الرحم

7- الحد الاعلى لاعطاء التاموكسيفين 5 سنوات

khalaf77

Quote:
Ultrasonography showing an endometrial thickness of less than 8 mm is a strong indication of the absence of tamoxifen-associated endometrial cancer

When 5 mm is used as the upper limit of normal endometrial thickness, the sensitivity of transvaginal sonography for the detection of endometrial abnormalities is 91–100

endometrial thickness of greater than 10 mm is almost always associated with some type of endometrial abnormali

Sonohysterography is particularly useful for delineating polyps and
space-occupying lesions

في النساء المعالجات بالتاموكسيفين وغير عرضيات فان المراقبة بالايكو او بالخزعة غير فعال في مسح سرطان بطانة الرحم

في النساء العرضيات نجري فورا خزعة بطانة رحم بغض النظر عن موجودات الايكو

BREAST CANCER 2008

khalaf77


If atypical endometrial hyperplasia develops in patient treated with tamoxifene

what is appropriate management

khalaf77


مناقشة رائعة، شكرا لكم

moonberg's picture
moonberg
بعد التخرج


مناقشة رائعة، شكرا لكم

moonberg's picture
moonberg
بعد التخرج

Quote:
If atypical endometrial hyperplasia develops in patient treated with tamoxifene

what is appropriate management

khalaf77


-

Quote:
Evaluate infertility (specifically short luteal phase)

كيف نشخص luteal phase defect

ما هي اهم اسباب حدوث هذه المشكلة LPD

khalaf77
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