Endometrial Biopsy for diagnosis of endometriosis Ppt Powerpoint Presentation slides Moamar Al-jefout Medical Slideshow Ultrasonography-Guided Transvaginal Endometrial Biopsy: A Useful ...

Endometrial Biopsy for diagnosis of endometriosis

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Slide 1 :

Endometrial biopsy for diagnosis of endometriosis Moamar Al-Jefout, Natasha Andreadis, Natsuko Tokushige, Robert Markham & Ian S Fraser. Queen Elizabeth II Research Institute for Mothers & Infants, O&G Department, University of Sydney Royal Prince Alfred Hospital, Sydney Mu’tah University ( Jordan)

Slide 2 :

A pilot study to evaluate the relative efficacy of endometrial biopsy and full curettage in making a diagnosis of endometriosis by the detection of endometrial nerve fibres.

Slide 3 :

Problems with diagnosis of endometriosis At present requires laparoscopy. Delay in diagnosis is common. Signs and symptoms are not always specific for endometriosis, and are highly variable. No sufficiently sensitive and specific diagnostic tests for the clinical diagnosis of endometriosis. No diagnostic strategy is well supported by evidence of effectiveness.

Slide 4 :

Laparoscopy for endometriosis Visual assessment at laparoscopy. Variable skill levels of surgeons. Biopsy & histopathological confirmation. Long waiting lists in some hospitals. Morbidity and rare mortality. Cost.

Slide 5 :

Endometriosis is an endometrial disease Major differences in several molecular systems. Major differences in protein expression using proteomic techniques. (ten Have, S, Fraser, I, Markham, R, Lam, A, Matsumoto, I. Proteomics - Clinical Applications. 2007; 1: 1243 – 125). Increased angiogenesis. Unique presence of nerve fibres in the functional layer of the eutopic endometrium (N. Tokushige, R. Markham, P. Russell, and I.S. Fraser, Hum Reprod, 2006. 21(3): p.782- 7).

Slide 6 :

Objectives To compare the efficacy of endometrial biopsy and curettage in making a diagnosis of endometriosis by detecting small unmyelinated sensory C-nerve fibres in the functional layer of eutopic endometrium in women with laparoscopically proven endometriosis.

Slide 7 :

Study design and Methods Endometrial biopsies (Endosampler®, MedGyn Industries) and curettings were collected from 37 women (mean age, 33.7 years): 20 women with endometriosis (not hormonally treated) 17 women without endometriosis. Highly specific immunohistochemical staining with the pan-neuronal marker PGP9.5(Dako, Australia).

Slide 8 :

Slide 9 :

Hysteroscopic view after endometrial biopsy using “Endosampler®” (MedGyn Industries)

Slide 10 :

Nerve fibres in the eutopic endometrium in endometriosis

Slide 11 :

Results Small nerve fibres were detected in ALL 20 women with laparoscopically confirmed endometriosis. Nerve fibres were never detected in women in whom endometriosis was excluded at laparoscopy.

Slide 12 :

Endometrial nerve fibre density in the functional layer in women with and without endometriosis (mean ± SD)

Slide 13 :

Why endometrial biopsy in endometriosis? I Delayed diagnosis might be associated with adverse outcomes. May prevent progression of disease and allow earlier management and prevention of recurrence. Less invasive than laparoscopy.

Slide 14 :

Why endometrial biopsy in endometriosis? II Special target group may be: Adolescents with CPP and a strong family history of endometriosis. All infertility patients. Atypical pelvic pain sufferers. Reduction of unnecessary laparoscopies without adversely affecting outcomes. (Laparoscopy may will be required later for assessment and surgery).

Slide 15 :

Conclusion Endometrial biopsy with careful technique combined with meticulous immunohistochemical staining for small nerve fibres is as effective as expert laparoscopic assessment in making a diagnosis of endometriosis. A double-blind study of women with pelvic pain and/or infertility is underway.

Slide 16 :

Thank you

	aljefoutmr 1 Years ago. Category: Research

Tags:	Research

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