D&C material biopsy - Medium 1-3 cm

Biopsy

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Tissue after curettage/evacuation.

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D&C Material Biopsy - Medium 1-3 cm

Why is it done?
- This test involves histopathological examination of tissue samples obtained through dilation and curettage (D&C) of the uterine cavity, specifically measuring samples between 1-3 cm in size
- Diagnosis of abnormal uterine bleeding (AUB) and identification of underlying pathology
- Detection of endometrial hyperplasia, carcinoma, polyps, and myomas
- Evaluation of postmenopausal bleeding and abnormal vaginal bleeding in perimenopausal women
- Investigation of failed medical management of heavy menstrual bleeding
- Assessment of endometrial pathology in patients with tamoxifen use or unopposed estrogen exposure
- Follow-up of abnormal imaging findings such as thickened endometrium on ultrasound
Normal Range
- Benign Findings (Normal/Negative):
  - Normal proliferative or secretory endometrium appropriate to menstrual cycle phase
  - Absence of malignancy, atypical hyperplasia, or significant abnormalities
  - Normal endometrial thickness and uniform glandular architecture
  - Absence of inflammation, infection, or foreign bodies
- Specimen Adequacy (Medium Size 1-3 cm):
  - Specimen size: 1-3 cm in greatest dimension
  - Adequate tissue for histopathological evaluation with representative endometrial sampling
  - Sufficient material to assess glandular and stromal components
Interpretation
- Normal/Benign Findings:
  - Indicates endometrium is normal and appropriate for patient's menstrual cycle phase or menopausal status
  - No evidence of malignancy or significant pathology requiring intervention
  - Reassuring finding for patients with abnormal bleeding
- Endometrial Hyperplasia (Without Atypia):
  - Indicates increased glandular and stromal proliferation with normal cytology
  - Associated with unopposed estrogen exposure and prolonged anovulation
  - Requires medical management with progestins or other hormonal therapy
  - Follow-up biopsy may be recommended after treatment
- Atypical Endometrial Hyperplasia:
  - Indicates hyperplasia with cytologic atypia and architectural abnormalities
  - Precancerous lesion with risk of progression to endometrial carcinoma (up to 30-40%)
  - Requires aggressive treatment and close follow-up monitoring
  - Hysterectomy may be recommended, especially in postmenopausal women
- Endometrial Carcinoma:
  - Presence of malignant epithelial cells with invasion into stroma or myometrium
  - Requires immediate referral to gynecologic oncology and comprehensive staging
  - Further investigation including imaging, tumor markers, and molecular testing may be needed
- Benign Polyps or Myomas:
  - Identifies benign neoplastic growths as cause of abnormal bleeding
  - May be treated with hormonal therapy or surgical removal if symptomatic
- Insufficient Specimen:
  - Sample too small or lacks adequate tissue representation
  - Repeat biopsy or alternative diagnostic method (hysteroscopy) may be recommended
Associated Organs
- Primary Organ System:
  - Female reproductive system - specifically the uterus and endometrial lining
- Associated Conditions and Pathology:
  - Abnormal uterine bleeding (AUB) and menorrhagia
  - Postmenopausal bleeding and perimenopausal abnormal bleeding
  - Endometrial cancer and precancerous lesions (atypical hyperplasia)
  - Simple and complex endometrial hyperplasia
  - Endometrial polyps and submucosal fibroids (myomas)
  - Endometritis and chronic endometrial inflammation
  - Polycystic ovary syndrome (PCOS) with chronic anovulation
  - Obesity-related endometrial pathology from unopposed estrogen
  - Tamoxifen-induced endometrial changes (increased thickness and pathology)
  - Effects of hormone replacement therapy (HRT) on endometrial tissue
- Associated Medical Conditions:
  - Type 2 diabetes mellitus - increased endometrial cancer risk
  - Hypertension and metabolic syndrome
  - Lynch syndrome (hereditary nonpolyposis colorectal cancer) - increased endometrial cancer risk
  - History of breast cancer treated with tamoxifen
- Potential Complications/Risks:
  - Progression of atypical hyperplasia to endometrial adenocarcinoma if untreated
  - Undiagnosed malignancy leading to delayed treatment and poor outcomes
  - Uterine perforation during D&C procedure (rare but serious complication)
  - Infection or endometritis following the procedure
  - Excessive bleeding or hemorrhage
  - Intrauterine adhesions (Asherman's syndrome) from aggressive curettage
Follow-up Tests
- If Normal Results:
  - Routine follow-up as clinically indicated - no specific surveillance needed
  - If bleeding persists despite normal biopsy, consider alternative diagnoses (coagulopathy, anovulation, medication side effects)
  - Consider pelvic ultrasound if structural abnormalities suspected
- If Simple Hyperplasia Without Atypia:
  - Initiate progestin therapy (oral, intrauterine, or injection) for 3-6 months
  - Address underlying risk factors (weight loss, metabolic management, estrogen control)
  - Repeat endometrial biopsy or imaging after treatment to confirm resolution
  - Annual surveillance if risk factors persist
- If Atypical Hyperplasia Identified:
  - Urgent referral to gynecologic oncologist
  - Pelvic ultrasound to assess endometrial thickness and exclude adenomyosis
  - Diagnostic hysteroscopy with direct visualization and targeted biopsy to exclude malignancy
  - Consider molecular/genetic testing (MMR status, PTEN, KRAS, PIK3CA) if available
  - Hysterectomy often recommended, particularly in postmenopausal women
  - Aggressive progestin therapy if patient declines or is not surgical candidate, with close follow-up
- If Endometrial Carcinoma Diagnosed:
  - Immediate referral to gynecologic oncology
  - CT or MRI pelvis/abdomen for staging and assessment of metastatic disease
  - Tumor markers (CA-125, possibly others based on histology)
  - Molecular testing (MMR, PTEN, POLE mutations) for prognosis and treatment planning
  - Surgical staging with total abdominal hysterectomy, bilateral salpingo-oophorectomy
  - Pelvic/para-aortic lymph node assessment and peritoneal washings
  - Adjuvant chemotherapy, radiation, or immunotherapy based on stage and risk factors
- If Benign Polyps or Fibroids Identified:
  - Diagnostic hysteroscopy for precise localization and removal if symptomatic
  - Pelvic ultrasound for comprehensive evaluation of structural abnormalities
  - Hormonal management trial if patient prefers conservative approach
- If Specimen Insufficient:
  - Repeat endometrial biopsy with improved technique
  - Diagnostic hysteroscopy with direct visualization for comprehensive assessment
  - Consider advanced imaging (3D ultrasound, MRI) if biopsy repeatedly insufficient
Fasting Required?
- Fasting Required: No
- Timing of Procedure:
  - Preferably performed in the luteal phase or anytime outside of menstruation
  - Ideal timing is 7-21 days after ovulation for fertility evaluation
  - Can be performed anytime for abnormal bleeding evaluation
  - Postmenopausal biopsy can be performed anytime with no cycle constraints
- Pre-Procedure Medications to Avoid:
  - Heavy anticoagulant therapy (aspirin, NSAIDs, anticoagulants - discuss with provider)
  - Continue regular medications unless specifically instructed otherwise
- Patient Preparation Requirements:
  - Ensure negative pregnancy test or exclude pregnancy possibility before procedure
  - Informed consent for D&C procedure with discussion of risks and benefits
  - Pelvic examination performed immediately prior to procedure
  - Mild to moderate sedation or local anesthesia typically offered
  - Advance instructions regarding anesthesia type (NPO status varies with anesthesia)
  - Cervical ripening with misoprostol may be used prior to procedure if needed
  - Prophylactic antibiotics may be considered in select cases
  - Plan for transportation home after procedure as driving is not recommended
  - Post-procedure activity restrictions (no intercourse, tampons, or douching for 1 week)

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