endometrial biopsy

An endometrial biopsy primarily aims to determine endometrial cancer and hyperplasia with atypia at an early stage.

This study aims to evaluate the indications, histopathological diagnoses, and the number of endometrial biopsies performed in our clinic, according to the age groups of patients, in light of the literature.

A retrospective review was conducted on the file data of 4,965 patients who underwent endometrial biopsy for non-obstetric reasons between 2014-2021. The patients were divided into five groups, according to their age. Pathology diagnoses were classified as benign endometrial pathology, premalignant-malignant pathology, and insufficient for diagnosis.

The most common biopsy indication was abnormal uterine bleeding (61.9%), while the most common histopathological result was benign endometrial pathologies (75.3%). Endometrial cancer was also detected in 3% of the patients. The highest diagnosis of benign endometrial pathology among age groups was 96.6% in those below 35. The comparison of age groups in the diagnosis of premalignant-malignant pathology revealed that the highest diagnosis rate was 32.1% in those 65 years and over. Furthermore, the evaluation of the relationship between indications and material adequacy showed that the highest rate of insufficient for diagnosis pathology was in the postmenopausal patient group (34.0%). Moreover, insufficient for diagnosis and endometrial surface epithelium results were highest in patients over 65 (46.7%).

Patients aged 55-64 and those over 65 had the highest rate of endometrial cancer and insufficient for diagnosis biopsy results. Therefore, dilation and curettage may be recommended while taking a biopsy from patients in this age group.

Inflammation and its master regulator, Nuclear Factor-kB (NF-kB), have been implicated in the development of endometriosis. Inhibition of NF-kB pathway using small molecules ameliorated disease progression and reduced the lesion size; nevertheless, the underlying mechanism is not fully understood. Therefore, this study, is an attempt to assess whether inhibiting NF-kB signaling by aloe-emodin (AE) or aspirin (Asp), as anti-inflammatory compounds, can suppresses the invasive activity of human endometrial stromal cells at stage IV endometriosis.

The eutopic and healthy endometrial biopsies from a total of 8 infertile women with confirmed endometriosis and 8 women without endometriosis were digested and the single cells were cultured. Gene and protein markers of proliferation, migration, adhesion, and invasion of eutopic endometrial stromal cells (EuESCs) with and without treatment with AE or Asp, as well as control endometrial stromal cells (CESCs) was analyzed using q-PCR and immunofluorescence staining, respectively. Comparison between groups was performed using one-way ANOVA and the Bonferroni post hoc and p≤0.5 was considered statistically significant.

There was an association between NF-kB overexpression and higher proliferation/adhesion capacity in EuESCs. EuESCs (at stage IV endometriosis) displayed no invasive and migratory behaviors. Pre-treatment of EuESCs with AE or Asp significantly attenuated NF-kB expression and reduced proliferative, adhesive, invasive, and migratory activity of endometrial cells (p≤0.5).

Eutopic endometrial stromal cells seem to have a semi-invasive activity which is largely suppressed by AE or Asp. It can be suggested that both Asp and AE (as potent NF-kB inhibitors) can be used as a supplement in conventional endometriosis treatments.