Endometrial biopsy
Encyclopedia
The endometrial biopsy is a medical office procedure that is used to remove a sample of the lining of the uterus
. The tissue subsequently undergoes a histologic evaluation
which is supplied to the physician to aid in the diagnosis.
s for obtaining an endometrial biopsy in a non-pregnant woman:
Transvaginal ultrasonography
is generally done before obtaining an endometrial biopsy as it may help in the gynecologic diagnosis, or even make the taking of a biospy superfluous if the lining is thin. If the endometrial lining is less than 5 mm thick on sonography, it is highly unusual to encounter endometrial cancer.
The test is usually done in women over age 35. A more thorough histologic evaluation can be obtained by a dilatation and curettage, which requires anesthesia.
before a biopsy is taken to assure that the test is not done during a pregnancy. Other contraindications are pelvic inflammatory disease and coagulopathies.
An endometrial biopsy usually cannot be done as an office procedure in children, young women, women with vaginismus
, or women with cervical stenosis
. If necessary, an examination under anesthesia
could be performed at which time a biopsy could be taken.
The Pipelle is a more flexible plastic tube with a side opening at the tip. A smaller tube (internal piston) inside the Pipelle will be withdrawn to create suction. The pipelle will be rotated and moved in and out to collect small pieces of endometrial tissue.
Recently, the TruTest has been introduced as an alternative method of endometiral biopsy. Rather than using a suction tube, this method uses the Tao Brush
to gently brush the lining of the uterus. Generally, this method has been found to be less painful than the traditional suction method.
or an infection are rare complications.
1. The patient is asked to lie on the table with her feet in the stirrups for a pelvic examination
. She may or may not be given localized anesthesia
.
2. A speculum
will be inserted into the vagina to spread the walls of the vagina apart to expose the cervix
.The cervix will then be cleansed with an antiseptic solution.
3. A tenaculum
, a type of forceps, will hold the cervix steady for the biopsy.
4. The biopsy curette will be inserted into the uterine fundus and with a scraping and rotating motion some tissue will be removed.
5. The removed tissue will be placed in formalin or equivalent for preservation.
6. The tissue will be sent to a laboratory, where it will be processed and tested. It will then be read microscopically by a pathologist who will provide a histologic diagnosis.
Both the application of the tenaculum as well as the removal of tissue by the biopsy may cause pain. Patients, in general, may want to take some pain medication (such as ibuprofen
) before the procedure and inquire about local anesthesia
.
Endometrium
-Function:The endometrium is the innermost glandular layer and functions as a lining for the uterus, preventing adhesions between the opposed walls of the myometrium, thereby maintaining the patency of the uterine cavity. During the menstrual cycle or estrous cycle, the endometrium grows to a...
. The tissue subsequently undergoes a histologic evaluation
Histology
Histology is the study of the microscopic anatomy of cells and tissues of plants and animals. It is performed by examining cells and tissues commonly by sectioning and staining; followed by examination under a light microscope or electron microscope...
which is supplied to the physician to aid in the diagnosis.
Indications
There are a number of indicationIndication
Indication can refer to:* A synonym for Sign.* Human interface Highlighting the single object pointed to as a cursor is moved, without any other user action such as clicking, is indication....
s for obtaining an endometrial biopsy in a non-pregnant woman:
- Women with chronic anovulation such as the polycystic ovary syndromePolycystic ovary syndromePolycystic ovary syndrome is one of the most common female endocrine disorders. PCOS is a complex, heterogeneous disorder of uncertain aetiology, but there is strong evidence that it can to a large degree be classified as a genetic disease....
are at increased risk for endometrial problems and an endometrial biopsy may be useful to assess their lining specifically to rule out endometrial hyperplasiaEndometrial hyperplasiaEndometrial hyperplasia is a condition of excessive proliferation of the cells of the endometrium, or inner lining of the uterus.Most cases of endometrial hyperplasia result from high levels of estrogens, combined with insufficient levels of the progesterone-like hormones which ordinarily...
or cancerEndometrial cancerEndometrial cancer refers to several types of malignancies that arise from the endometrium, or lining, of the uterus. Endometrial cancers are the most common gynecologic cancers in the United States, with over 35,000 women diagnosed each year. The incidence is on a slow rise secondary to the...
. - In women with abnormal vaginal bleedingVaginal bleedingVaginal bleeding refers to bleeding in females that is either a physiologic response during the non-conceptional menstrual cycle or caused by hormonal or organic problems of the reproductive system. Vaginal bleeding may occur at any age, but always needs investigation when encountered in female...
the biopsy may indicate the presence of abnormal lining such as endometrial hyperplasiaEndometrial hyperplasiaEndometrial hyperplasia is a condition of excessive proliferation of the cells of the endometrium, or inner lining of the uterus.Most cases of endometrial hyperplasia result from high levels of estrogens, combined with insufficient levels of the progesterone-like hormones which ordinarily...
or cancerEndometrial cancerEndometrial cancer refers to several types of malignancies that arise from the endometrium, or lining, of the uterus. Endometrial cancers are the most common gynecologic cancers in the United States, with over 35,000 women diagnosed each year. The incidence is on a slow rise secondary to the...
. - In patients with suspected uterine cancerUterine cancerThe term uterine cancer may refer to any of several different types of cancer which occur in the uterus, namely:*Uterine sarcomas: sarcomas of the myometrium, or muscular layer of the uterus, are most commonly leiomyosarcomas.*Endometrial cancer:...
, the biopsy may discover the presence of cancer cells in the endometrium or cervix. - In female infertilityInfertilityInfertility primarily refers to the biological inability of a person to contribute to conception. Infertility may also refer to the state of a woman who is unable to carry a pregnancy to full term...
the assessment of the lining can determine, if properly timed, that the patient ovulated, however, the same information can be obtained by a blood test of the progesteroneProgesteroneProgesterone also known as P4 is a C-21 steroid hormone involved in the female menstrual cycle, pregnancy and embryogenesis of humans and other species...
level.
Transvaginal ultrasonography
Gynecologic ultrasonography
Gynecologic ultrasonography or Gynecologic sonography refers to the application of medical ultrasonography to the female pelvic organs, specifically the uterus, the ovaries, the Fallopian tubes, as well as the bladder, the adnexa, the Pouch of Douglas, and any findings in the pelvis of relevance...
is generally done before obtaining an endometrial biopsy as it may help in the gynecologic diagnosis, or even make the taking of a biospy superfluous if the lining is thin. If the endometrial lining is less than 5 mm thick on sonography, it is highly unusual to encounter endometrial cancer.
The test is usually done in women over age 35. A more thorough histologic evaluation can be obtained by a dilatation and curettage, which requires anesthesia.
Contraindications
The procedure is contraindicated in pregnancy. Therefore, women in the reproductive years may need a pregnancy testPregnancy test
A pregnancy test attempts to determine whether or not a woman is pregnant.These markers are found in urine and blood, and pregnancy tests require sampling one of these substances. The first of these markers to be discovered, human chorionic gonadotropin , was discovered in 1930 to be produced by...
before a biopsy is taken to assure that the test is not done during a pregnancy. Other contraindications are pelvic inflammatory disease and coagulopathies.
An endometrial biopsy usually cannot be done as an office procedure in children, young women, women with vaginismus
Vaginismus
Vaginismus, sometimes anglicized vaginism, is the German name for a condition which affects a woman's ability to engage in any form of vaginal penetration, including sexual intercourse, insertion of tampons and/or menstrual cups, and the penetration involved in gynecological examinations...
, or women with cervical stenosis
Cervical stenosis
Cervical stenosis can refer to:* Stenosis of uterine cervix* Cervical spinal stenosis...
. If necessary, an examination under anesthesia
Anesthesia
Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...
could be performed at which time a biopsy could be taken.
Biopsy instruments
A number of biopsy instruments are in use. The Novak curette is a thin metallic tube with a side opening at the tip; suction with attached syringe can be applied to help to remove tissue.The Pipelle is a more flexible plastic tube with a side opening at the tip. A smaller tube (internal piston) inside the Pipelle will be withdrawn to create suction. The pipelle will be rotated and moved in and out to collect small pieces of endometrial tissue.
Recently, the TruTest has been introduced as an alternative method of endometiral biopsy. Rather than using a suction tube, this method uses the Tao Brush
Tao Brush
The Tao Brush is a medical instrument used to perform an alternative method of endometrial biopsy.The traditional method of endometrial biopsies uses a specialized catheter to suction away a portion of the uterine lining. The Tao Brush method instead uses a small, flexible brush to gently brush...
to gently brush the lining of the uterus. Generally, this method has been found to be less painful than the traditional suction method.
Risks
While procedure is generally considered safe, cramps or pelvic pain is a common if short-lived side effect. After the procedure, the patient may experience some bleeding. A uterine perforationUterine perforation
Uterine perforation is a potential complication of any intrauterine procedure. It may be associated with injury to surrounding blood vessels or viscera such as the bladder or intestine. If not diagnosed at the time of the procedure it can result in massive hemorrhage or sepsis...
or an infection are rare complications.
Endometrial Biopsy Pain
Endometrial biopsy pain is quite common. The reason that doctors spray the lidocain is to help to deal with some of the pain from the procedure, but the lidocain spray burns when it is sprayed into the area. The clamp that is put onto the cervix will be another major cause of pain and the procedure itself, where the doctor has to procure a piece of the lining with the tube is extremely painful. Most of the time, this will only be required once, but sometimes the procedure can entain two or three instances of procuring a piece of the endometrium.Endometrial biopsy procedure
Generally, an endometrial biopsy follows this process:Pelvic examination
A pelvic examination, also pelvic exam, is a physical examination of the female pelvic organs.Broadly, it can be divided into the external examination and internal examination.It is also called "Bimanual Exam" & "Manual Uterine Palpation"....
. She may or may not be given localized anesthesia
Anesthesia
Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...
.
2. A speculum
Speculum
The term speculum, Latin for "mirror", and its plural specula, may refer to:* Speculum , a medical tool used for examining body cavities* Speculum , a journal of medieval studies published by the Medieval Academy of America...
will be inserted into the vagina to spread the walls of the vagina apart to expose the cervix
Cervix
The cervix is the lower, narrow portion of the uterus where it joins with the top end of the vagina. It is cylindrical or conical in shape and protrudes through the upper anterior vaginal wall...
.The cervix will then be cleansed with an antiseptic solution.
3. A tenaculum
Tenaculum
A tenaculum is a surgical instrument, usually classified as a type of forceps. It consists of a slender sharp-pointed hook attached to a handle and is used mainly in surgery for seizing and holding parts, such as blood vessels.Uses include:...
, a type of forceps, will hold the cervix steady for the biopsy.
4. The biopsy curette will be inserted into the uterine fundus and with a scraping and rotating motion some tissue will be removed.
5. The removed tissue will be placed in formalin or equivalent for preservation.
6. The tissue will be sent to a laboratory, where it will be processed and tested. It will then be read microscopically by a pathologist who will provide a histologic diagnosis.
Both the application of the tenaculum as well as the removal of tissue by the biopsy may cause pain. Patients, in general, may want to take some pain medication (such as ibuprofen
Ibuprofen
Ibuprofen is a nonsteroidal anti-inflammatory drug used for relief of symptoms of arthritis, fever, as an analgesic , especially where there is an inflammatory component, and dysmenorrhea....
) before the procedure and inquire about local anesthesia
Local anesthesia
Local anesthesia is any technique to induce the absence of sensation in part of the body, generally for the aim of inducing local analgesia, that is, local insensitivity to pain, although other local senses may be affected as well. It allows patients to undergo surgical and dental procedures with...
.
External links
- http://leahandmark.com/2008/11/15/for-the-womenfolk-endometrial-biopsy/: Truth about Endometrial Biopsy Procedure Pain