The endometrial biopsy is a medical procedure that involves taking a tissue sample of the lining of the uterus. The tissue subsequently undergoes a histologic evaluation which aids the physician in forming a diagnosis.

Medical uses

There are a number of indications for obtaining an endometrial biopsy from a non-pregnant woman: * Women with chronic

anovulation Anovulation is when the ovaries do not release an oocyte during a menstrual cycle. Therefore, ovulation does not take place. However, a woman who does not ovulate at each menstrual cycle is not necessarily going through menopause. Chronic anovulat ...

such as the

polycystic ovary syndrome Polycystic ovary syndrome, or PCOS, is the most common endocrine disorder in women of reproductive age. The syndrome is named after the characteristic cysts which may form on the ovaries, though it is important to note that this is a sign and no ...

are at increased risk for endometrial problems and an endometrial biopsy may be useful to assess their lining specifically to rule out

endometrial hyperplasia Endometrial 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 t ...

cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...

. * In women with abnormal

vaginal bleeding Vaginal bleeding is any expulsion of blood from the vagina. This bleeding may originate from the uterus, vaginal wall, or cervix. Generally, it is either part of a normal menstrual cycle or is caused by hormonal or other problems of the reproductiv ...

the biopsy may indicate the presence of abnormal lining such as

. * In patients with suspected

uterine cancer Uterine cancer, also known as womb cancer, includes two types of cancer that develop from the tissues of the uterus. Endometrial cancer forms from the lining of the uterus, and uterine sarcoma forms from the muscles or support tissue of the uteru ...

, the biopsy may discover the presence of cancer cells in the endometrium or cervix. * In female

infertility Infertility is the inability of a person, animal or plant to reproduce by natural means. It is usually not the natural state of a healthy adult, except notably among certain eusocial species (mostly haplodiploid insects). It is the normal state ...

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

progesterone Progesterone (P4) is an endogenous steroid and progestogen sex hormone involved in the menstrual cycle, pregnancy, and embryogenesis of humans and other species. It belongs to a group of steroid hormones called the progestogens and is the m ...

level.

Transvaginal ultrasonography Vaginal ultrasonography is a medical ultrasonography that applies an ultrasound transducer (or "probe") in the vagina to visualize organs within the pelvic cavity. It is also called transvaginal ultrasonography because the ultrasound waves go ''a ...

is generally done before obtaining an endometrial biopsy as it may help in the gynecologic diagnosis, or even make the taking of a biopsy 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 Dilation (or dilatation) and curettage (D&C) refers to the dilation (widening/opening) of the cervix and surgical removal of part of the lining of the uterus and/or contents of the uterus by scraping and scooping (curettage). It is a gynecologic ...

, which requires anesthesia.

Contraindications

The procedure is contraindicated in pregnancy. Therefore, women in the reproductive years may need a

pregnancy test A pregnancy test is used to determine whether a female is pregnant or not. The two primary methods are testing for the female pregnancy hormone (human chorionic gonadotropin (hCG)) in blood or urine using a pregnancy test kit, and scanning with ...

before a biopsy is taken to assure that the test is not done during a pregnancy. Other contraindications are

pelvic inflammatory disease Pelvic inflammatory disease, also known as pelvic inflammatory disorder (PID), is an infection of the upper part of the female reproductive system, namely the uterus, fallopian tubes, and ovaries, and inside of the pelvis. Often, there may be no ...

and coagulopathies. An endometrial biopsy usually cannot be done as an office procedure in children, young women, women with

vaginismus Vaginismus is a condition in which involuntary muscle spasm interferes with vaginal intercourse or other penetration of the vagina. This often results in pain with attempts at sex. Often, it begins when vaginal intercourse is first attempted. ...

, or women with cervical stenosis. If necessary, an examination under

anesthesia Anesthesia is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia (relief from or prevention of pain), paralysis (muscle relaxation), ...

could be performed at which time a biopsy could be taken.

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 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 occasion ...

or an infection are rare complications.

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. The lidocain spray can burn when it is sprayed into the area. The clamp that is put onto the cervix may be another cause of pain and the procedure itself, with the doctor procuring a piece of the lining with the tube potentially being painful. Most of the time, this will only be required once, but sometimes the procedure can entail two or three instances of procuring a piece of the endometrium.

Procedure

Generally, an endometrial biopsy follows this process: # The patient is asked to lie on the table with her feet in the stirrups for a

pelvic examination A pelvic examination is the physical examination of the external and internal female pelvic organs. It is frequently used in gynecology for the evaluation of symptoms affecting the female reproductive and urinary tract, such as pain, bleeding, dis ...

. She may or may not be given localized

. # A speculum will be inserted into the vagina to spread the walls of the vagina apart to expose the

cervix The cervix or cervix uteri (Latin, 'neck of the uterus') is the lower part of the uterus (womb) in the human female reproductive system. The cervix is usually 2 to 3 cm long (~1 inch) and roughly cylindrical in shape, which changes during ...

. The cervix will then be cleansed with an antiseptic solution. # A

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.Merriam-Webster Onl ...

, a type of forceps, will hold the cervix steady for the biopsy. # The biopsy

curette A curette is a surgical instrument designed for scraping or debriding biological tissue or debris in a biopsy, excision, or cleaning procedure. In form, the curette is a small hand tool, often similar in shape to a stylus; at the tip of the cu ...

will be inserted into the uterine fundus and with a scraping and rotating motion some tissue will be removed. # The removed tissue will be placed in

formalin Formaldehyde ( , ) (systematic name methanal) is a naturally occurring organic compound with the formula and structure . The pure compound is a pungent, colourless gas that polymerises spontaneously into paraformaldehyde (refer to section Fo ...

or equivalent for preservation. # The tissue will be sent to a laboratory, where it will be processed and tested. It will then be read microscopically by a

pathologist Pathology is the study of the causal, causes and effects of disease or injury. The word ''pathology'' also refers to the study of disease in general, incorporating a wide range of biology research fields and medical practices. However, when us ...

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 is a nonsteroidal anti-inflammatory drug (NSAID) that is used for treating pain, fever, and inflammation. This includes painful menstrual periods, migraines, and rheumatoid arthritis. It may also be used to close a patent ductus arte ...

) before the procedure and inquire about

local anesthesia Local anesthesia is any technique to induce the absence of sensation in a specific 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 ...

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 is withdrawn to create suction. Meanwhile, the pipelle is rotated and moved outwards from the fundus to the internal os to collect small pieces of endometrial tissue.Endometrial Biopsy, A Review of Sampling Techniques
, Product bulletin from CooperSurgical, the producer of Pipelle. April 2012. Recently, the TruTest has been introduced as an alternative method of endometrial 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.

References

{{DEFAULTSORT:Endometrial Biopsy Female genital procedures Biopsy