II. Indications for Endometrial Biopsy
- All Postmenopausal Bleeding
- Persistent or heavy perimenopausal bleeding
- High risk of Endometrial Cancer
- More than twelve months of bleeding
- Abnormal Bleeding at any age (esp. >45) or if high risk (e.g. Unopposed Estrogen)
- Very high risk asymptomatic women
- Morbid Obesity
- Unopposed Estrogen
- Chronic Anovulation
- Refractory Anovulatory Dysfunctional Uterine Bleeding
- Tamoxifen use
III. Contraindications
- Absolute Contraindications
- Pregnancy
- Acute Pelvic Inflammatory Disease
- Clotting disorder or Coagulopathy
- Acute cervical infection
- Acute vaginal infection
- Cervical Cancer
- Relative Contraindications or complicating factors
- Morbid Obesity
- Uterine Descensus
- Severe cervical stenosis
IV. Efficacy
- As effective as D&C for Endometrial Cancer
- Test Sensitivity: 99.6% (91% in premenopausal women)
- Test Specificity: >97%
- Insufficient sample (no glandular tissue) is common
- Misses most Endometrial Polyps and can miss focal Endometrial Hyperplasia
- References
V. Equipment: General Materials
VI. Equipment: Sterile Uterine Pack (may use for IUD also)
- Sterile vaginal speculum
- Sterile Uterine sound
- Sterile scissors
- Sterile Ring forceps
- Sterile Cervical tenaculum
VII. Equipment: Biopsy Materials
- Endometrial suction catheter (e.g. Pipelle)
- Labeled formalin container
- Sterile cervical dilator available if needed
VIII. Technique
- Non-sterile bimanual exam and speculum placement
- Determine Uterine Size and position
- Insert speculum
- Change to sterile gloves
- Apply topical anesthetic
- Apply topical antiseptic solution (povidone-Iodine)
- Pain control
- Apply tenaculum to 12:00 at anterior cervical lip
- Close very slowly when applying to minimize pain
- Insert uterine sound to determine uterine depth
- Normal depth: 6 to 8 cm
- Obtain endometrial sample (consider 2-3 samples)
- Insert suction catheter via cervical os to fundus
- Withdraw internal piston
- Move catheter tip in and out while twisting
- Do not remove catheter from Uterus (suction lost)
- Twist catheter to cover 360 degrees
- Make at least 4 in and out cycles per sample
- Withdraw catheter when filled with tissue
- Store sample in formalin
- Hold catheter over formalin container
- Reinsert internal piston to deposit sample in cup
IX. Management: Stenotic cervical os
- Cytotec 200 mcg orally 6 hours before biopsy
X. Interpretation
XI. References
- Apgar in Pfenninger (1994) Procedures 563-70
- Shelly (1997) Am Fam Physician 55(5): 1731-6 [PubMed]
- Zuber (2001) Am Fam Physician 63(6): 1131-35 [PubMed]
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Related Studies
| Definition (NCI) | Removal of tissue from the endometrial cavity for microscopic examination. |
| Definition (NCI_NCI-GLOSS) | A procedure in which a sample of tissue is taken from the endometrium (inner lining of the uterus) for examination under a microscope. A thin tube is inserted through the cervix into the uterus, and gentle scraping and suction are used to remove the sample. |
| Concepts | Diagnostic Procedure (T060) |
| ICD10 | 1264 , 35620-00 |
| SnomedCT | 176885008, 236881007, 386802000 |
| CPT | 58100, 58110 |
| English | Endometrial scraping, Endometrial Biopsy, Biopsy endometrium, Biopsy;endometrial, Biopsy of uterine lining, Biopsy of endometrium, endometrial biopsy, EB - Endometrial biopsy, Endometrial sampling, Endometrial biopsy (procedure), Endometrial biopsy |
| Italian | Biopsia dell'endometrio |
| Dutch | biopsie endometrium, endometriumbiopsie |
| French | Biopsie de l'endomètre, Biopsie endométriale |
| Spanish | Biopsia endometrial, biopsia de endometrio (procedimiento), biopsia de endometrio, Biopsia de endometrio |
| Japanese | 子宮内膜生検, ｼｷｭｳﾅｲﾏｸｾｲｹﾝ |
| Czech | Biopsie endometria, Endometriální biopsie |
| Hungarian | Endometrium biopszia |
| Portuguese | Biopsia do endométrio |
| German | Endometriumbiopsie |
