II. Indications for Endometrial Biopsy

  1. All Postmenopausal Bleeding
  2. Persistent or heavy perimenopausal bleeding
    1. High risk of Endometrial Cancer
    2. More than twelve months of bleeding
  3. Abnormal Bleeding at any age (esp. >45) or if high risk (e.g. Unopposed Estrogen)
  4. Very high risk asymptomatic women
    1. Morbid Obesity
    2. Unopposed Estrogen
    3. Chronic Anovulation
  5. Refractory Anovulatory Dysfunctional Uterine Bleeding
  6. Tamoxifen use

III. Contraindications

  1. Absolute Contraindications
    1. Pregnancy
    2. Acute Pelvic Inflammatory Disease
    3. Clotting disorder or Coagulopathy
    4. Acute cervical infection
    5. Acute vaginal infection
    6. Cervical Cancer
  2. Relative Contraindications or complicating factors
    1. Morbid Obesity
    2. Uterine Descensus
    3. Severe cervical stenosis

IV. Efficacy

  1. As effective as D&C for Endometrial Cancer
    1. Test Sensitivity: 99.6% (91% in premenopausal women)
    2. Test Specificity: >97%
  2. Insufficient sample (no glandular tissue) is common
  3. Misses most Endometrial Polyps and can miss focal Endometrial Hyperplasia
  4. References
    1. Dijkhuizen (2000) Cancer 89(8):1765-72 [PubMed]
    2. Stovall (1989) Obstet Gynecol 73:405 [PubMed]

V. Equipment: General Materials

  1. Sterile gloves
  2. Povidone-Iodine solution (betadine)
  3. Benzocaine (Hurricane spray) or Lidocaine 2% jelly
  4. Sterile Gauze (4x4) for betadine application

VI. Equipment: Sterile Uterine Pack (may use for IUD also)

  1. Sterile vaginal speculum
  2. Sterile Uterine sound
  3. Sterile scissors
  4. Sterile Ring forceps
  5. Sterile Cervical tenaculum

VII. Equipment: Biopsy Materials

  1. Endometrial suction catheter (e.g. Pipelle)
  2. Labeled formalin container
  3. Sterile cervical dilator available if needed

VIII. Technique

  1. Non-sterile bimanual exam and speculum placement
    1. Determine Uterine Size and position
    2. Insert speculum
    3. Change to sterile gloves
    4. Apply topical anesthetic
  2. Apply topical antiseptic solution (povidone-Iodine)
    1. Apply povidone-Iodine to gauze or cotton balls
    2. Apply to Cervix and vagina with ring forceps
  3. Pain control
    1. NaproxenSodium 550 mg PO one hour before biopsy
    2. Lidocaine 2% solution 5 ml infused into Uterus
      1. Use 18 gauge angiocatheter sheath
      2. Leave angiocatheter in place for 3 minutes
    3. References
      1. Dogan (2004) Obstet Gynecol 103:347-51 [PubMed]
  4. Apply tenaculum to 12:00 at anterior cervical lip
    1. Close very slowly when applying to minimize pain
  5. Insert uterine sound to determine uterine depth
    1. Normal depth: 6 to 8 cm
  6. Obtain endometrial sample (consider 2-3 samples)
    1. Insert suction catheter via cervical os to fundus
    2. Withdraw internal piston
    3. Move catheter tip in and out while twisting
      1. Do not remove catheter from Uterus (suction lost)
      2. Twist catheter to cover 360 degrees
      3. Make at least 4 in and out cycles per sample
    4. Withdraw catheter when filled with tissue
  7. Store sample in formalin
    1. Hold catheter over formalin container
    2. Reinsert internal piston to deposit sample in cup

IX. Management: Stenotic cervical os

  1. Cytotec 200 mcg orally 6 hours before biopsy

X. Interpretation

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Ontology: Endometrial biopsy (C1510477)

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