Office Endometrial biopsy
Links:
Indications
How to Prepare
Procedure
Complications
Post endometrial biopsy follow up
An office endometrial biopsy is a gynecologic procedure that is performed at Total Care for Women in the office. It is a very simple and brief procedure to sample the lining of the uterus. The lining of the uterus is called the endometrium. This a time honored rapid procedure to evaluate the endometrium as a same surgical specimen. The minute tissue sample obtained in the office is sent to the pathologist for examination.
Indications for an endometrial biopsy
- Abnormal uterine bleeding at any reproductive age or postmenopausal age
- postmenopausal vaginal bleeding
- dating the endometrium within an infertility evaluation
- Evaluation of progestin therapy to treat endometrial hyperplasia (overgrowth of the endometrial lining)
- Endometrial cancer evaluation
- Preoperative biopsy prior to a planned hysterectomy due to heavy periods or any abnormal uterine bleeding condition such as associated with uterine fibroid(s) in order to preoperatively rule out endometrial cancer
The procedure: endometrial biopsy is an office based minor procedure!
How to prepare for an endometrial biopsy:
There is very little preparation required. The patient should avoid sexual intercourse for 24 hours prior to the planned procedure. She should avoid intravaginal application of medications. She should not douche for 24 hours before the procedure. She may want to bring her own fresh sanitary pad for use after the procedure; Dr. Purdy's office has a supply of fresh pads if needed by the patient after the procedure. There is no food or oral fluid restrictions for the procedure. Endometrial biopy is a simple nearly painless procedure performed in the office.
Endometrial Biopsy Procedure
Generally, an endometrial biopsy follows this process:
1. The patient will be asked to undress and lie on the table with her feet in the stirrups for a pelvic examination. The condition of undressed is the same as a routine pelvic exam!
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. Dr. Purdy then sprays the cervix with Hurricane solution* that is a topical anesthetic to superficialy numb the cervix. Dr. Purdy usually advises the injection of 30 to 60 mg of Toradol (intramuscular) before the procedure to reduce discomfort.
3. A single toothed tenaculum, a type of grapser, will hold the cervix steady for the biopsy.
4. A very thin tube (2 mm diameter) also called a catheter, will be inserted into the uterus via the endocervical canal. A smaller tube (internal piston) inside the plastic (sterile) tube or pipelle will be withdrawn to create suction. The catheter be will rotated and moved in and out to collect small pieces of endometrial tissue. Cramping may occur. This is very short lived and very mid.
5. The removed tissue is placed in a preservative.
6. The tissue will be sent to a laboratory, where it will be processed and tested. It will then be reviewed microscopically by a pathologist who will create a diagnosis. This will be reported back to Dr. Purdy as an official pathology report.(Note:There is a procedure/office visit charge and latter a pathologist/lab charge from separate medical facilities)
Complications
Significant complications from a office endometrial biopsy are not common - in fact very rare, but may include a remote risk of an endometrial or uterine infection that may develop a few days after the procedure. It is normal for some vaginal bleeding to occur and this will stop within a few hours after the procedure; spotting may persist for a few days. Crampy lower abdominal pain will usually resolve before the patient leaves the office. Some backaches may occur as well. Fever is very uncommon and should prompt a phone to Dr. Purdy's office. If after hours and a phone call is needed, please call the answer service 601-485-8609.
Post office endomerial biopsy and follow up:
Dr. Purdy recommends no sexual intercourse for 2 days or untill the vaginal discharge/bleeding clears by 24 hours if a biopsy was performed. Showering is recommended rather than a tub bath untill all discharge stops by 24 hours!. Strenous physical activity should be avoided for only the day of the actual procedure. In general, there should no major life style change required after the biopsy.
Follow up: Dr.Purdy usually schedules the patient to return in 2 weeks for a review of the biopsy report.
Dr. Purdy does not allow follow up phone conversations on the outcome of the tissue biopsied. The pathology repor t is always discussed in a face to face meeting with Dr. Purdy! This practice reduces errors.
Adequate follow-up is critical to the success of this procedure.
*Hurricane aerosol is a spray anesthetic that dentists use for local numbing on the mouth mucus membranes. The vapor of Huricane smells like wild cherry. It may sting very slightly due to a differecne in the mouth and vaginal Ph of the mucus membranes. The numbing action works immediately.