From the Guidelines
An endometrial biopsy should be performed by first obtaining informed consent and reviewing the patient's medical history, including allergies, medications, and contraindications such as pregnancy or acute pelvic infection, followed by positioning the patient in lithotomy position and inserting a speculum to visualize the cervix. The procedure involves several key steps, including:
- Obtaining informed consent and reviewing the patient's medical history, including allergies, medications, and contraindications such as pregnancy or acute pelvic infection 1
- Positioning the patient in lithotomy position and inserting a speculum to visualize the cervix
- Cleansing the cervix with antiseptic solution, typically povidone-iodine
- Administering local anesthesia via cervical injection of 1-2% lidocaine, if necessary
- Placing a tenaculum on the anterior cervical lip to stabilize the uterus
- Assessing the uterine depth and position using a uterine sound
- Inserting the endometrial biopsy device (commonly a Pipelle, Novak curette, or endometrial aspirator) through the cervical os into the uterine cavity to the fundus
- Withdrawing the inner sleeve of the device to create suction, and rotating and moving the device up and down to collect tissue samples from multiple areas of the endometrium
- Removing the device and placing the specimen in formalin solution
- Removing the tenaculum and speculum, and monitoring the patient briefly for cramping or bleeding
The procedure is most accurate when performed during the secretory phase of the menstrual cycle to evaluate for endometrial pathology, and patients should be advised to expect light bleeding for 1-3 days and can take NSAIDs like ibuprofen 600-800mg every 6-8 hours for pain 1. Complications are rare but include infection, perforation, or vasovagal reaction. The use of endometrial biopsy is preferred for diagnosing endometrial hyperplasia or cancer due to its less invasive nature, safety, and lower cost compared to dilation and curettage. However, the sensitivity of endometrial biopsy can be affected by various factors, including lesion type, size, and quantity, as well as uterine malformation and volume of pathology 1.
From the Research
Steps for Performing an Endometrial Biopsy
The steps for performing an endometrial biopsy include:
- Inserting an endometrial biopsy catheter through the cervix into the uterine cavity 2, 3
- Creating suction by drawing out the catheter's piston 2
- Obtaining tissue sampling by rolling the catheter while moving it in and out of the uterine cavity 2, 3
- Using nonsteroidal anti-inflammatory drugs and topical lidocaine to reduce procedure-associated pain 2
- Applying a tenaculum only if required by cervical mobility or uterocervical angulation 2
Pre-Procedure Considerations
Before performing an endometrial biopsy, consider the following:
- Pregnancy is an absolute contraindication to the procedure 2, 3
- Acute pelvic inflammatory disease and acute cervical or vaginal infections are also contraindications 3
- The procedure is indicated for evaluating abnormal uterine bleeding, cancer screening, and infertility evaluation 2, 4, 3
Post-Procedure Care
After the procedure:
- Cramping is a common adverse effect, but serious complications are rare 2, 3
- Patients should be referred for further evaluation if the procedure fails or an insufficient sample is obtained 2
- Postmenopausal women and women with persistent or recurrent symptoms should receive further evaluation even when biopsy results are normal 2