From the Guidelines
The steps for performing an endometrial biopsy involve positioning the patient in the lithotomy position, performing a bimanual examination, inserting a speculum, and using a thin, hollow instrument to collect tissue samples from the endometrium, as outlined in the most recent guidelines 1. The procedure begins with the patient positioned in the lithotomy position on an exam table with feet in stirrups.
- The healthcare provider first performs a bimanual examination to determine the position of the uterus.
- A speculum is then inserted into the vagina to visualize the cervix, which is cleansed with an antiseptic solution.
- Local anesthesia may be applied to the cervix to reduce discomfort.
- The cervix might be stabilized with a tenaculum, and the cervical canal may be dilated slightly if needed.
- A thin, hollow instrument (such as a Pipelle, Novak curette, or endometrial suction catheter) is gently inserted through the cervix into the uterine cavity.
- The instrument is rotated and moved back and forth to collect tissue samples from different areas of the endometrium.
- Suction is often applied to draw tissue into the device. After sample collection, the instrument is removed, and the tissue is placed in a preservative solution and sent to the laboratory. The procedure typically takes 5-10 minutes and causes cramping similar to menstrual cramps, as noted in previous studies 1. Patients may experience light bleeding for a few days afterward. Complications are rare but can include infection, perforation of the uterus, or excessive bleeding. The procedure is most commonly performed to evaluate abnormal uterine bleeding, postmenopausal bleeding, infertility, or to rule out endometrial cancer, with a false-negative rate of about 10% 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
- Creating suction by drawing out the catheter's piston 2
- Obtaining tissue samples by rolling the catheter while moving it in and out of the uterine cavity 2
- Administering nonsteroidal anti-inflammatory drugs orally before the procedure and applying topical lidocaine to the cervix to reduce procedure-associated pain 2, 3
- Applying a tenaculum only if required by cervical mobility or uterocervical angulation, as it can increase pain and lengthen procedure times 2
Pre-Procedural Considerations
Before performing an endometrial biopsy, consider the following:
- Pregnancy is the only absolute contraindication to the procedure 2
- Evaluate the patient's medical history and current symptoms to determine the need for the procedure 4, 5, 6
- Discuss aftercare instructions and results delivery with the patient in advance 6
Technical Procedure
The technical procedure for performing an endometrial biopsy involves:
- Using a narrow polyethylene sampling device, which results in a sensitivity approaching 95% for the diagnosis of endometrial cancer 4
- Ensuring adequate sampling, as inadequate samples are more common in postmenopausal than premenopausal women 4
- Considering the use of intrauterine anesthesia, such as levobupivacaine or lidocaine, to reduce pain during the procedure 3