ENDOMETRIAL BIOPSY? NOT SO QUICK!

 

 

Dr Steven R. Goldstein is a highly regarded Gynecologist in NYC for abnormal uterine bleeding, Menopause, Perimenopause and more for women’s health. His research in the field of gynecological ultrasound has been ground breaking with much of it being adopted as the standard of care by the American College of Obstetricians and Gynecologists.

Many women who suffer from pelvic pain or irregular bleeding are told to have an “endometrial biopsy” as the first means of diagnosis. If you’ve been told to have an endometrial biopsy, then “not so quick.”

 Blind endometrial biopsies with these tiny plastic devices became very popular in the early 90’s. and became the standard of care after a report said they were 97.5% accurate. Before that, women had Dilatation and Curettage (D&C) or a scraping that was done under anesthesia. Both of these are painful, invasive, procedures that cause women a lot of discomfort and needless pain.

In 1995, a much better study of women with known cancer had a biopsy in the operating room before the hysterectomy. They missed 11 out of 65 of the cancer in those women, which meant that 16% of the time in these women with cancer who had a blind biopsy, the cancer was missed! In all of these cases, it was found that the cancer occupied less than half of the surface area of the uterine cavity. So, unless the cancer or precancer is detected by a blind biopsy, a gynecologist should not consider a blind endometrial biopsy as a stopping point for diagnosis.

Dr Goldstein, a NYC Gyn, says that a better option for diagnosis is a saline infusion sonohysterogram where some fluid is put into the uterus with a much thinner catheter tube. This enables the operator to see the uterine cavity better. The reason ultrasound is such a home run in obstetrics is because the baby is in a bag of water. This is why we get such beautiful images. So, by putting some fluid into the uterus, we can see better and get high resolution images of the entire uterine cavity instead of doing a blind biopsy and only sampling a small portion of the uterine lining for diagnosis.

A sonohysterogram has become the new standard of care in such situations. In the right hands, it is painless, takes a few minutes and is done right in your gynecologist’s office. The clear, high-resolution images produced show minute detail of the ovaries, fallopian tubes, uterus, endometrial lining etc. Such details cannot be obtained with painful, invasive endometrial biopsies that are unfortunately still performed by physicians who are not using up to date methods to diagnose patients.

Either that or, for some women, the use of disposable office hysteroscopes may be appropriate. With these, a physician can see inside the uterus in a matter of minutes painlessly, but the procedure requires more preparation and analgesia.

So, if you, a friend, relative or colleague are told to have an endometrial biopsy, ask first for a saline infusion sonohysterogram. As usual, Dr Goldstein, a leading Gynecologist in NYC is always available for a consultation.