ENDOMETRIAL (ASPIRATION) BIOPSY
A tissue sample obtained through biopsy permits diagnosis of cel-lular changes in the endometrium. Endometrial biopsy, a method of obtaining endometrial tissue, is performed during the pelvic examination when indicated as an outpatient procedure.
Women undergoing this procedure may experience slight discomfort. Usu-ally, the procedure can be performed without anesthesia; however, a paracervical block or a small injection of lidocaine into the uterus is effective if required. The examiner may apply a tenaculum (a clamp-like instrument that stabilizes the uterus) after the pelvic examination and then inserts a thin, hollow, flexible suction tube (pipelle or sampler) through the cervix into the uterus.
Endometrial biopsy is usually indicated in cases of midlife irregular bleeding, postmenopausal bleeding, and infertility (to identify changes in the uterine lining after ovulation). Women who are bleeding irregularly while receiving hormone replacement therapy or who experience any bleeding while taking tamoxifen are usually advised to undergo endometrial biopsy.
Findings on aspiration may include normal endometrial tis-sue, hyperplasia, or endometrial cancer. Simple hyperplasia is an overgrowth of the uterine lining and is usually treated with pro-gesterone. Complex hyperplasia is a risk factor for uterine cancer and is treated with progesterone and careful follow-up. Women who are overweight, who are over 45, who have a history of nul-liparity and infertility, and who have a family history of colon cancer seem to be at higher risk for hyperplasia (Farquhar, Lethaby, Sowter et al., 1999).