Endometrial Biopsy: Tips and Pitfalls

Endometrial biopsy is a safe and efficient method to evaluate the endometrium for a variety of indications, most commonly abnormal uterine bleeding and postmenopausal bleeding. Endometrial biopsy is highly specific for diagnosing atypical hyperplasia and endometrial cancer in postmenopausal women. Pregnancy is the only absolute contraindication to the procedure. The biopsy is performed with an endometrial biopsy catheter that is inserted through the cervix into the uterine cavity. The catheter's piston is then drawn out to create suction. Tissue sampling occurs by rolling the catheter while moving it in and out of the uterine cavity. Nonsteroidal anti-inflammatory drugs can be administered orally before the procedure, and topical lidocaine can be applied to the cervix before starting the procedure to reduce procedure-associated pain. A tenaculum should be applied only if required by cervical mobility or uterocervical angulation because it increases pain and lengthens procedure times. Cramping is a common adverse effect, but serious complications are rare. Patients should be referred for further evaluation if the procedure fails or an insufficient sample is obtained. Postmenopausal women and women with persistent or recurrent symptoms should receive further evaluation even when biopsy results are normal because blind sampling may miss focal lesions.