Biopsy techniques

Abstract

Most gynaecology textbooks consider that any postmenopausal bleeding or even spotting not related to the use of hormone replacement therapy is suspicious and should be evaluated in order to rule out the existence of endometrial cancer. Endometrial biopsy is a simple, inexpensive and safe procedure to assess the endometrium. This review evaluates the use of endometrium biopsy in the management of menopause. Screening endometrial biopsy is not justified in asymptomatic perimenopausal and postmenopausal women but it is useful in symptomatic women. Different devices exist, the most popular of which are Pipelle, Novak and Vabra. They provide detection rates of between 74% and 91%. Lower detection rates are obtained in post-menopausal than in pre-menopausal women. Cervix stenosis and pain may limit the sample adequacy but local anaesthesia may attenuate the latter. Another source of limitation is the disagreement in assessing endometrial pathology and this is more frequently encountered in women who are treated by oestrogen-only therapy. A pathological biopsy can thus save patients time, costs, and the inconvenience of a dilatation and curettage. A non-specific finding should be interpreted with caution. In Belgium, gynaecologists assess symptomatic patients in about one third of the cases using office biopsy.