WOMENS-HEALTH Messages for January, 1998: Re: endometrial biopsy and false negative test results

Re: endometrial biopsy and false negative test results

From: Kelly Shanahan, MD (anonymous@obgyn.net)
Sat, 31 Jan 1998 13:03:27 -0600 (CST)

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In reply to: Sharon: "endometrial biopsy and false negative test results"
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Reply: Harvey S. Marchbein, M.D.: "Re: endometrial biopsy and false negative test results"

At Sat, 31 Jan 1998, Sharon wrote: >
>Recently I asked whether it was preferable to take pathology from tissue
>taken during a hysteroscopy or to do a D&C to determine whether
>treatment for hyperplasia has been effective. I have been diagnosed
>with endometrial hyperplasia and polycistic ovary syndrom (PCOS) that
>was discovered by an hysteroscopy that my doctor wisely insisted on even
>though an endometrial biopsy came back normal just six weeks earlier.
>Question: Given the false negative that came back on the endometrial
>biopsy before, when I complete my 4 month Provera treatment, can I rely
>on the results of another endometrial biopsy to accuratly show if the
>hyperplasia has been taken care of? My doctor mentioned that it is
>unusual for a endometrial biopsy to be so far off the mark, but has
>suggested that in my case we should do another hysteroscopy and take
>tissue for pathology, or a offce or outpatient D&C. Any suggestions on
>which of these two options would give me the best chance of accurate
>results? [My Thanks to Dr. Marchbein who provided great information to
>my previous posting]

Hysteroscopy with directed biopsies is more accurate than endometrial biopsy. First and foremost, with the hysteroscope we can see what we are doing. If there is an abnormal appearing area, we can watch ourselves biopsy it -- if we do a D&C, we can go back and check that we actually sampled teh abnormal appearing area. Endometrial biopsies are blind procedures and do not sample the entire uterine lining -- I like to use this example: take a lightbulb and a small artists paintbrush. Put the paintbrush in the lightbulb and rotate it. Can you "paint" the entire inside of the lightbulb with a couple of twirls? NO. Just like we can't sample every speck of uterine lining with an endometrial biopsy -- I find them much more useful if something shows up, but I can't rule out hyperplasia or even cancer in a small area if it is negative.

Given your history, I'd recommend hysteroscopy and D&C.

--
Kelly Shanahan, MD, FACOG
S. Lake Tahoe, CA

note: Opinions here are for educational purposes only. This information is not intended to supplant the need for you to consult with your own physician. It cannot take the place of a face to face consultation and examination.
Sorry, but private e-mails will not be answered.

Next message: Kelly Shanahan, MD: "Re: HYSTERECTOMY"
Previous message: Kelly Shanahan, MD: "Re: Prempro"
In reply to: Sharon: "endometrial biopsy and false negative test results"
Next in thread: Harvey S. Marchbein, M.D.: "Re: endometrial biopsy and false negative test results"
Reply: Harvey S. Marchbein, M.D.: "Re: endometrial biopsy and false negative test results"

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