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

Re: endometrial biopsy and false negative test results

From: Harvey S. Marchbein, M.D. (anonymous@obgyn.net)
Sat, 31 Jan 1998 22:21:00 -0600 (CST)

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In reply to: Kelly Shanahan, MD: "Re: endometrial biopsy and false negative test results"

At Sat, 31 Jan 1998, Kelly Shanahan, MD wrote: >
>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

In your particuar case, the D&C with hysteroscopy may be the best choice due to "false negative' results previously, as Dr Shanahan stated.

I just want to point out that for the majority of patients, the endometrial biopsy has replaced the D&C as a diagnostic tool and the literature substantiates this. A sonohysterogram done with an endometrial biopsy can also be very revealing by giving the thickenss of the endometrium and help the doctor delineate a possible "false negative".

--
Harvey S. Marchbein, M.D. FACOG
OBGYN.net U.S. Representative, New York
Great Neck, New York
http://www.obgyn.net/states/bios/marchbein.htm
http://www.obgyn.net/women/advisors/harveym.htm

**Note:  Opinions expressed here are for educational purposes only
and, as such, do not constitute a physician-patient relationship.
This information is not intended to supplant the need for you to
consult with your physician prior to choosing therapeutic options
and/or interventions.

**Private emails cannot be entertained due to time constraints,
consequently no private emails will receive a response.

**Thank you for your understanding ;-)

Next message: Harvey S. Marchbein, M.D.: "Re: moval of cervix during hysterectomy"
Previous message: Harvey S. Marchbein, M.D.: "Re: Prempro"
In reply to: Kelly Shanahan, MD: "Re: endometrial biopsy and false negative test results"

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