What is the difference between endometrial biopsy and colposcopy

Imaging tests show pictures of the inside of the body. Doctors may also do tests to learn which treatments could work best. For most types of cancer, a biopsy is the only sure way for the doctor to know if an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory.

If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. This section describes options for diagnosing uterine cancer. Not all tests listed will be used for every woman. Your doctor may consider these factors when choosing a diagnostic test:.

In addition to a physical examination, the following tests may be used to diagnose uterine cancer:. Pelvic examination. The doctor feels the uterus, vagina, ovaries, and rectum to check for any unusual findings. A Pap test , often done with a pelvic examination, is primarily used to check for cervical cancer.

Sometimes a Pap test may find abnormal glandular cells, which are caused by uterine cancer. Endometrial biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. A pathologist analyzes the sample s. An endometrial biopsy is a relatively quick and simple procedure. During an endometrial biopsy, a small sample is taken from the lining of your uterus — the endometrium — so that it can be studied for signs of cellular abnormalities.

You might also hear an endometrial biopsy referred to as a uterine biopsy. There could be several reasons why your doctor can recommend a biopsy:. You may be told to stop these medicines before the procedure. Your healthcare provider may ask you to keep a record of your menstrual cycles.

You may need to schedule the procedure for a specific time of your cycle. If your provider gives you a sedative before the procedure, you will need someone to drive you home afterwards.

You may want to bring a sanitary napkin to wear home after the procedure. Based on your condition, your healthcare provider may call for other preparation. What happens during an endometrial biopsy?

Generally, an endometrial biopsy follows this process: You will be asked to undress fully or from the waist down and put on a hospital gown. You will be told to empty your bladder before the procedure. You will lie on an exam table, with your feet and legs supported as for a pelvic exam. Your healthcare provider will insert an instrument called a speculum into your vagina to spread the walls of the vagina apart to view the cervix. Your provider will clean your cervix with an antiseptic solution.

Your provider may numb the area using a small needle to inject medicine, or he or she may apply a numbing spray to your cervix. A type of forceps may be used to hold the cervix steady for the biopsy. You may feel some cramping when it is applied. Your provider may insert a thin, rod-like instrument, called a uterine sound, through the cervical opening to find the length of the uterus and location for biopsy. This may cause some cramping. The other authors have no relevant financial affiliations.

Women who have abnormal Papanicolaou test results may undergo colposcopy to determine the biopsy site for histologic evaluation. Traditional grading systems do not accurately assess lesion severity because colposcopic impression alone is unreliable for diagnosis. The likelihood of finding cervical intraepithelial neoplasia grade 2 or higher increases when two or more cervical biopsies are performed. Excisional and ablative methods have similar treatment outcomes for the eradication of cervical intraepithelial neoplasia.

However, diagnostic excisional methods, including loop electrosurgical excision procedure and cold knife conization, are associated with an increased risk of adverse obstetric outcomes, such as preterm labor and low birth weight. Methods of endometrial assessment have a high sensitivity for detecting endometrial carcinoma and benign causes of uterine bleeding without unnecessary procedures.

Endometrial biopsy can reliably detect carcinoma involving a large portion of the endometrium, but is suboptimal for diagnosing focal lesions. A 3- to 4-mm cutoff for endometrial thickness on transvaginal ultrasonography yields the highest sensitivity to exclude endometrial carcinoma in postmenopausal women. Saline infusion sonohysteroscopy can differentiate globally thickened endometrium amenable to endometrial biopsy from focal abnormalities best assessed by hysteroscopy.

Hysteroscopy with directed biopsy is the most sensitive and specific method of diagnosing endometrial carcinoma, other than hysterectomy. Cervical cancer was diagnosed in 12, American women in , resulting in 4, deaths.

Treatment of high-grade cervical intraepithelial neoplasia CIN may be necessary to prevent progression to invasive cervical cancer, despite concern about adverse obstetric outcomes.

Endometrial cancer, the most common female genital cancer, was diagnosed in more than 43, women and resulted in 7, deaths in Enlarge Print. Two or more colposcopic-directed cervical biopsies should be performed to increase the sensitivity of colposcopy for identifying high-grade CIN lesions. Colposcopic-directed biopsies of acetowhite epithelium should be performed even when the colposcopic impression is squamous metaplasia or low-grade disease.

Excisional techniques for treating CIN increase the risk of preterm labor and low birth weight, especially with greater depth of excision.

Transvaginal ultrasonography showing endometrial thickness of less than 3 to 4 mm essentially rules out endometrial carcinoma in a postmenopausal woman. A focal endometrial lesion found on saline infusion sonohysteroscopy should be evaluated with hysteroscopy. Women who have abnormal Pap test results may undergo colposcopy to determine the biopsy site for histologic evaluation. Colposcopy allows for visualization of the lower genital tract using magnification and illumination after applying dilute acetic acid.

Colpophotograph of a woman with low-grade squamous intraepithelial lesion cytology. Colposcopic impression is low-grade disease with unsatisfactory colposcopy. Histology revealed cervical intraepithelial lesion grade 3.

Philadelphia, Pa. Because histology determines disease severity and dictates management, 12 methods have been sought to improve the sensitivity of colposcopy. Recent evidence demonstrates that colposcopists should perform multiple cervical biopsies and consistently sample acetowhite epithelium. Colpophotograph of a woman with atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion ASC-H. There is a significant amount of acetowhite epithelium.

Multiple biopsies showed cervical intraepithelial lesion grade 1 and grade 3. The role of random biopsies in increasing the sensitivity of colposcopy is being investigated. Given that the accuracy of colposcopy is lower than anticipated, criteria for determining where to biopsy are needed. Using a grading system may encourage colposcopists to perform a biopsy only if the lesion appears high grade, and high-grade lesions that are small and subtle may be missed.

Data from one study 16 demonstrate that colposcopic-directed biopsies of acetowhite lesions should be performed even when the colposcopic impression is squamous metaplasia or low-grade disease 7 , 16 Figure 1 6. According to the American Society for Colposcopy and Cervical Pathology ASCCP , endocervical curettage should be performed in specific situations, such as unsatisfactory colposcopy following low-grade intraepithelial lesion, colposcopic evaluation of high-grade squamous intraepithelial lesion Figure 3 6 , or initial evaluation of all subcategories of atypical glandular cell cytology.

Colpophotograph of a woman with high-grade squamous intraepithelial lesion cytology. Colposcopic impression is high-grade disease and unsatisfactory colposcopy.

Ectocervical histology showed cervical intraepithelial lesion CIN grade 1 and grade 3. Endocervical curettage revealed CIN 3. The patient is not a candidate for ablation, and diagnostic excision should be performed. No significant differences in success rates were observed with any modality. Same as for LEEP, but preferable when margin status is critical for determining residual disease e.

Information from references 3 , 12 , and 20 through LEEP and cold knife conization allow histologic review of the excised tissue, whereas ablative techniques destroy the transformation zone, precluding histologic evaluation.

Effect on Pregnancy Outcomes. Retrospective, case-control observations conclude that overly aggressive use of diagnostic excisional procedures may produce long-term adverse obstetric outcomes. The goals of excisional treatment are complete removal of the lesion and the transformation zone, resulting in interpretable margins.

Most women with involved margins will not develop persistent or recurrent disease. Endometrial biopsy was developed for in-office assessment of the endometrium as an alternative to dilation and curettage. Transvaginal ultrasonography can be used to triage women with suspected endometrial pathology.

In post-menopausal women, an endometrial thickness of 3 mm or less has the greatest sensitivity to exclude endometrial carcinoma, although using a cutoff of 4 mm or less may be more cost-effective.