I want to talk to you more about these endometrial or so-called uterine biopsies which are not really biopsies at all. It’s a little complicated but try to stay with me. I’ll make it simple. Medical students are even taught that any bleeding in menopause is uterine cancer until proven otherwise. Most studies would indicate that 5 to 10% of such patients have endometrial cancer. For arguments sake, let’s be generous and say at the highest 12% of these women with postmenopausal bleeding actually have cancer.
Studies have indicated that the miss rate on patients with cancer with blind endometrial biopsy sampling ranges from 2 to 33%. The best study however places that at about 16%. That’s one out of every six cancers that are missed. Thus out of 100 women who have bleeding, 12 might have cancer, blind sampling would miss two. So if you do sampling on 100 women with bleeding, you will find 10 with cancer and you will miss 2. It looks like blind endometrial sampling is 98% effective unless you’re the two women who are missed.
Let’s compare this to obstetrical sonograms. Virtually every woman in America has at least one Ultrasound at approximately 20 weeks of gestation looking for any Fetal malformation. The overall incident of malformation s is approximately 3%. If you simply rubbed the transducer over the abdomen without even turning on the machine, you will look like you were correct 97% of the time. Our job is not to credit for the 97%, you are fine. Our job to find the 3% who have serious malformations. Likewise, our job is identify the women with endometrial cancer, not to be credited for those who do not have it.
A miss rate of 16% with endometrial sampling ( again it isn’t really a “biopsy”) in women with cancer is too high to accept its reliability. Distinct lining on transvaginal Ultrasound when it’s able to be seen in its entirety is much more reliable at excluding cancer than blind “biopsy”
Why do I put “ biopsy” in quotations? By definition a biopsy is taking tissue to be examined by a pathologist and it’s either done as a needle biopsy, an incisional, biopsy, or excisional biopsy. Sampling is defined as taking a portion of something that is representative of the entire body. For instance when you take water out of reservoir to analyze it, you assume that the portion you took out to analyze is representative of the entire body of water. These uterine so-called biopsies are really not biopsies. They are sampling done, blindly and if the process whether cancer or precancer or polyp occupies less than 50% of the surface area of the uterine lining such blind sampling has been shown to be very very unreliable.
Still even ACOG seems to use the terms interchangeably and clearly they are not. Patients beware. Most practitioners and even their governing body the American College of Obstetricians and Gynecologists don’t seem to get it.
Dr Steven R. Goldstein is a top Gynecologist in Manhattan in practice for over 35 years. He is also a tenured Professor of Obstetrics and Gynecology at New York University School of Medicine. He is the Recipient of the 2018 Joseph H. Holmes Clinical Pioneer Award from the American Institute of Ultrasound in Medicine (AIUM). This is in recognition of Dr Goldstein’s distinguished career in ultrasound in medicine, and making outstanding contributions to the growth and development of medical ultrasound which he favors over blind endometrial biopsies.
If you have been told you need an endometrial biopsy, or a uterine biopsy as a first means of diagnosis for uterine cancer, abnormal bleeding, post menopausal bleeding etc then don’t! Opt for a painless transvaginal ultrasound instead. To schedule a consultation with Dr Goldstein, a leading obgyn in Manhattan, feel free to contact the office.