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Endometrial Biopsy

CheeseQueen57's picture
CheeseQueen57
Posts: 936
Joined: Feb 2016

My conclusion is don't let them do this painful procedure when they often don't get enough tissue to tell you anything. 
https://www.cancertherapyadvisor.com/home/cancer-topics/gynecologic-cancer/endometrial-cancer-study-reveals-practice-gap-treatment/

NoTimeForCancer's picture
NoTimeForCancer
Posts: 2841
Joined: Mar 2013

From the article:

In their concluding remarks, the study authors noted that “considering that D&Cs are invasive and costly, but were used for a majority of the follow-up care for women with Pipelle failures, it is particularly important in future research to determine whether repeat Pipelle, perhaps with supportive care, might prove more successful and reduce the need for invasive procedures.”

So, the Pipelle has FAILURES so they should just keep doing them over and over rather than a D&C?  That doesn't make sense.  The article said failures MISSED cancer - that is a pretty big MISS with a failure.  

My gyn tried the biopsy - too much pain and we went to the D&C.  I was fine with that, and knowing what I know now, I would suggest the D&C route and wouldn't be surprised if she recommends it too.  

cmb's picture
cmb
Posts: 594
Joined: Jan 2018

I've had three attempts at a Pipelle biopsy, by three different doctors (twice for the same instance of bleeding). None could be completed as the pain was intolerable. I was happy to have the D&C/hysteroscopy afterwards.

The first time years ago I had a benign polyp that was removed during the D&C. That fixed the bleeding I had been having. So even if the biopsy could have been completed, I still would have needed a D&C to remove the polyp.

The second D&C/hysteroscopy forewarned the gynecological oncologist that I had a rare cancer type, which he factored into my treatment plan.

Therefore, I'm definitely in favor of a D&C versus a biopsy.

So I find the conclusion of the researchers worrisome:

“considering that D&Cs are invasive and costly, but were used for a majority of the follow-up care for women with Pipelle failures, it is particularly important in future research to determine whether repeat Pipelle, perhaps with supportive care, might prove more successful and reduce the need for invasive procedures.”

I don't know what supportive care they're talking about here – perhaps they mean the patient taking misoprostol before the procedure. I had no side effects from taking misoprostol before the D&Cs. But I never taken it before a biopsy. And given where my polyp and later tumor were located, I'm not sure the biopsy would have been useful even if the doctors had been able to complete them.

Thanks for sharing the article link.

CheeseQueen57's picture
CheeseQueen57
Posts: 936
Joined: Feb 2016

Yes, in my opinion the conclusive statements in this article sucked. Endometrial biopsies hurt like hell, you will not just feel "a little disconfort!"  No man would let this be done to them. If your doctor suggests one, I would refuse and ask for a D&C. What supportive care???  They can't get a damned tissue sample!  How do you "support" that?  Ridiculou!

Donna Faye's picture
Donna Faye
Posts: 430
Joined: Jan 2017

I have always credited my female gyn for saving my life. When at 76, I had a gush of brown fluid, I went the next day to her. She did a sonogram and when she saw the thickened wall, she did a biopsy - she and a nurse stayed after hours to do it. The next day she called me and had already made an appointment with a gyn/onc! 3 weeks later I had the hysterectomy - stage 1 but UPSC. As I look back at the past 4 years and as I read others' experiences, I realize that many times our lives are in the hands of the doctors and their wisdom and compassion. I also think her age ( 56 ) and her gender played a role. I also wonder if the sonogram helped her know where to take the biopsy tissue??

MoeKay
Posts: 301
Joined: Feb 2004

This Supplement to OBG Management (Oct. 2017) is entitled "Endometrial Evaluation: Are You Still Relying on a Blind Biopsy."  Especially worthwile reading is the section "Shortcomings of Blind Biopsy." 

See:  https://www.globalacademycme.com/sites/default/files/obgm_worldclasssuppl_1017_0.pdf

My cancer was found on endometrial biopsy.  However, I have a major concern about women who have a negative endometrial biopsy that do not receive additional appropriate workup.  Based on the shortcomings outlined in this article, a negative endometrial biopsy is inadequate to rule out cancer.  I get the argument that D&C's are more expensive, and I'm all for saving money where appropriate, but not at the expense of women receiving delayed diagnoses that result the need for additional treatment, with all the associated side effects, or worse yet, death. 

Can you imagine a woman going in for a breast biopsy and having the doctor say that we're just going to poke around in your breast and take blind samples to see what if anything we come up with? 

 

Primavera's picture
Primavera
Posts: 217
Joined: Mar 2019

When I went to the gynecologist with post-menopausal bleeding, they said they would do a biopsy. I read they were very painful, but braced myself for it. They tried the first time; I was OK at the pain level. But she failed to get any tissue, so she went out to call another doctor and said they had to do it again. They tried the second time, and this time they said they would call me with results if they were not good.

I waited a week, nothing happened, then another week. At the end of two weeks, I got a call saying they didn't have enough tissue and that I needed to have a D&C. I wanted this D&C now asap. They did the D&C and found endometrial cancer, grade 3. From then on, it was a whirlwind because of the grade.

So now I don't believe in biopsies and I would go straight into a D&C, especially with postmenopausal bleeding as a symptom. They could have missed my cancer too, since it was all the way at the back of the uterus and the tumor was so tiny at that point.

When I had the D&C I was already doing reading here, so thank you all for getting me ready.

Molly110
Posts: 182
Joined: Oct 2019

I'm new enough to this that I didn't even know a biopsy alone was sometimes recommended. My gyn/oncologist said he would do a biopsy if I wanted one, but a D&C would be necessary to rule out cancer.  In other words, a biopsy might be adequate if it showed cancer, but a D&C would be definitive. Perhaps, though, that was due to something about my particular case. He also warned me that biopsies are pretty painful. It just outrages me when health care providers underdescribe (not a real word, I know) pain involved in procedures. How can someone prepare herself if she's been misled? I've been putting off having my port removed because the center where I get my care does not do any sedation for removal. I wish my wonderful gyn/onc could do it, rather than the interventional radiology department, but I know it doesn't work that way.

CheeseQueen57's picture
CheeseQueen57
Posts: 936
Joined: Feb 2016

My advice is leave the port for a while. I'm sure you'll be getting regular blood tests and it makes it so much easier. I've had my port for over 4 years now and it sure made it easier when I reoccurred or when I had to have other procedures. If it's not causing you other problems, I wouldn't be in a hurry to remove. 

Molly110
Posts: 182
Joined: Oct 2019

Thanks Cheese Queen (I love that name, BTW), for responding. I want the port out of my body, as it reminds me everything I want to forget at the time I most want to forget it. (I can feel it at night when I try to sleep on my side.)

I resisted getting a  port and waited until midway through chemo to do it. You are so right about how much easier it made everything! So, I've debated leaving it, but right now I'm thinking that the benefit of easy blood draws every 3 months isn't worth the stress of having it in. 

If I recur, I most likely will not do chemo again. Although the chemo itself was a breeze, I have considerable neuropathy and can't imagine living with the nerve damage from another set of treatments. I'm concerned, too, about losing my hearing to carboplatin if I had to do that again. Right now, I have no hearing damage but do have ringing and buzzing in my ears. I feel very lucky to have made it through chemo with relatively modest damage, and I don't know that I can count on being that fortunate again. 

You are such a fighter, and I admire that and am amazed at your grit. I was so glad to read that you are feeling better than you have in years on the new treatments.

Thanks again, 

Molly

 

CheeseQueen57's picture
CheeseQueen57
Posts: 936
Joined: Feb 2016

Keep in mind that many other treatments other than chemo (e.g. Keytruda) are also infusions. Also the port is helpful when getting contrast for imaging. My veins are pretty blown out and they often have to stick me multiple times to get a good vein. Thank you for your kind words and good luck to you. 

TeddyandBears_Mom's picture
TeddyandBears_Mom
Posts: 1707
Joined: Jun 2015

Molly,

If you do decide to get your port removed, just wanted to let you know it is not very painful. They will numb the area before they take it out. 

I actually put lidocaine on my skin with some cellophane before I had them numb the area. It helped to not feel the shots.

I was apprehensive too, but found it to be very tolerable.

Love and Hugs,

Cindi

Molly110
Posts: 182
Joined: Oct 2019

Hi Cindi,

I wasn't at all clear in my post that my concern about port removal is not pain. I have pretty severe anxiety about medical procedures, anxiety that isn't linked to whether something is painful. They use lidocaine for removal, and, like you, I used a lidocaine compound to numb the site before needle access, so I know it won't be painful. 

There was no pain when the interventional radiologist put the port in, but with the failed sedation it was one of the worst hours of my life (and, despite the advertised 20 minutes the procedure was supposed to take, I was wide awake from start to finish, which was 58 minutes). From what I can tell, best practice for port removal is to offer the patient twilight sedation if she wants it, but my hospital does not. The University of Wisconsin at Madison is just a couple of hours away, and they use conscious sedation, but unfortunately my insurance wouldn't cover me out of state.

Thanks again for responding,

Molly

 

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