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How reliable is an endometrial biopsy How reliable is an endometrial biopsy

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  #1  
Unread 07-03-2009, 08:53 AM
How reliable is an endometrial biopsy

OK...I've been having problems w/pain & heavy bleeding for years - lap in 1997 confirmed endo. It has been getting worse & runs my life (my last period lasted 10 days!) - went to my GYN, sent me for bloodwork & a regular ultrasound & transvag ultrasoung. The tech saw something, wouldn't tell me.
At my follow up appt w/ my GYN I was told I have endo, adnomyosis(sp?)and a cyst on my ovary - I could handle this news. Due to these we decided on TAH.
He then told me he was VERY worried I have uterine cancer (I can't remember exactly why he thought this - something showed up in the tests). He said I could go in for D & C or we could do an endometrial biopsy in the office that day- I opted for the biopsy - I wanted to know ASAP what is going on. It wasn't as bad as I thought & what he told me other women said. He was so sure I have Uterine C that he started telling me about removing lymph nodes, surgery would be longer, etc. Well, I go home & wait days & they call me - good news - its benign! They don't know what it is, but will send everything out to pathology after my TAH.
I should be happy, right? BUT all I keep thinking about is the biopsy didn't get the right spot. Just how accurate is an endometrial biopsy? I have this REALLY BAD feeling when I wake up on the 14th after surgery he will be standing there to give me the news that the biopsy missed it & he was right. Can some of you sisters that had an endometrial biopsy let me know how things went for you? I am the type that has to know all possibilities & info possible.

Any info would be so GREATLY appreciated!!
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  #2  
Unread 07-03-2009, 11:43 AM
Re: How reliable is an endometrial biopsy

Hi --

First, I'm really sorry that you're having to deal with this. Everyone on this board knows the anxiety and fear of waiting for biopsy news.

My gynecologist told me that endometrial biopsies were accurate in the 90% range -- very, in other words, but not completely. In my case, my endometrial biopsy came back: "hyperplasia with atypia" -- which caused enough concern to do a D&C, which showed cancer cells. My surgery showed much more advanced cancer than anyone anticipated. If there's any fear of cancer, I would get an appointment with a gynecological oncologist. And I'd make sure that a gyn/onc is at least assisting with the surgery.

Thinking of you, and wishing you a safe surgery, quick recovery, and the best of news.
  #3  
Unread 07-03-2009, 11:47 AM
Re: How reliable is an endometrial biopsy

Hi!

Wow! That would be very scary and confusing to be told by your doctor that he was sure there was cancer in there and then have the endometrial biopsy come back ok.
The doctors won't be able to really tell exactly if it is or isn't cancer until the surgery is done and the pathology report comes back. From what I have read on this wonderful website, it sounds like most people who have uterine cancer know before surgery from a biopsy or D&C. I had 2 endometrial biopsies, a D&C, and a frozen section/biopsy during surgery that showed complex endometrial hyperplsia with atypia (pre-cancer). I think that is very unusual though and it was a very, very, very small area. Keep in mind, that if after its all done, there was cancer in there, that it is highly curable. After being told you probably have cancer and then not, that's just not something you can erase from your mind but try to stay positive and don't dwell on the "what ifs". Talk to your doctor and ask questions until you feel comfortable. Get a second or third opinion if you need to.
Good luck! Keep us updated!
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  #4  
Unread 07-03-2009, 11:50 AM
Re: How reliable is an endometrial biopsy

Hi
The sad reality is that anything is possible. but what you need to know is that while a biopsy can miss something the hyst may still resolve the prob. My cancer was contained and they did remove lymph nodes to be safe but, if it is contained inside the uterus most often further treatment isnt required. Best of luck, I Hope your considering a da vinci hyst as it is so much better, faster healing, better margins, better visualization etc. at least ask.
Until then you should know that only a small percentage of ut cancer becomes advanced and treatment when caught early is mild not like you might imagine.
I am a survivor, and an advocate, i have been where you are and all the info can consume you. I am like you in wanting the info. balance is the key. Keep in touch let us know how you are
Lots of love
  #5  
Unread 07-03-2009, 05:34 PM
Re: How reliable is an endometrial biopsy

I has a biopsy 5/26 and knew 5/29 that I had endometeroird andenocarcinoma gade 2 aggressive,,done in my dr office...I think they are pretty accurate but I think only after your surgery do they know for sure, Early dx is almost a total cure, Ask questions, demand answers you understand....I am waiting on staging pathology now....dr said he thinks he got it allbut not confirmed yet. Doing pretty well post op..one week today. I know your'e scared...information is vital to your peace of mind....Bless you as you wait..the hard part
  #6  
Unread 07-03-2009, 06:53 PM
Re: How reliable is an endometrial biopsy

From personal experience, it can show cancer, but none of the rest of my biopsy was right!

I was initially diagnosed from an endo biopsy with Grade 3 and they could not figure out the cell type.

We got the path report back yesterday and it was Grade 1.
  #7  
Unread 07-03-2009, 09:46 PM
Re: How reliable is an endometrial biopsy

Hi Cheryl,

So sorry you're having to go through this.

May I urge you to consult with a gyn/oncologist before you have surgery? They are better trained to do cancer surgery, and you'll probably have much better results if a gyn/oncologist is at least supervising your care.

And also a TAH is the traditional way to do a hyst for cancer, but you may want to look into the DaVinci or Robotic surgery. If it is appropriate for your situation and if it's available in your area, you may want to consider it. It is a much easier recovery and even better visualization for the surgeon than the TAH.

Best of luck to you,
  #8  
Unread 07-04-2009, 05:12 AM
Re: How reliable is an endometrial biopsy

IMHO, there are so many variables to gynecological cancer that it certainly adds to the difficulty of the experience. Having to wait until surgery to have the cancer staged conclusively, for example, is very trying. I, too, prefer to be well informed and amassed a lot of information, only to find out as things evolved that I would not have the need for a lot of it. But, it made me feel better and more confident to learn as much as I could.

I ended up with a D&C with hysterscope, which found the cancer, because they were unable to retrieve enough tissue with an endometrial biopsy due to my cervix toughening with age (I was 57 at the time). I also had an ovarian cyst, which I have read is likely to be malignant at my age, but the cyst turned out to be benign. And, my tumor was initially graded at 2 based on the D&C but after surgery it was downgraded to 1-2. Before surgery, the gyn onc told me I might have to have internal radiation - after surgery, no further treatment was needed and I am already on an annual exam basis.

For your peace of mind if for no other reason, I think it would be best to consult a gyn onc. And, as my sister the pharmacist advised me, be careful what web sites you visit as you are looking for info. Unfortunately, some web sites do not have accurate information.

Please continue to let us know how things are going for you.
  #9  
Unread 07-04-2009, 05:49 AM
Re: How reliable is an endometrial biopsy

Thanks everyone for responding!!! I just keep thinking that I made a mistake & should have gone for the D&C for a better sample. I will call my Dr on Wednesday & ask more questions. I do know this - I want whatever it is OUT OF ME!!!
Sorry to be so whiney - so many of you are dealing with REAL issues & mine are in my mind at this point.
  #10  
Unread 07-04-2009, 08:08 AM
Re: How reliable is an endometrial biopsy

Hi Cheryl,
Since your doctor initially was concerned re possible cancer, I can understand how you remain worried/confused even though the path report came back showing all is fine. I recommend you talk to a gyn/onc explaining what occurred and at the least s/he will review your records and explain why your gyn initially mentioned possible cancer. If the gyn/onc believe pre-cancer or cancer could be there, pls have them at least present during your surgery.
An endometrial biopsy frequently catches pre-cancerous or cancerous cells; I've read it is ca87-95% accurate. The alleged "gold standard" is a D&C with hysteroscope but while very accurate it is not 100% full proof; I had one and while only pre-cancer was found, my post-surgery path report showed 2B grade 1 cancer. My gyn/onc explained that as cancer may hide INSIDE the uterus out of reach even during a D&C and surgery is the only means for 100% confirmation.
I know the waiting, possibility of further testing, etc; is very hard; for me this was the hardest; most frustrating time. Once surgery was scheduled I knew IF the beast were there it would be removed and if necessary further treatment could very likely assure it's would be all gone. Endometrial cancer is considered the best gyn cancer to have as it exhibits symptoms in the earliest stages which means surgery alone often can be the cure.
As you gather more info, talk with your doctor(s,) I know you'll make the right decision for you. Pls keep us posted.
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