The occasional endometrial biopsy.

An endometrial biopsy is a safe and efficient office-based procedure for sampling the endometrium in a patient presenting with abnormal uterine bleeding. The endometrial sample pro vides a tissue diagnosis for guiding further management. Insertion of an intrauterine contraceptive device and an endometrial biopsy share common steps, which can aid the rural practitioner when performing the occasional endometrial biopsy. Endometrial biopsy has replaced dilation and curettage (D&C) as the initial procedure for sampling the en dometrium because it is safer, more convenient, less costly and gives equally accurate results. Studies comparing endometrial biopsy and D&C have found excellent agreement of samples (83%–96%). Endometrial biopsy gives an adequate tissue sample in 84% to 91% of women when the polypro pylene catheters are used. The procedure is highly sensitive for the detection of endometrial carcinoma. A metaanalysis that included almost 8000 wom en revealed that endometrial biopsy using a polypropylene catheter detected 99.6% of endometrial cancer in postmenopausal women and 91% of en dometrial cancer in premenopausal women, along with 81% of atypical hyperplasia.