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Uterine biopsy not enough tissue extracted: Now What?

Gynecologic Cancers | Last Active: Apr 23 9:14pm | Replies (31)
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@tclare15

This is an update to my experience at Stanford regarding post menopausal workup for 15 mm thick endometrial thickness, Post menopausal bleeding, and a small lesion found on Transvaginal Ultrasound. I need to say this far my experience has been frustrating. Initial consult with gynecologist was fine and plan for operating room hysteroscopy decided upon. Dr. forgot to send in request for the OR, so this set me back a week and the operation could not be scheduled until May, so I opted for an "in office" hysteroscopy with another doctor which was a week ago (April 15). Message from Attending Physician sent to me a couple of days after procedure says "Good News: no cancer or pre-cancer..no need for additional treatment or workup....Let me know if you would like to dicuss the results further". I then look at the attatched Pathology report which says under Diagnosis comments: "The sections demonstrate extremely scant strips of surface inactive endometrium. There is not sufficient intact endometrium showing endometrial glands with stroma to evaluate for hyperplasia or carcinoma. Additional sampling is suggested if clinical concern persists".......So Again...I am left with questions and insufficient tissue to make a diagnosis, BUT the gynecologist is saying I'm in the clear ... Has anyone on this forum encountered such a conflicting situation? Am I reading this correctly? The Resident's notes after the procedure indicated no lesion was found, but the pathology report claims the operation was "hysteroscopic polypectomy"..... I am so confused! Any light to be shed on this? I have left a message asking for an appointment to discuss this with the doctor, but I am frankly unsure now about getting a straight answer.

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Replies to "This is an update to my experience at Stanford regarding post menopausal workup for 15 mm..."
blanchette | @blanchette | Apr 23 1:53pm

@tclare15 - what a frustrating series of experiences. I share your skepticism that you will get a straight answer during your upcoming appointment. However, it is probably necessary to clarify your gyn's perspective and ascertain her explanation for why her opinion diverges from that of the pathologist.

I think the pathologist was advising you to have another procedure done. S/he was giving you a head's up that the purpose of the hysteroscopy was not accomplished. Have you considered a second opinion?

I am not in the medical field. But I was in a similar situation to you 9 months ago: long past menopause with bleeding and abdominal pain. An ultrasound showed my endometrial lining to be 18 mm. My gyn wanted to do an in-office endometrial biopsy. I declined and insisted on a procedure in a hospital under sedation. I had a hysteroscopy and D & C in hospital. Pathology report came back with diagnosis of endometrioid cancer, FIGO stage 2. Subsequent CT scan showed pulmonary nodules, subsequent PET scan and lung biopsy showed metastases. I had hysterectomy and BSO in January 2024 (pathology report showed 100% myometrial invasion). Started chemo and immunotherapy in February, and am now N.E.D. So kind of a bad news/ good news scenario.

All along the way I had to speak up for myself, and follow up when professionals (or their admin staff) dropped the ball. It's tiring and frustrating. When I asked my 1st gyn a series of questions about anesthesia, she blurted out, "Do you want to cancel this surgery? Because I'm coming in on my day off." She sounded like my mother on her worst day. Not wanting an angry woman with a sharp instrument rummaging around in my uterus, I canceled the surgery and started all over again with a different gyn practice and different hospital. In sum, we have to navigate not only our anxiety about serious health issues, but we have to deal with other obstacles, as well.

But this is your health. No one in health care will care as much as you do. I am thinking of you, and wishing you strength and much better outcomes in your next steps.

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