After my first episode of light spotting, my doctor performed an exam and I had a vaginal ultrasound. Both were normal so my doctor said nothing further needed to be done. When I had light spotting a second time, my doctor and I agreed to get a biopsy. My doctor explained that a hysteroscopy includes a camera inserted into the uterus and an instrument is used to grab samples of the lining for biopsy. A D&C will remove any remaining tissue to ensure the entire lining is biopsied. If results are benign, I don't think a doctor would do a hysterectomy unless there are other indications of cancer. If no cancer is found, in my case the doctor said my slight spotting would most likely be due to vaginal atrophy.