Uterine biopsy not enough tissue extracted: Now What?

Posted by tclare15 @tclare15, Jan 28 12:05pm

I am post menopausal (72) and had vaginal discharge and spotty bleeding. Ultrasound early this month showed Endometrial thickness of 15 mm and a small 0.6 cm hyperchoic avascular lesion surrounded by fluid. Though I requested a hysteroscopy so that the lesion could be removed and tested (as was recommended on the ultra sound report), my gynecologist said the first step needed to be in-office ultra sound guided endometrial biopsy.

During the procedure, I asked if the lesion would be removed , she indicated it might or might not be, but she would concentrate in that area for removal of tissue. A week later, she called and said "no cancer is seen", but when I asked her to actually read the report to me, she admitted that no cancer was seen because there was not enough tissue retrieved at the biopsy to actually test ("No definitive endometrial tissue identified"....so the biopsy was "inconclusive" and she did not know if the lesion was still there or not!

So, now I am left with no more information than I had before and the additional worry that the lesion may or may not be available for testing at this point! She suggested waiting to see if spotting re-occurs and said my chances of actually having cancer were tiny, but if I'm one of the 1% who actually have it, that is no satisfactory answer! What should be my next step?

Interested in more discussions like this? Go to the Gynecologic Cancers Support Group.

@dovelandgriff

My cancer was detected, or at least strongly suspected, by a CAT scan with contrast. Ask for that as a next step. I will be 65 this month.

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Thankyou...I'll definitely keep this suggestion on my list of points to cover on my next visit.

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@naturegirl5

@tclare15 My earlier message was getting long so I did not add the following which I will do now.

My brother was treated for prostate cancer at Stanford. His doctor (medical oncology with a speciality prostate cancer) is outstanding. When he was diagnosed with prostate cancer by his urologist (in private practice) I urged my brother to go to an academic medical center. My brother is also in the Bay Area so for him it was Stanford or UCSF. We've been impressed with his care.

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We are indeed fortunate here in the Bay Area to have two great teaching hospitals within an hour or less drive. You have been so helpful to me with your re-assurances and information.

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My cancer was detected, or at least strongly suspected, by a CAT scan with contrast. Ask for that as a next step. I will be 65 this month.

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@tclare15

Your message is very reassuring and I sure appreciate it!

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@tclare15 My earlier message was getting long so I did not add the following which I will do now.

My brother was treated for prostate cancer at Stanford. His doctor (medical oncology with a speciality prostate cancer) is outstanding. When he was diagnosed with prostate cancer by his urologist (in private practice) I urged my brother to go to an academic medical center. My brother is also in the Bay Area so for him it was Stanford or UCSF. We've been impressed with his care.

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@naturegirl5

@tclare15 Thank you for sharing all of these details of your appointment. I'm relieved to know that your doctor spent so much time with you and explained, in detail, what and how the hysteroscopy procedure will go. Like you, I would be nervous waiting until April but it sounds like your doctor was reassuring about the wait. Perhaps there will be a cancellation and you'll get in before April?

I'm going to respond to your concern in a following post about residents present at Stanford during your procedure. I have received and continue to receive my specialty care at Mayo in Rochester. Mayo Clinic is an academic medical center and there are frequently residents and fellows in my appointments. I was referred to Mayo for endometrial cancer and so that's where I had my hysterectomy, my radiation treatments, as well as all of my cancer surveillance appointments. There was a physician present (fellowship in gyn-oncology, not a resident) during hysterectomy procedure and this was clearly detailed in my surgery notes. In fact, I met the gyn-oncology fellow in pre-op. I personally have great confidence in teaching hospitals because the residents and fellows are under the supervision of these skilled physicians who are on the faculty at teaching institutions. I was a professor in a university with an academic medical center and while my academic appointment was not in medicine I did interact frequently with physicians in research. I worked with physicians at "the top of their game" and this is what I have observed in my own care at Mayo Clinic as well as the care my partner receives at Mayo. They conduct research and they know the literature in their respective fields. I hope this will give you more confidence in your upcoming hysteroscopy procedure.

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Your message is very reassuring and I sure appreciate it!

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@tclare15

I'm writing to let you know what happened with my Stanford visit on Feb. 7th as you requested. I was pretty impressed with how attentive the doctor was with my concerns and she was very thorough with answers and plan of action. Since the biopsy done by the previous gynocologist was unsucessful and there was not sufficient endometrial tissue for the pathologist to work with from that procedure, the next step needs to be a hysteroscopy which will allow the doctor to see clearly the inside of the uterus. She will get a good sampling of tissue as well as locate and take out the lesion (if it is still there) for pathology. She was very clear that she understood the possibility of puncture was a huge concern to me given the natural post-menopausal condition of my reproductive organs, and addressed that saying she is and will be very mindful of that when the procedure takes place. Today I had a telehealth visit with her just to clarify points and plan for hysteroscopy. The problem is that the soonest she can get me in for the procedure will be in April. She assured me that given the images from the ultrasound and reading the reports, she felt confident the wait would not be problematic. She will perform a hysteroscopy in the Operating room at the hospital under MAC (Monitored Anesthesia Care). If the results are shown to be pre-cancer or cancer, then she will refer me to Stanford's oncology gynecologist department for further action (which I have already determined will be a hysterectomy) . Right now, I just need to wait for the scheduler to call me and schedule the surgery. I find that researching on-line is both scary and re-assuring depending on what reports and clinical trials I read and I clearly need to step back from that at some point and trust my decisions thus far. There is so much to absorb, and without a medical background, it is hard sometimes to put what I read into helpful and relevant perspective. Thank you so much for your concern and comments. Really appreciate that!

Jump to this post

@tclare15 Thank you for sharing all of these details of your appointment. I'm relieved to know that your doctor spent so much time with you and explained, in detail, what and how the hysteroscopy procedure will go. Like you, I would be nervous waiting until April but it sounds like your doctor was reassuring about the wait. Perhaps there will be a cancellation and you'll get in before April?

I'm going to respond to your concern in a following post about residents present at Stanford during your procedure. I have received and continue to receive my specialty care at Mayo in Rochester. Mayo Clinic is an academic medical center and there are frequently residents and fellows in my appointments. I was referred to Mayo for endometrial cancer and so that's where I had my hysterectomy, my radiation treatments, as well as all of my cancer surveillance appointments. There was a physician present (fellowship in gyn-oncology, not a resident) during hysterectomy procedure and this was clearly detailed in my surgery notes. In fact, I met the gyn-oncology fellow in pre-op. I personally have great confidence in teaching hospitals because the residents and fellows are under the supervision of these skilled physicians who are on the faculty at teaching institutions. I was a professor in a university with an academic medical center and while my academic appointment was not in medicine I did interact frequently with physicians in research. I worked with physicians at "the top of their game" and this is what I have observed in my own care at Mayo Clinic as well as the care my partner receives at Mayo. They conduct research and they know the literature in their respective fields. I hope this will give you more confidence in your upcoming hysteroscopy procedure.

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@tclare15

Point well taken! I realize what a knot I've put my stomach in trying to anticipate everything that could go wrong and trying to prevent it somehow. Thank you for the sage advice.

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You are welcome!

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@aardvark2118

Hello as much as you can please try not to google fir info. Write your questions down and most physicians now have a patient portal so you can ask questions in between visits I made the mistake of searching early on and only resulted in needless worry about things I’d read that didn’t pertain to my diagnosis. Since then I have two sites I use and then come to every appointment with my questions written down. Take care

Jump to this post

Point well taken! I realize what a knot I've put my stomach in trying to anticipate everything that could go wrong and trying to prevent it somehow. Thank you for the sage advice.

REPLY
@tclare15

I'm writing to let you know what happened with my Stanford visit on Feb. 7th as you requested. I was pretty impressed with how attentive the doctor was with my concerns and she was very thorough with answers and plan of action. Since the biopsy done by the previous gynocologist was unsucessful and there was not sufficient endometrial tissue for the pathologist to work with from that procedure, the next step needs to be a hysteroscopy which will allow the doctor to see clearly the inside of the uterus. She will get a good sampling of tissue as well as locate and take out the lesion (if it is still there) for pathology. She was very clear that she understood the possibility of puncture was a huge concern to me given the natural post-menopausal condition of my reproductive organs, and addressed that saying she is and will be very mindful of that when the procedure takes place. Today I had a telehealth visit with her just to clarify points and plan for hysteroscopy. The problem is that the soonest she can get me in for the procedure will be in April. She assured me that given the images from the ultrasound and reading the reports, she felt confident the wait would not be problematic. She will perform a hysteroscopy in the Operating room at the hospital under MAC (Monitored Anesthesia Care). If the results are shown to be pre-cancer or cancer, then she will refer me to Stanford's oncology gynecologist department for further action (which I have already determined will be a hysterectomy) . Right now, I just need to wait for the scheduler to call me and schedule the surgery. I find that researching on-line is both scary and re-assuring depending on what reports and clinical trials I read and I clearly need to step back from that at some point and trust my decisions thus far. There is so much to absorb, and without a medical background, it is hard sometimes to put what I read into helpful and relevant perspective. Thank you so much for your concern and comments. Really appreciate that!

Jump to this post

Hello as much as you can please try not to google fir info. Write your questions down and most physicians now have a patient portal so you can ask questions in between visits I made the mistake of searching early on and only resulted in needless worry about things I’d read that didn’t pertain to my diagnosis. Since then I have two sites I use and then come to every appointment with my questions written down. Take care

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My remaining concern is that as great of a reputation as Stanford has, I realized that it is a teaching hospital and the surgeon will have a resident assisting her. I will need to confirm exactly what "assisting" means in this case.

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