Ultrasound and Endometrial Biopsy


What is ultrasound? Ultrasound is an instrument that utilizes sound waves to visualize various internal structures and operates on the same principle as sonar on a submarine. In gynecology, ultrasound is used to evaluate conditions such as abnormal bleeding, uterine fibroids and ovarian cysts.

Sonohysteroscopy or Fluid-contrast Ultrasound

What is fluid-contrast ultrasound (FCUS)?  FCUS is a special type of  ultrasound which helps evaluate the endometrium (lining of the uterus or womb) and any abnormalities in the uterine cavity (the space inside the womb).  Polyps and fibroids are commonly seen with the FCUS and cannot be seen with plain ultrasound.

FCUS Procedure

How is a FCUS done, and does it cause pain? After the cervix (mouth of the womb) is cleansed with an antiseptic, a tiny plastic tube is gently inserted into the uterine cavity. In most instances the patient will not be aware of the catheter being placed into the uterus. Two situations may make the insertion of the catheter more difficult and as a result cause mild discomfort. These are the retro- or ante-verted uterus (tilted backward or forward) and cervical stenosis (the canal going into the uterine cavity is closed). In both instances, a paracervical nerve block is given to minimize any discomfort associated with the insertion of the plastic catheter. Usually the patient does not feel the nerve block being administered, which is accomplished by injecting a local anesthetic into the cervix with a needle. Fortunately, the cervix has very few nerve cells which accounts for the nerve block being painless for most patients.
 Occasionally, the patient will experience light-headedness, a detached feeling, or ringing in the ears. If this occurs with you, do not panic; these symptoms are transient and will disappear quickly. Once the plastic catheter is in place, the vaginal ultrasound probe is gently inserted into the vaginal canal (this feels very similar to insertion of a speculum for a PAP smear. A small amount of sterile solution is slowly injected through the catheter into the uterine cavity while looking with the ultrasound. Once the measurements and evaluation are completed, the fluid is withdrawn and the vaginal probe removed. In most instances the entire procedure from start to finish takes less than 15 minutes. This is a photo of a lesion seen at FCUS. What you are seeing is the wall of the uterus surrounding the cavity filled with fluid. In the center of the fluid is a lesion that could be either a large polyp or fibroid. You would not be able to see this without the fluid.


What happens next?
If any abnormality (lesion) such as a polyp or fibroid is seen, a hysteroscopy is scheduled to be done at a later date to remove the lesion. Briefly, hysteroscopy is a surgical procedure performed as an outpatient under a light general anesthetic (patient is asleep). A thin telescope-like instrument is inserted through the cervix (no incisions are necessary), and the inside of the uterine cavity visualized and the lesions removed under direct vision. The “hospital stay” is usually just a couple of hours after the surgery is completed, and there is minimal discomfort after the procedure.

Endometrial Biopsy

In the case no lesion is seen with FCUS, an endometrial biopsy may be done immediately after the ultrasound is completed. If a paracervical nerve block was not utilized for the FCUS (see above), one is usually given just prior to the biopsy. A thin plastic tube is inserted into the uterine cavity, suction applied, and a small amount of tissue removed and sent to the laboratory for evaluation. Most patients report minimal discomfort (occasionally moderate menstrual-like cramping) which only lasts a few seconds. It will usually take several days to get the final results. Assuming no evidence of pre-cancer or cancer is found, hormonal therapy will frequently eliminate the abnormal bleeding. If the unlikely happens and cancer is diagnosed, further therapy will be necessary to treat the condition.

In summary
Advancing technology has allowed the development of minimally-invasive techniques which frequently can be done in an office setting and are associated with minimal discomfort. Additionally, by diagnosing conditions early we are frequently able to prevent a problem before it occurs.

The information provided by Advanced Healthcare for Women and E. Daniel Biggerstaff, III, M.D. is for informational purposes only. As each woman is unique, do not rely on this information for diagnosis and treatment. We cannot guarantee the accuracy of the content and advise that you see a qualified Health Care Professional for individual needs and care.