• Endometrial sampling
• Cervical Smear   

A 'blind', that is not under visual guidance, sampling (biopsy) of the uterine lining tissue.

• Having an endometrial biopsy
• Purpose of an endometrial biopsy
• Information obtained from this procedure

Having an endometrial biopsy

The woman removes the clothes from the lower half of her body, slips on a gown and lies on the examination couch on her back. She may be asked to lift her legs into supports or stirrups. An instrument called a speculum will be inserted into the vagina, this then allows the walls of the vagina to be gently parted so that the neck of the womb (cervix) can be seen (see fig. 1). The device or pipelle for taking the biopsy from the lining of the womb (the endometrium), is inserted into the womb (uterus) via the cervix. A small piece of tissue is taken from the uterus by the pipelle. The pipelle is then removed and the tissue it has sampled retrieved and placed in a specimen pot and sent to the laboratory for analysis. With the removal of the speculum the procedure is completed.

The procedure may be associated with minimal discomfort, which can of course be heightened by the psychological stresses induced by having to undergo a procedure which can be viewed as embarrassing, plus the anxiety of what might be found. The movement of the pipelle through the cervical canal and the taking of the biopsy can induce a period like pain or cramp. Any discomfort experienced should be rapidly resolved with the conclusion of the procedure.



Figure 1

Purpose of an endometrial biopsy

An endometrial biopsy is a useful adjunct to an ultrasound scan, especially if the scan has demonstrated that the lining tissue of the uterus is thicker than that which was to be expected. The thickening of the tissue needs classifying as to whether it is a normal response due to hormonal stimulation, or if it is the result of abnormal cellular changes, a small percentage of which may be cancerous.

Information obtained from this procedure





Figure 2 - Normal cells





Figure 3 - Abnormal cells

Author:
B. Phipps
Clinical Nurse Specialist
Last Review: 21/02/2003

The taking of a sample of cells from the neck of the womb which are then sent to the laboratory for a detailed analysis. This investigation is used specifically to identify cancerous cells, although other cellular abnormalities and infections are not infrequently diagnosed.

• Having a cervical smear
• Information obtained from this procedure

Having a cervical smear

The woman removes the clothes from the lower half of her body, slips on a gown and lies on the examination couch on her back. She is asked to draw her knees up, placing her heels together and allowing her legs to relax. Alternatively dependent upon facilities in the examination room, she may be asked to lift her legs into supports or stirrups. An instrument called a speculum will be inserted into the vagina, this then allows the walls of the vagina to be gently parted so that the neck of the womb (cervix) can be seen. Cells from the cervix are removed using either a wooden spatula or long cotton swab (see fig 4). These cells are then transferred to a glass slide, a fixative solution is added before the slide is sent to the laboratory for processing. The speculum is removed and the procedure is completed. The procedure is generally pain free, although sometimes there is discomfort associated with the speculum's presence in the vagina.



Figure 4

NB in the post menopausal woman this procedure may be more uncomfortable due to the general deterioration of the vaginal tissue once oestrogen levels are lost. For this reason the procedure may also cause some vaginal bleeding. The procedure may also be less successful in this group of woman, again due to oestrogen's absence, which results in a diminished number of cervical cells available to be sampled.

Information obtained from this procedure

The sole purpose of this procedure is to identify abnormal cellular changes, especially those of a pre cancerous or cancerous state.



Figure 5 - Vaginal Atrophy

On the left side of Figure 5: Pre menopause - vaginal cells are large and flat with small nuclei

On the right side of Figure 5: Post menopausal - vaginal cells become thin and dry and appear clumped together with large nuclei this may cause soreness & increase the likelihood of vaginal infection