How Often Is Endometrial Cancer Missed with Biopsy and Accuracy of In-Office Screening

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Endometrial Biopsy Procedure

A biopsy is the preferred method for detecting endometrial cancer as the familiar Pap smear is not sensitive enough on its own to detect endometrial cancer. Certainly, if abnormal cells are detected during a routine step, your doctor may then follow up with a biopsy, especially if you have any of the risk factors associated with it. Risk factors include obesity, diabetes, and infertility.

The procedure is similar to a Pap smear and can be done in your doctor’s office. A speculum is inserted into the vagina. Then, a tenaculum is used to stabilize the uterus. Suction by a small, hollow plastic tube called a Pipelle suction curet will retrieve the necessary sample.

Accuracy of the Biopsy

The accuracy of the biopsy is determined by what is collected in the sample. If no tissue is present, your doctor may perform a D & C procedure to gather the necessary material. This type of sampling is typically quite accurate.

A 1995 study published in Obstetrics and Gynecology reported that use of the Pipelle for detecting endometrial cancer was excellent, with nearly a 100 percent detection rate. However, its use in detection of other endometrial diseases was only rated fair. A review of diagnostic methods published in the journal, American Family Physician, corroborated these finding, suggesting that in-office testing is an accurate and perhaps more comfortable way for women to be screened for endometrial cancer.

How often is endometrial cancer missed with a biopsy? To increase the accuracy, doctors may use a vaginal ultrasonography to screen patients prior to the biopsy. Of course, avoiding any invasive procedure is optimal. A vaginal ultrasonography will measure the thickness of the endometrium which can indicate the risk of developing cancer. A cutoff of 5 mm has demonstrated good results.

However, endometrium thickness alone is not necessarily the primary risk factor, especially in postmenopausal women, according to a 2010 study published in the journal, Obstetrics and Gynecology. The main symptom associated with endometrial cancer is abnormal bleeding. This symptom along with other risk factors can determine the efficacy of an endometrial biopsy.


As with many types of cancer, early detection greatly improves the rate of survival. The survival rate for those with Stage I cancer in which the tumor is limited to endometrium is over 90 percent. Endometrial cancer is a slow-growing form, making annual examinations an important means to detect early cancer stages.

With in-office screening methods such as the endometrial biopsy, you can avoid negative thinking of how often is endometrial cancer missed and trust your doctor and technology.


Canavan, Timothy and Doshi, Nipa. Endometrial Cancer. American Family Physician. 1999.

Goldstein, S.R. Modern Evaluation of the Endometrium. Obstetrics and Gynecology. 2010

Van Den Bosch, T., Vandendael, A., Van Schoubroeck, D., Wranz, P. A. B, and Lombard, C. J. Combining Vaginal Ultrasonography and Office Endometrial Sampling in the Diagnosis of Endometrial Disease in Postmenopausal Women. Obstetrics and Gynecology. 1995.