Endometrial sampling

1. In-office sampling of the endometrial lining may be accomplished with a Novak or Kevorkian curet, the Pipelle endometrial-suction curet, or the Vabra aspirator. Before having an in-office biopsy, the patient should take a preoperative dose of a nonsteroidal anti-inflammatory drug (NSAID). With the patient in the lithotomy position, a speculum is inserted in the vaginal canal. The cervix should be cleansed with a small amount of an antiseptic solution. After 1 mL of a local anesthetic is infused into the anterior lip of the cervix, a tenaculum is placed. The paracervical block is then performed using 1 or 2 percent lidocaine (Xylocaine) without epineph-rine.

2. The cannula is then placed in the uterus and placement is confirmed with the help of the centimeter markings along the cannula. The inner sleeve is then pulled back while the can-nula is held within the cavity. This generates a vacuum in the cannula that can be used to collect endometrial tissue for diagnosis. Moving the cannula in and out of the cavity no more than 2 to 3 cm with each stroke while turning the cannula clockwise or counterclockwise is helpful in obtaining specimens from the entire cavity.

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