Help! They messed up my endometrial biopsy!

[dandeliondandy]

Hi, please can anyone advise? I had a hysteroscopy and endometrial biopsy on June 24th. Been waiting for results. Today I got a letter stating that the biopsy sample they took was too small for pathology to process. This was despite me opting for a GA, being unconscious so they could do whatever they liked to me! I feel furious that they didn't take adequate samples and that was the whole point of me having a GA! Now they are saying they want to do another trans vaginal ultrasound in 4 weeks and a biopsy on the day - presumably whilst I am conscious! I wanted GA because a previous coil fitting had been so painful I almost passed out and I had a LLETZ procedure on my cervix so scar tissue/stenosis issues would make it even worse. I am so angry right now that I can't think straight because although I have tried to stay calm, at the back of my mind, I have been worrying about a sinister outcome
Now more uncertainty, more procedures etc. I feel so stressed.

Please can someone advise what to do next? Ask gynae for explanation, get referral to different hospital? Tell them no to biopsy without sedation/anaesthesia! I don't understand how they could mess it up with an unconscious patient on the table and the opportunity to take as much as they needed. I feel like crying.
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I'd try not to worry too much - I know that's easier said than done. I had a biopsy on its own and it was pretty much painless. (I did have a hysteroscopy some time later, without a GA and that was fine.)

The instrument they use is smaller than the one for a hysteroscopy. It took about 2 minutes and apart from a slight 'nip' that was it. No pain or anything afterwards. They do remove such a tiny amount. I suppose that's why it's possible the tiny amount wasn't able to be used (although it may also come down to the skill of the dr doing it.)

I can understand how you feel after going through it all, but it's a bit like a smear where they sometimes don't get enough cells (and then have to repeat it months later.)

Also- trying to be positive!- the procedure you had- the LLETZ- doesn't always result in stenosis - it's risk but many women are fine (I know women who've had it done and there was no scarring.)

I can't say for sure of course but it's unlikely they would give you a GA or sedation for a biopsy as it's such a quick procedure. You could ask for a local to be available it was a problem at the time?

Would you consider that?

Thank you for trying to be reassuring but I had two coils fitted before and I was in excruciating pain with the fittings and that was pre-LLETZ. I also suffer very badly from anxiety. I just don't understand how they coukd not have taken enough tissue for a biopsy during a GA. I wouldn't have felt anything, they could have taken their time to get as much as they needed. I feel so angry because they admit in the letter that the sample they took was too small for pathology to test! I wonder if the junior who was with the consultant was the one who actually performed the hysteroscopy/biopsy and they messed up?

I don't want local. I know that is painful too from other womem and that is without scar tissue etc. I am feeling so let down by them.

This is relatively common unfortunately. The samples are taken with a flexible straw and the endometrial tissue is sucked into the straw with gentle suction. You often get a bit of bleeding during the biopsy and it can be difficult to see how much of what has been pulled into the straw is actual endometrial tissue, and how much is blood clots, until it gets to the lab and they look at it under a microscope. It could also be that your endometrium was quite thin, and there wasn’t actually any more tissue to remove. This is relatively common after the menopause, depending on why they are doing the biopsy in the first place.

If you don’t want a further biopsy while you’re awake you’re completely within your rights to refuse. If was just a precaution they might not even need to repeat it. Have the conversation with your consultant and see what your options are.

Oh @dandeliondandy I too have had LLETZ, multiple times, a normal smear makes me cry now due to the pain from the scarring left behind. I feel physically sick when the results letter comes through in case I have to go through the colposcopy again.
Is there a number on the letter you can call, explain the situation and demand GA?

I have been told to expect the same from my biopsy as the lining was so thin it was difficult to collect any do likely to be 'scanty'. However, my gynecologist said that as everything looked fine during the hysteroscopy, that wouldn't concern her.

Do you think they want to do a transvaginal scan in 4 weeks to see if the lining is thick again? Would you be OK having that but telling them you won't have a biopsy without GA, and only then if it's necessary?

It's so stressful and I think they can be quite gung ho about it, not understanding how traumatic it can be. Good luck.

This happened to me. I went to the follow up appointment, which was in my case for another hysteroscopy and another biopsy ( but this time without a general anaesthetic)

I was a complete and utter mess in the waiting room for the appointment so the nurse went and got the consultant to come out and talk to me. He really listened to me and said as far as he was concerned he was happy for me to go home and he would request another biopsy under a general anaesthetic. However he said that as I had travelled a long way for the appointment ( an hours car journey) and as he was very good at his job ( yes he was arrogant but he said this with a smile and somehow it helped) how about we tried a hysteroscopy and he would talk me through it and if I wanted to stop we would stop. He also said that he would keep me totally topped up with gas and air and local anaesthetic.
And I agreed to try, and unbelievably to me I managed it. At every bit of the procedure he stopped and asked for my continued consent, he explained everything he was doing and he even found a polyp that was missed in my first hysteroscopy under general anaesthetic and removed it successfully.

I'm not sure if this helps at all, but I who find smear tests very painful and have had a lot of gynae problems over the years, was surprised at how well I coped with the whole process, which is just as well as I now will have to have six monthly hysteroscopies!