Biopsy of lesions of the female genital tract in the ambulatory setting

Abstract

The organs of the female genital tract (vulva, vagina, cervix, uterus, ovaries, and fallopian tubes) are capable of elaborating an immense array of pathologic conditions. These conditions can be primarily infectious in nature, or they can be neoplastic, precancerous, or frankly cancerous. In most instances the patient's history and physical examination alone are insufficient to establish a diagnosis, given the extreme similarity in clinical presentation of the various abnormalities of the female genital tract and the subtle differences that distinguish one from the other. In order to definitively establish the diagnosis, it is often necessary to obtain a tissue sample. Most clinicians are intimidated at the prospect of performing a biopsy of the lower female genital tract given concerns for patient discomfort and bleeding, in conjunction with a lack of familiarity with the specific techniques and instruments available to perform these biopsies. Conditions may go undiagnosed, or there may be a significant delay in diagnosis, as a result. In fact, failure to biopsy and obtain an accurate diagnosis in a timely fashion is a major concern from the medicolegal perspective. There is an increasing emphasis upon ambulatory care in our society. For this reason, it is essential that the clinician be familiar with the techniques that permit safe and reliable tissue diagnosis in the outpatient setting. This article is intended to describe the various techniques available to biopsy the organs of the female genital tract, as well as the instruments designed and uniquely suited for that purpose. An extensive Medline search was performed from the years 1965-2003, cross-referencing the terms "biopsy techniques" and "organs of the female genital tract." The results of this analysis detail both incisional and excisional biopsy techniques that can be safely employed by the clinician in the out-patient or ambulatory settings to obtain tissue samples to aid in initial diagnosis, or to accomplish therapeutic excision in order to definitively address a previously known condition. Being aware of the various biopsy techniques available for the outpatient evaluation of the female genital tract, and being comfortable with their use, increases the likelihood that abnormalities of the reproductive organs will be expeditiously evaluated, accurately diagnosed, and appropriately treated in a timely fashion.