Stephenson Milex Biopsy Technique (Mary Stephenson, MD - University of Illinois, Chicago)
If a routine Pipelle biopsy is not successful, consider using the following technique developed by Dr. Mary Stephenson.
Bimanual exam of uterus, need to know position because catheter is rigid. Cleanse cervix with Betadine swab, apply xylocaine spray to external os. Insert catheter to anterior fundal wall. Pull back syringe to 1 or 2 cc only, further will just cause more discomfort. Apply back and forth motion to obtain sample. Avoid the lower uterine segment because it is usually not as well developed. Release the pressure in the syringe before removing catheter. This will allow the specimen to remain in the catheter and not in the syringe. Gentle push the tissue out of the catheter into the formalin (or cut tip off before pushing tissue out to minimize damage to specimen).
10-20% of the time you may need to use a tenaculum on the anterior lip of the cervix.
Failure rate (unable to insert or inadequate specimen) estimated at 5%.