Biopsy of uterine fibroids is not generally recommendable or feasible.  First of all, the cancerous fibroid is an extraordinarily rare finding in women prior to menopause.  Thus the overwhelming majority of women will not have this condition.  In addition because fibroids usually occur in clusters, that is, several tumors being located in the same uterus, it is technically not possible to accurately biopsy multiple areas even if a cancer were suspected. 

Fibroids are tumors.  Oft times the term “tumor” to many people always means “cancer”.  In spite of the fact that we make every effort to explain that tumors can be either benign or cancerous and that a fibroid is a NON-cancerous tumor, nevertheless many women express a desire to have their myomas biopsied.  This is especially true when they are contemplating doing nothing about the tumors and attempting to just observe them instead of undergoing some surgical treatment. 

Biopsying a myomatous uterus is not a practical thing to do for several reasons.  Firstly, cancer masquerading as a fibroid is extremely rare and thus one would literally have to carry out biopsies on thousands of women before a cancer would be diagnosed.  But more importantly, most uteruses that are affected by fibroid tumors have multiple fibroids.  If one is to accurately perform a biopsy, each one of these tumors would have to be biopsied. This could for example mean performing a biopsy on as many as a hundred tumors. This is a practical impossibility.  The only way to prove that fibroids are not cancerous would be to remove them all either through myomectomy (cutting the fibroid off of the uterus) or through hysterectomy (removing the uterus).  The amount of surgery that this would require, given the population, would exceed the ability of surgeons and hospitals to accommodate it if every woman wished to have this assurance. Fortunately, concern over cancer in a fibroid is rarely justified in the typical woman that we see with this problem.  It is for this reason that fibroids are routinely assumed to represent non­cancerous growths.  Our management principles are based on this concept. 

All of these tests may seem somewhat confusing and overwhelming, but now you have the background to be able to engage in informed conversation with your doctor and to be able to make intelligent decisions about your care. – Francis Hutchins, Jr., M.D.   

*********

2006 Email:  "Perhaps you should discuss your "rarity" statement about fibroids being cancerous before menopause.  I know someone who has cancer." 

On the contrary, my statement stands.  I have had a number of such patients over the years but the fact remains that leiomyosarcoma  is found in less than 1% of all fibroids removed (remember the vast majority of fibroids are never removed).  In addition, overwhelmingly these tumors are in post menopausal women.  There has been no change in these statistics.

The fact that you are aware of one woman who unfortunately was found to have this sarcoma puts you in the same position as most gyns.  Most will see thousands of women with fibroids yet will see one or two with sarcoma prior to menopause.  Yet in any lecture there are always those who want to do hysterectomies for all women with fibroids for fear of sarcoma which by the way is a vicious tumor that kills in @ 1 yr. from diagnosis. 

So if we act on anecdotal experience there would not be enough gynecologists or OR's to perform all the hysterectomies requires recognizing that fibroids are the most common tumor of the female pelvis.   - Francis L. Hutchins, Jr., MD

Note:  Endometrial Biopsy and My Journey - Endometrial Biopsy.