Any pathological changes in the structure of the endometrium have Negative influence on reproductive function women (cycle disorders, infertility and miscarriage, development of neoplasms).
One of the most modern diagnostic methods is a pipell biopsy of the endometrium. During the operation, a particle of the uterine mucosa is removed, then a histological examination is performed. The operation allows you to identify atypical changes and establish the cause of the disorder menstrual cycle or infertility.
Depending on the technique, there are several ways to extract tissue: partial curettage, surgery, hysteroscopy.
The purpose of an endometrial biopsy is to study to identify the causes of infertility, miscarriage, and menstrual irregularities. The procedure is also used in preparation for IVF. Lets get full information about the condition of the mucous membrane.
Aspirate from the uterine cavity is also taken in case of hormonal abnormalities, a history of miscarriages, uterine bleeding that is not associated with menstruation, hyperplasia, and malignant neoplasms.
During the procedure, mucous particles are surgically removed. Depending on the tactics of execution, tissue sampling is performed using a tube, a vacuum apparatus or a syringe. In conventional curettage, a surgical curette is used for diagnostic purposes. Material for research can also be obtained during hysteroscopy using a probe. Equipped with a video camera, the device has a small surgical instrument that takes precise samples from the lining of the uterus (endometrium).
Modern equipment allows you to take a sample of the mucous membrane in the desired area - the uterus, the cervical canal - without damaging healthy tissue. The possibility of complications and discomfort during the operation is minimized. A biopsy is considered minor surgical intervention. It is usually performed routinely for diagnostic purposes, but in rare cases it is performed as part of the main operation or in urgently.
Carrying out diagnostics
Diagnosis using aspiration biopsy or other type of material collection is carried out when various defects uterus, lack of menstruation, and bleeding during menopause.
If the study is carried out as planned, the operation is preceded by the following diagnostic measures:
- taking a smear for cytology and flora;
- Ultrasound of organs located in the woman’s pelvis;
- General analysis of urine and blood.
An emergency biopsy is performed in case of suspicion or precise establishment of the presence of a malignant neoplasm in the uterine cavity or cervix, and the day of the cycle is not taken into account.
- refusal to take drugs that affect blood clotting and anticoagulants;
- temporary abstinence from sexual activity (at least three days before surgery);
- refusal to douche;
- exclusion from the menu of dishes that cause gas formation.
Improper preparation for surgery can cause various complications, such as vascular damage (resulting in bleeding), endometrial rejection, and cycle disruption.
When to take aspirate from the uterine cavity
An endometrial biopsy is performed according to indications determined by the doctor observing the woman. Taking an aspirate from the uterine cavity is necessary in the following cases:
- suspicion of tumor growth;
- scanty menstruation or uterine bleeding, including dysfunctional;
- in the presence of inflammatory processes endometrium;
- determining the cause of infertility, spontaneous abortions or missed pregnancies;
- amenorrhea without pregnancy for unknown reasons;
- preparation for the IVF procedure;
- pregnancy pathologies.
Scraping the endometrium allows you to determine its structure and identify atypical cells. Its thickness and exact location are also determined.
The procedure is applied if, after standard gynecological examination and performing an ultrasound, the doctor detects pathological changes in the endometrium. Diagnosis is always carried out before removing fibroids or myomas, polyps, or malignant neoplasms.
Contraindications
The list of contraindications is the same for all variants of this diagnostic procedure. Pipelle biopsy is not performed in the following cases:
- Pregnancy. Even in the presence of unprotected sexual intercourse before the operation, when determining conception is impossible with a standard home test, a study is done to hCG level to accurately establish the fact of fertilization.
- Blood clotting disorders. In such cases, aspiration biopsy is not performed. Sometimes diagnostic measure precedes treatment of the underlying pathology.
- Presence of infection (chronic or acute process). Pathology is indicated by pain, itching, bleeding not associated with menstruation, purulent discharge.
- Contraindications also include hemophilia, high degree of anemia, some chronic diseases in the acute stage.
The list of contraindications is strictly taken into account before diagnosis in order to avoid side effects after surgery.
Suspicion of cancer pathology is a direct indication for diagnostics, and an emergency one at that. In this case, the biopsy is performed with a minimum number of contraindications.
What is the procedure
Endometrial biopsy is performed according to different methods, however, the aspiration option is more often used. It is less traumatic, there is absolutely no discomfort during the procedure, the risk of complications and side effects is minimized, and the information content of the study is quite high.
The analysis is taken after appropriate preparation for the procedure, which begins 3 days before the procedure. Immediately before the examination, the intestines are cleansed with an enema.
A biopsy of the mucous membrane of the cervical canal or uterus lasts no more than 3 minutes (on average 30–60 seconds depending on the qualifications of the doctor). Rarely, a woman may need anesthesia. The absence of nerve fibers allows manipulation to be performed with minimal use of painkillers.
It involves collecting material from the cervical or uterine canal using a vacuum/syringe/tube/curette. Additionally, the doctor can remove polyps.
Curettage of the uterine lining and further histological examination of the material are carried out for women of any age, including during menopause, before or after childbirth and pregnancy.
Timing and technique of performing a biopsy
Endometrial biopsy is performed at certain periods of the cycle depending on the diagnostic goals pursued:
- When clarifying the factors of infertility against the background of anovulatory cycles and the minimum luteal phase, the analysis is done one day before the onset of menstruation or on the first day of bleeding.
- In the case of acyclic bleeding not associated with menstruation, curettage of the mucous membrane is prescribed on the first or second day of menstruation.
- When diagnosing polymenorrhea, manipulation is carried out between the fifth and tenth days of the cycle.
- To determine the cause of hormonal imbalance, a sample is taken in the second phase of the cycle between the 17th and 25th days.
- If you suspect the presence of benign and malignant neoplasms The scraping is taken regardless of the day of the cycle (emergency).
Any study involves the insertion of a special device into the vagina to collect a sample of the endometrium. The methods differ in duration, possible side effects, and information content.
Scraping
Biopsy curettage is both a diagnostic and therapeutic procedure. Curettage was previously used not only to identify endometrial pathology, but also to emergency assistance with bleeding.
Curettage of the cervix is used less frequently today than other methods, since it is performed blindly, sometimes under the control of an ultrasound machine or visualization of the organ using a hysteroscope. The manipulation is carried out under general anesthesia, often intravenous.
This procedure not only makes it possible to identify the cause of changes in the structure of the mucous membrane, but also has a therapeutic effect:
- emergency stop of bleeding from the uterus;
- removal of the damaged area of the mucosa;
- removal of glandular polyps and other neoplasms (except malignant ones).
The optimal time for curettage is considered to be the 3-4th day before menstruation, and in case of cycle disorders, the first day of the appearance of acyclic blood discharge.
The total operation time takes up to 20 minutes; intravenous anesthesia is preferable for pain relief. During the operation, the external genitalia are disinfected with iodine-containing preparations, and urine is removed using a catheter.
After a short-term anesthesia is administered, the cervical canal is opened with a special instrument, the material is scraped out with a surgical curette and placed in a special bottle. After this, a hysteroscope is used to examine the mucous membranes of the uterus, then a curette bigger size Once again, material is taken from the inner surface of the organ. The resulting sample is placed in a separate bottle and sent for histology.
Aspiration biopsy
The aspiration technique for obtaining tissue samples is used more often than curettage. With this technique, expansion of the cervical canal is not required, since the procedure is quite painful. The flexible tube used during the procedure reduces the risk of trauma to the uterine wall to zero.
The aspiration tube allows you to obtain material from any part using sterile devices, which reduces the risk of infection. Also, if an aspirate is used, the biopsy is taken almost painlessly, the uterus recovers faster, and the woman can return to her normal life immediately after scraping.
Negative factors of performing aspiration biopsy include the impossibility of simultaneously examining the structure of all areas of the endometrium. There is a risk that local small areas of damage will remain unexamined.
The results of histological examination of material selected in this way are highly informative.
The collection of particles from the uterine mucosa is carried out on different days depending on the tasks:
- to remove a polyp immediately after the end of menstruation;
- on the 1st day of the cycle with atypical blood discharge;
- when conducting hormonal treatment– on the 17th–24th day of the cycle (including to monitor the prescribed treatment);
- in case of long and painful periods - on the 7th–10th day;
- to clarify the factors of infertility - 2–3 days in advance;
- regardless of the day after/before menstruation when determining a malignant neoplasm.
Aspiration biopsy is performed using several methods: collecting tissue particles directly into a syringe, placing tissue samples in saline, or using a vacuum unit.
Pipelle biopsy
This diagnostic method is preferable to aspiration biopsy and curettage. During diagnosis, the catheter replaces a small plastic cylinder. At one end, placed in the uterine cavity, there is a small hole on the side, at the other there is a piston. When the material is removed, a vacuum is created, the hole is attached to the wall of the uterus, and mucosal cells are literally sucked into the device.
The procedure is also performed at certain periods of the menstrual cycle, depending on the type of examination. The technique has a number of advantages:
- painless, no anesthetics are used;
- no side effects;
- carried out without dilation of the cervix;
- most informative;
- a flexible tube allows you to control the depth of insertion, which reduces the risk of injury to the internal walls of the uterus;
- no hospitalization required;
- fewer contraindications, possible use in women with serious chronic or acute diseases.
This technique also allows us to identify the causes hormonal disorders, infertility, assess the growth of tumors.
Zug biopsy
This technique is one of the least dangerous and least traumatic compared to endometrial aspiration biopsy or curettage. Can be executed a maximum of three times per loop.
This technique is not used to diagnose cervical precancer or malignant neoplasms.
To determine the cause of uterine diseases, the cervical canal is artificially expanded, and a small curette is carefully inserted into the organ cavity. With its help, tissues are collected from the surface of the inner layer.
Line scraping of the endometrium is carried out from the depths outward up to the internal os of the cervix. Two samples of material are collected at a time.
The procedure is performed on the 1st–2nd day of menstruation or after it. The taken uterine material is also sent for histology, which makes it possible to accurately identify the causes of infertility, hormonal changes, uterine bleeding, and the location of tumors.
Infertility procedure
Endometrial biopsy is considered one of the leading methods for clarifying the factors causing infertility, miscarriage, spontaneous abortions, interruption of fetal viability and other disorders of female reproductive function. In addition, it is possible to establish the causes of uterine diseases with a biopsy, and increase the chances of embryo implantation during IVF.
The procedure helps not only to identify factors of infertility. Even pregnancies that occur as a result of in vitro fertilization are observed more often. A high percentage of successful IVF was noted. Positive effects were recorded when the biopsy was performed in the month preceding fertilization.
To clarify the factors of infertility, the operation is performed according to the same scheme as the usual diagnostic procedure. Examination of the material allows us to identify the presence or absence of atypical cells, including precancerous conditions, hormonal disorders, inflammatory processes, hyperplasia and other factors leading to lack of conception.
Complications and consequences
Aspiration biopsy, when performed professionally, causes virtually no side effects. The most dangerous in terms of risks is conventional curettage, since after it bleeding may develop due to injury to the walls of the uterus and other complications. In general, the following undesirable consequences are possible:
- heavy bleeding - may occur due to trauma to the walls of the uterus or cervix;
- dizziness and other signs of weakness;
- nagging or sharp pain;
- development of the inflammatory process after infection with insufficient sterility of the instrument (during curettage);
- fever.
A woman receives biopsy results no earlier than 6–7 days after the procedure. Histological examination of a fragment of the endometrium allows us to identify various pathological processes: oncology, diffuse and atypical hyperplasia, atrophy, endometritis, hormonal disbalance. Based on the results, appropriate therapy is prescribed.
Manipulations are always carried out before surgery to remove uterine fibroids and malignant neoplasms.
Biopsy is the most effective method determining the causes of endometrial pathologies. This minimally invasive technique most accurately reflects the processes occurring inside the uterus and allows early stages identify growth malignant tumor or polyps, serves to clarify hormonal status, identifies the causes of infertility and other reproductive disorders.
The use of endometrial biopsy as a diagnostic method has a long history. In 1937, the American gynecologist, the founder of contraception, John Rock, first took the endometrium of the uterus for analysis and recorded this fact. The famous doctor used curettage of the mucous membrane - a method that is still used in gynecology.
What is an endometrial biopsy?
Removal of material from the uterine cavity and subsequent histology of the endometrium are included in the diagnostic minimum to determine the cause gynecological disease. An endometrial biopsy is the obtaining of samples of the mucous membrane of the inner layer of the uterus for subsequent histological examination.
In most cases, taking a biopsy is an independent, minimally invasive study. A situation may arise when a biopsy is performed as part of a large-scale surgical intervention, and the condition of the tissues is assessed on an emergency basis within 15-20 minutes after their removal.
Histological examination of the taken endometrium helps to distinguish diseases of the uterus with similar symptoms from each other and to select treatment individually.
Although in the vast majority of cases a biopsy is a diagnostic procedure, it is sometimes used in the treatment of endometrial pathologies. It takes from 7 to 12 days to study the biopsy in the laboratory, during which the histologist performs the following manipulations:
- Dehydrates tissues and makes them fat-soluble;
- Impregnates the biopsy material with paraffin, forming solid cubes;
- Cuts the cube using an extremely sharp instrument (microtome) into the thinnest plates;
- Layers with a thickness of 3 to 10 microns are laid out on a glass slide and stained;
- Covers with another glass, fixing for storage and study;
- Performs microscopic examination;
- Describes the structural features of the endometrium.
The histologist does not diagnose clinical diagnosis, this is done by a gynecologist based on a combination of data from biopsy, colposcopy, hysteroscopy, visual examination, study of the patient’s medical history and complaints.
If the conclusion states that the endometrium has no signs of atypia, its structure corresponds to the phase of the menstrual cycle, this indicates the absence of deviations.
Pathologies detected during the study:
- Endometrial hyperplasia;
- Polyposis, single polyps;
- Malignant transformations;
- Endometritis;
- Discrepancy between the structure of the endometrium and the phase of the cycle.
The presence of atypia in a biopsy specimen in some forms of hyperplasia is considered a precancerous condition. Precancer is indicated by a violation of the structure of cells and the mechanism of cell division, the transformation of glandular epithelium into stroma, and changes in the structure of the endometrium.
Indications for the study
Biopsy is performed in women of different ages regardless of whether they gave birth or not. There must be reasons for prescribing manipulation.
Indications:
- Bleeding between periods;
- Metrorrhagia;
- Amenorrhea;
- Bleeding after childbirth, abortion, against the background hormone therapy;
- Bleeding after menopause;
- Preparation for IVF;
- Atypical cells detected during a smear cytology examination (Pap test);
- Presence of a uterine tumor;
- Infertility of unknown etiology;
- Pathological changes identified during an ultrasound scan of the uterus that have existed for at least three menstrual cycles.
For these studies to be most informative, it is important to perform the biopsy exactly at the appointed time. This period depends on the phase of the menstrual cycle.
If a woman is in menopause, manipulation is carried out at any time, or they are guided by the date of the onset of bleeding. If a cancerous tumor is suspected, aspirate from the uterine cavity is taken on any day of the cycle.
Timing of the manipulation:
- Uterine polyp - at the end of menstruation;
- Uterine bleeding - on the first day of its appearance;
- Metrorrhagia – 7-10 days from the onset of heavy bleeding;
- Infertility – 2-3 days before menstruation;
- Determination of endometrial sensitivity to hormones - 17-24 days of the cycle;
- Hormonal imbalance - several studies with an interval of 7-8 days.
A biopsy is prohibited at any stage of pregnancy, as it interrupts the development of the fertilized egg. Manipulation is not performed if the level of coagulation decreases, if there are inflammatory processes in the pelvic organs, or if you are allergic to pain medications.
How is a biopsy procedure performed in the uterine cavity?
The location of the diagnostic test depends on the chosen method of taking a biopsy sample. This can be either a procedure room in a gynecological office or a small operating room in a hospital.
Before the manipulation begins, the vaginal walls are expanded with the help of speculum, the entrance to the vagina and cervix is treated with an antiseptic. Then the neck is fixed with bullet forceps. The doctor’s further actions depend on the chosen method.
Diagnostic curettage
Due to its informative nature, this radical method is still used in gynecology. Indications for its implementation: bleeding during menopause and after abortion, the possibility of developing oncological pathology.
At the first stage cervical canal the cervix is dilated by sequentially introducing bougies into it different diameters. Next, a curette in the form of a narrow spoon with sharp edges is inserted into the uterus.
With this curette, the doctor scrapes the internal cavity of the uterus, moving the instrument from the fundus to the internal pharynx. The taken portion of the endometrium is placed in a container with formaldehyde, and the curette is reinserted to treat the posterior wall of the uterus and the mouth of the fallopian tubes.
Advantages:
- Curettage is at the same time a therapeutic manipulation, as it removes foci of pathology;
- The completeness of the picture allows you not to miss atypical processes.
- The painful and traumatic procedure requires the use of intravenous anesthesia;
- After it you have to recover within a month;
- A gynecologist's lack of experience increases the risk of complications.
A type of complete curettage is a CUG biopsy, performed to determine the cause of infertility or to study the response to hormonal therapy. Material from the walls of the uterus is obtained as a result of only 2-3 scrapings (trains). They are performed with a small curette without dilating the cervical canal.
Endometrial aspiration biopsy
To perform aspiration biopsy of endometrial areas, a Brown uterine syringe or a vacuum aspirator is used. This gentle method is used as screening for negative ultrasound results.
Expansion of the cervical canal is not required during manipulation, but anesthesia is still used to prevent discomfort. The doctor removes the material by inserting a catheter attached to an aspiration syringe into the uterine cavity, and then pulling the piston of the instrument towards himself.
For vacuum aspiration of endometrial samples, an electric device with a similar operating principle is used instead of a uterine syringe.
An aspiration tube is attached to it, which is passed along the walls of the uterus, collecting material for research. Before the procedure, the woman is given an antispasmodic injection, the cervix and peri-uterine tissue are anesthetized.
Advantages:
- Low trauma;
- Fast recovery in the first case;
- Minimal pain.
- Long-term recovery after vacuum aspiration;
- Difficulty in maintaining the structure of the taken material.
Pipelle endometrial biopsy
Low-traumatic and virtually painless pipel biopsy is a modern option for endometrial aspiration. To remove the material, use a flexible thin Pipel tip with a diameter of 3 mm, pressed tightly against the wall of the uterus.
It is attached to a piston, which the doctor uses to create negative pressure to remove endometrial samples. Taking a biopsy sample is repeated 3 times, after which the probe is removed.
Advantages:
- Allows you to obtain high quality material;
- Does not injure the uterine mucosa;
- Performed on an outpatient basis;
- Does not require anesthesia;
- Does not cause complications.
- Serious pathology may be missed due to limited tissue sampling sites;
- It is difficult to restore the structure of the endometrium using histology.
A biopsy performed during hysteroscopy has high diagnostic accuracy. The manipulation is performed under intravenous anesthesia and endoscope control. After it, the woman quickly recovers.
With high-quality anesthesia of any biopsy method, a woman does not experience pain, pipel aspiration is practically painless even without anesthesia.
Since diagnostic curettage and taking an aspirate from the uterine cavity by any method is a minimally invasive surgical intervention, they prepare for the manipulation following a single standard. Preoperative diagnosis includes:
- General analysis blood and urine;
- Blood chemistry;
- Coagulogram;
- Blood test for HIV, the presence of syphilis and hepatitis;
- Smear on the flora of the vagina and cervical canal.
To completely rule out pregnancy, women of fertile age donate urine or blood to be tested for the presence of hCG (human chorionic gonadotropin).
How to prepare for a biopsy?
Firstly. To prepare for pipel biopsy and other methods of removing biopsy material, it is recommended to stop taking hormonal medications 4-5 weeks before the procedure, and not to take medications that affect blood clotting 3-4 days before the procedure.
Secondly.
The use of vaginal tampons, suppositories and vaginal tablets. You should avoid intimate contact for 2-3 days before the biopsy.
Third.
On the day of the procedure or the day before, hair in the genital area is removed. When using general or intravenous anesthesia, you should not eat for 8-12 hours before the intervention; you should refuse water 6 hours before the biopsy. It is advisable to do an enema or take a mild laxative the day before.
Because biopsy cannot avoid damage blood vessels endometrium, for several days after the manipulation the woman will definitely experience slight bleeding. Have no selection unpleasant odor, last no longer than 5-6 days.
It is optimal to follow the recommendations for 3-4 weeks after the procedure:
- After aspiration vacuum biopsy of the endometrium and diagnostic curettage, you need to remain in bed for several days;
- You cannot take a hot bath, swim in a pool, in an open body of water, or visit a sauna or steam bath;
- It is important not to overcool and avoid excessive overheating;
- It is advisable not to overexert yourself physically and emotionally, you need to avoid stress;
- Intimate contacts are temporarily prohibited.
The time it takes for a woman to recover depends on how the biopsy was performed. For example, after a gentle pipel biopsy of the endometrial mucosa, you can return to your normal life within 2-3 days.
After curettage, complete regeneration may take 3-4 weeks. If there is heavy bleeding and severe pain If you have cramps in the lower abdomen or fever, you should immediately consult a doctor.
Endometrial biopsy for proper preparation and full compliance with antiseptics - this is an informative diagnostic study that helps restore reproductive health and avoid serious diseases.
The formation of the uterine mucosa is influenced by the ratio of hormones produced by the ovaries. Violation of the structure of the endometrium, deviation of its thickness from the norm causes the appearance serious problems able reproductive health women. In order to establish the reason menstrual irregularities, infertility, the occurrence of neoplasms in the uterus, it is necessary to carefully examine the condition of its cavity, to identify possible developmental pathologies epithelial cells. Effective method A biopsy is used to examine the endometrium.
Content:
What is the procedure
The procedure allows you to extract endometrial particles for subsequent histological examination. In this way, it is determined what structure the cells of the mucous membrane of the uterine cavity have, and whether there are any atypical changes in it. Based on the results of the study, conclusions are drawn about the character pathological processes in the endometrium, the cause of infertility or menstrual irregularities.
There are several ways to extract endometrial particles. These include complete curettage of the uterine cavity, CUG biopsy (partial curettage), aspiration of the mucous membrane using a special syringe (aspiration biopsy), targeted extraction of material during hysteroscopy. The disadvantage of these methods is the need to dilate the cervix and insert instruments into the cavity, which makes the procedure for collecting endometrial particles painful and traumatic.
Advantages of pipel biopsy
When using pipell biopsy of the endometrium, much simpler and safer manipulations are performed. The so-called “Pipel instrument” is used, which is a soft elastic narrow tube with a special tip. There is a piston inside the tube. The tube is inserted into the uterine cavity. In this case, it is not necessary to expand the cervix using a special device. By pulling back the piston, the tube is approximately half filled with the sampled contents, which are then examined under a microscope.
A single insertion of the instrument allows you to select the endometrium from large areas of the uterine cavity. The duration of the procedure is 0.5-1 minute. It is practically painless. Held in outpatient setting, after which the woman can go about her usual business. Due to the lack of risk of tissue and blood vessel damage, this sampling method can be used when diabetes mellitus and even (with caution) with reduced blood clotting.
A disposable instrument is used to collect endometrial particles, eliminating the possibility of infection during the procedure.
Video: How an endometrial biopsy is performed. Benefits of the procedure
In what cases is pipell biopsy prescribed?
Diagnostics using pipell biopsy of the endometrium is prescribed in the following cases:
- a woman experiences prolonged and painful menstrual bleeding;
- heavy uterine bleeding occurs between periods for an unknown reason;
- dangerous bleeding appeared after hormonal therapy or long-term use of contraceptives;
- discharge with blood appears during menopause;
- An ultrasound showed the presence of a tumor or endometrial polyps in the uterus, and the patient was found to have an excess amount of estrogen in the blood;
- the woman experiences infertility, the pregnancy was repeatedly terminated in the early stages;
- a blood test for tumor markers when detecting tumors in the uterus shows the presence of cancer cells;
- a woman is preparing for IVF.
Contraindications
Before performing a pipell biopsy of the endometrium, the doctor must be sure that the patient is not pregnant. The material selection procedure is not carried out in the presence of inflammatory processes and various types infections (fungi, pathogens of sexually transmitted diseases), as well as vaginal dysbiosis. The procedure is canceled if a purulent inflammatory process occurs in the uterus (endometritis) or inflammatory diseases other pelvic organs, from which the infection can spread to the genitals.
Contraindication for use this method diagnostics is the presence of blood diseases in a woman such as hemophilia and anemia (which can cause life-threatening bleeding), as well as cardiovascular pathologies that can cause blood clots. Pipelle biopsy is not performed in the presence of congenital developmental disorders of the genital organs.
On what days of the cycle is pipell biopsy performed?
The procedure can be scheduled on different days of the cycle depending on what pathologies require diagnosis:
- Before menstruation, if it is necessary to find out the cause of infertility due to the presence of hormonal disorders and lack of ovulation.
- At the end of menstruation (approximately on the 7th day of the cycle), to identify the cause of too long periods, which may be incomplete rejection of the endometrium.
- In the second phase of the cycle (on days 17-25). Pipelle endometrial biopsy allows you to monitor the results of hormonal therapy.
- In the first phase of the cycle (in the absence of bleeding). The study is carried out to detect the cause of intermenstrual bleeding.
To study the causes of amenorrhea and if there is a suspicion of the formation of malignant tumors in the uterine cavity, a pipel biopsy is performed any day.
Preparation for the procedure
Before the procedure, it is necessary to donate blood for analysis of hemoglobin content and determination of coagulability, levels of estrogen, progesterone, and pituitary hormones.
Analysis of a smear from the vagina and cervix makes it possible to detect the presence of fungus and other types of infection. A general urine test allows you to determine the level of leukocytes and detect inflammatory diseases of the urinary organs.
A blood test is performed for syphilis, HIV, and hepatitis viruses. If cancer is suspected, a blood test is done for tumor markers.
1 month before the procedure, the woman must stop taking hormonal medications, and 3 days - from using anticoagulants. You should avoid douching, tampons, the use of vaginal medications, and also abstain from sexual intercourse.
You must not eat food for 12 hours before the pipel biopsy, and immediately before going to the doctor you must do a cleansing enema.
After a pipel biopsy
The impact on the endometrium during pipell biopsy is associated with damage to small blood vessels, so a woman may experience minor bloody issues. Normally, there should be no pain.
After such a procedure, menstruation, as a rule, occurs with a delay of up to 10 days. Since the damage during manipulation is very minor, the condition of the endometrium is quickly restored.
Warning: The delay may be associated with the onset of pregnancy, since the egg fertilized after the next ovulation attaches even to that part of the endometrium that remains after the pipel biopsy. A woman should take this into account. If pregnancy is not desired, you should consult your doctor about using an appropriate barrier contraceptive method.
Doctors recommend abstaining from sexual intercourse for a month after an endometrial examination. In addition, physical fatigue and strong emotions should be avoided. Visiting a sauna, staying in a hot room, or swimming in a hot bath lead to bleeding.
If doubtful symptoms appear, you should never self-medicate or use folk remedies or medications other than those prescribed by your doctor.
When to see a doctor immediately
In rare cases, after a pipel biopsy, a woman’s character of her periods changes (for example, their volume and duration increase, they become painful). A serious complication may be the occurrence of an inflammatory process. As a rule, the reason is non-compliance with doctors’ recommendations on hygienic care behind the genitals recovery period, entry into sexual relations in the coming days after the endometrial pipette biopsy, hypothermia of the lower body.
You should consult a doctor if you have any symptoms of illness, especially if purulent discharge or bleeding from the genitals occurs, body temperature rises, pain appears in the lower abdomen, or menstruation disappears.
Research results
Depending on the purposes of diagnosis and the expected nature of the disease, examination of the material taken for analysis and interpretation of the results can be carried out urgently within 0.5 hours, but an answer can be received after 2 weeks.
After receiving an accurate answer about the nature of the pathology, treatment is carried out with anti-inflammatory drugs or antibiotics, hormonal drugs to regulate endometrial growth and restore the cycle. If surgical operations are necessary, pipel biopsy makes it possible to assess the required volume of intervention and possible consequences.
The endometrium is the mucous membrane of the mucous layer of the uterus, which changes cyclically under the stimulation of female reproductive hormones. The endometrium is extracted using special techniques, each of which involves penetration into the uterus using surgical instruments. Currently, endometrial biopsies are performed harmlessly and have low morbidity.
Biopsy techniques:
- diagnostic curettage (classical);
- aspirate biopsy;
- CG biopsy;
- targeted biopsy.
Aspiration biopsy Surgery using a hysteroscope
Classic curettage of the mucous membrane
This type of procedure involves collecting a biological sample using a surgical instrument. The specialist collects upper layer from the surface of the uterine cavity. The gynecologist can collect the material completely or make several scrapers - trains. The purpose of the event is diagnostic studies of the uterus and therapeutic procedures.
Curettage is done in these situations:
- menstrual irregularities;
- pathological changes in the endometrium;
- neoplasms;
- hyperplasia;
- polyps;
- cysts;
- abundant or poor menstrual flow;
- the presence of intermenstrual discharge;
- diagnosis of cervical tumors;
- spontaneous abortion;
- lack of fetal movements.
If the procedure is carried out on time, the doctor will be able to determine the exact causes of the disease. In this case competent treatment will be able to slow down the disease and heal the reproductive organ.
Aspirate biopsy with vacuum or aspirator
Aspiration biopsy is a more gentle method compared to curettage. It is not so traumatic because it does not involve a strong expansion of the uterine canal. The risk of complications is significantly reduced. The action is carried out using a thin Brown syringe or a vacuum apparatus.
For women who have never had a child, the procedure may cause some discomfort. To reduce it, your doctor may suggest general anesthesia.
The advantages of the aspiration technique can be found in the video from the Medical Center channel.
Pipel endometrial biopsy
The collection of biological fragments is carried out using a hollow catheter with a diameter of 3 mm with a slot at the end. Thanks to it, pressure is generated in the device and crypt and endometrial tissue is absorbed into the cylinder. Pipel is considered the most painless method of sample collection, which has almost no flaws.
During the process, the doctor places a Pipel tube into the uterus and pulls on a plunger. Due to the conditions, the technique does not cause injury to the mucous membrane and does not provoke infection. It is recommended for young women without children, with endometrial pathologies and infertility.
CUG biopsy
The operation is performed to expand the cervical uterine canal using a special device. The surgeon scrapes the walls of the mucous membrane, slowly moving towards the internal os of the uterus.
CUG biopsy is considered a safe and low-traumatic technique, and is prescribed during one menstrual cycle.
At this time, the surgeon takes biological segments in the form of streaks from several areas of the organ.
Targeted biopsy during hysteroscopy
The essence of the technique is that fragments of the mucosal layer are obtained during endoscopic examination using a hysteroscope. This probe is equipped with a special video camera and an instrument for surgical interventions. The size of the device does not exceed 4 mm in diameter.
Advantages and disadvantages of the research method
Procedure | Advantages | Flaws |
| Scraping |
|
|
| Aspiration biopsy |
|
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| Pipelle biopsy |
|
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| CUG biopsy |
|
|
| Targeted biopsy |
|
|
Indications
An endometrial biopsy is prescribed in the following cases:
- causeless bleeding;
- hemorrhage after menopause;
- severe and prolonged bleeding during the cycle;
- hemorrhage after childbirth or abortion;
- bleeding after taking hormonal contraceptives;
- causeless absence of menstruation;
- diagnosis of infertility;
- surgical removal of tumors of various types;
- uterine fibroids;
- hyperplasia;
- ovarian cyst;
- ococtology of the cervix;
- in vitro fertilization (IVF).
Contraindications
Carrying out any type of biopsy has its contraindications:
- pregnancy;
- inflammatory diseases of the reproductive organs;
- low blood clotting.
Dates
Features of the biopsy:
- if you have concerns about oncological diseases– any day of the menstrual cycle;
- if polyps or similar neoplasms are suspected, immediately after the end of the cycle;
- to establish the cause of non-cyclic bleeding - on the first menstrual day;
- for heavy monthly bleeding - a week after the end of menstruation;
- to diagnose the sensitivity of the endometrium to hormones - no earlier than two weeks;
- for infertility - three days before the expected menstruation.
How to prepare for a uterine endometrial biopsy?
When preparing for an inspection, it is important to adhere to some rules:
- three days before surgery, avoid douching, sexual intercourse, and vaginal medications;
- on the eve of the procedure, perform intestinal lavage;
- to avoid complications after surgery, it is necessary to do a number of things in advance special analyzes blood and urine;
- in the morning before the procedure, the patient must take a shower and remove hair from the genitals;
- If the operation is performed under anesthesia, then twelve hours before the operation it is necessary to refuse food.
How is the procedure performed?
Main stages of the operation:
- Treatment of the external genitalia with a special antiseptic.
- Dilatation of the vagina with a specialized surgical speculum.
- After access to the cervix, treatment with alcohol is carried out.
- The organ is fixed using bullet forceps.
- All further actions are carried out depending on the choice of biopsy technique.
Consequences and complications
Consequences after surgery may be:
- change in the duration of menstruation;
- bloody issues;
- painful menstruation;
- severe toxicosis;
- pain and pain in the abdominal area;
- uterine discharge with pus and an unpleasant odor;
- exacerbation of vaginitis;
- temperature increase;
- fever;
- loss of consciousness;
- convulsions;
- migraine.
Decoding the results
Diagnostics shows:
- adenomatosis of the uterus;
- hyperplastic processes;
- atrophy of various types;
- endometritis;
- tumors;
- discrepancy between the phase of the menstrual cycle and the thickness of the mucosal walls.
In the final document, the doctor fills out four parts:
- Information content of a biological sample. It can be inadequate and adequate. In the first case, the diagnosis revealed an insufficient endometrial indicator (the sample was taken incorrectly). In the second case, there are enough endometrial cells to draw the following conclusions.
- Macroscopic description of the drug. At this stage, the weight of the fragments, their size and color are reported. The doctor indicates the consistency of the samples, as well as the presence of blood clots and mucus.
- Microscopic description of the drug. The doctor indicates the size and type of epithelium, as well as the number of layers. The presence of stroma, its density and homogeneity. Uterine glands: their shape and description of the constituent epithelium. If there are lymphoid accumulations, the doctor detects the onset of inflammatory processes.
- Final diagnosis. Here the specialist clarifies which phase of the cycle the endometrium corresponds to and the presence of its expansion. Indicates the characteristics of neoplasms (polyps). How much the walls of the mucous membrane have become thinner and smaller. The presence of atypia and cancer cells. Degeneration of the epithelium and vessels of the chorionic villi.
- Often, in the final diagnosis, a specialist writes that the endometrium is normal in the proliferation phase (secretion, menstruation). This phrase indicates that the patient has no signs of abnormal formations.
How much does an endometrial biopsy cost?
Cost of the procedure in different medical centers and cities is different.
Video
How an endometrial biopsy is performed is shown in a video from the PROMATKA channel. RU.
Suspicion of the presence of any pathology makes a person worry. This is especially true for oncological processes. Cancer is terrible diagnosis both for the person himself and for all his close people. However, there are currently many ways to combat it. Treatment effectiveness oncological pathologies high on initial stages diseases. Therefore, in order to quickly detect cancer, it is necessary to be examined at the first signs of the disease. One of the diagnostic methods is aspiration biopsy. It is performed quickly and almost painlessly. In some cases, this study acts as a therapeutic procedure.
What is the purpose of aspiration biopsy?
In order to confirm or refute the presence of a malignant process, a study of the composition of the cells of the pathological formation is required. It is carried out using 2 diagnostic procedures. These include: The first involves making a section from the damaged organ, staining it and microscopy. This method is the diagnostic standard cancerous tumors. consists of performing a smear from the surface of the biopsy specimen. Next, microscopy of the glass slide is performed. To obtain material for research, an open biopsy is performed. This surgery, implying partial or complete removal organ. Another method of collecting cells is aspiration puncture biopsy. It can be used to perform histological and cytological analysis. For this purpose, biological material is obtained by puncturing the organ and breaking off small pieces of the affected area.
The advantages of the aspiration method include:
- No cuts on the skin.
- Painless procedure.
- Possibility of performing on an outpatient basis.
- Speed of execution.
- Reducing the risk of complications that may arise as a result of the procedure (inflammation, bleeding).
Aspiration biopsy can be performed using special instruments or an ordinary thin needle used for injections. This depends on the depth and location of the tumor.
Indications for biopsy
Aspiration biopsy is performed if a tumor is suspected various organs. Among them are the thyroid and mammary glands, uterus, lymph nodes, prostate, bones, soft fabrics. This diagnostic method is performed in cases where there is access to the tumor. Indications for the study include the following conditions:
- Suspicion of a malignant tumor.
- The inability to determine the nature of the inflammatory process by other methods.
In most cases, it is impossible to determine which cells the neoplasm consists of without cytological and histological examination. Even if the doctor is sure of the presence of a malignant tumor, the diagnosis must be confirmed. This is necessary to establish the degree of cell differentiation and conduct therapeutic measures. In addition to cancerous tumors, there are benign tumors that must be removed. Before proceeding with surgery, it is necessary to confirm that there is no oncological process. For this purpose, an aspiration biopsy is also performed.
Sometimes treatment of inflammatory processes is ineffective, despite the adequacy of the therapy. In such cases, histological examination of the tissue is required to exclude specific pathologies. In this way, tuberculosis, syphilitic or other inflammation can be detected.
Preparing for the study
Depending on the location of the pathological area, preparation for the study may vary. In all cases, diagnostic procedures are required before aspiration biopsy. These include: blood and urine tests, determination of biochemical parameters, coagulogram, tests for hepatitis and HIV infection. If tumors of external localizations are suspected, no specific preparation is required. This applies to neoplasms of the thyroid and mammary glands, skin, lymph nodes. In these cases, a fine-needle aspiration biopsy is performed. This method is completely painless and resembles an ordinary injection. If the tumor is deep, a trepanobiopsy is required. It is carried out using a special instrument and a thick needle. In this case, local anesthesia is required.
Preparation for an endometrial aspiration biopsy is somewhat different. In addition to the tests listed, before performing it, it is necessary to obtain the results of a smear from the vagina and cervix. If the patient is a woman of childbearing age, the biopsy is performed on the 25th or 26th day of the menstrual cycle. During the postmenopausal period, the study can be carried out at any time.
Performing a thyroid biopsy
Aspiration biopsy thyroid gland performed using a thin needle. It is required in the presence of nodules in the organ tissue. Before conducting the study, the doctor performs. For this, the patient is asked to make a swallowing movement. At this moment, the doctor determines the exact location of the node. This area is treated with an alcohol solution for disinfection. After which the doctor inserts a thin needle into the neck area. With his other hand, he fixes the knot to obtain cells from the pathological focus. The doctor pulls the plunger of the empty syringe towards himself to remove it biological material. The pathological tissue penetrates the lumen of the needle, after which it is placed on a glass slide. The resulting material is sent to the puncture site. A cotton swab soaked in alcohol solution, and fixed with adhesive tape.
A fine-needle aspiration biopsy of the thyroid gland helps determine whether there are malignant cells in the nodule. In their absence, conservative treatment of goiter is possible. If a doctor diagnoses thyroid cancer, removal of the organ and chemotherapy are required.
Technique for endometrial aspiration biopsy
Indications for uterine biopsy are: suspicion of cancer, hyperplastic processes (endometriosis, polyps), monitoring of hormone therapy. The study is carried out in treatment room or small operating room under ultrasound control. First of all, palpation of the pelvic organs is carried out. Then the cervix is fixed using gynecological speculum. A special conductor - a catheter - is inserted into the cervical canal. Through it, the contents of the endometrium are aspirated into a syringe. The resulting material is sent to the laboratory to determine the cellular composition of the fluid.
In some cases, aspiration biopsy of the uterus is performed using a special vacuum device. It is necessary to ensure that the material is collected under pressure. With its help, you can obtain several samples of biological material by performing 1 puncture.
Puncture and breast
A lymph node biopsy is performed if the doctor suspects specific inflammation or regional spread of the tumor. The study is carried out using a thin needle. The technique for performing it is similar to aspiration biopsy of the thyroid gland. The same technique is used to obtain material from breast tumors. In addition, aspiration biopsy of the breast is performed in the presence of large cysts. In this case this procedure is not only diagnostic, but also therapeutic.
If the obtained material is insufficient or it is not possible to confirm the diagnosis with its help, a trepanobiopsy of the mammary gland is performed. It is performed for research purposes. In this way, it is possible to track the progress of the needle. In some cases, a vacuum aspiration biopsy is performed.
Contraindications for the study
There are practically no contraindications to performing a fine-needle biopsy. Difficulties may arise if the patient is a person with mental illness or a child. In these cases, intravenous anesthesia is required, which is not always possible. Vacuum aspiration or fine-needle biopsy of the endometrium is not advisable for inflammatory pathologies of the cervix and vagina. Also, the procedure is not performed during pregnancy.
Interpretation of research results
Ready in 7-10 days. Cytological analysis is faster. After smear microscopy or histological specimen the doctor makes a conclusion about the cellular composition of the neoplasm. In the absence of atypia, the tumor is benign. If the cells obtained during the study differ from normal elements, the diagnosis of cancer is confirmed. In such cases, the degree of tumor differentiation is determined. The prognosis and treatment methods depend on this.
Aspiration biopsy: reviews from doctors
Doctors say aspiration biopsy method is reliable diagnostic study, safe for the patient's health. If the obtained material has little information content, tissue sampling can be repeated. For execution this study the patient does not require hospitalization.
