What does an endometrial biopsy show, cost and reviews. Endometrial aspiration biopsy: how it is performed, indications Endometrial aspiration with histological examination

The formation of the uterine mucosa is affected by the ratio of hormones produced by the ovaries. Violation of the structure of the endometrium, the deviation of its thickness from the norm causes serious problems in the reproductive health of women. In order to establish the cause of menstrual disorders, infertility, the occurrence of neoplasms in the uterus, it is necessary to carefully examine the state of its cavity, to identify possible pathologies in the development of epithelial cells. An effective method for examining the endometrium is a biopsy.

Content:

What is the procedure

The procedure allows you to extract particles of the endometrium for subsequent histological examination. In this way, it is established what structure the cells of the mucous membrane of the uterine cavity have, whether there are atypical changes in it. Based on the results of the study, conclusions are drawn about the nature of pathological processes in the endometrium, the cause of infertility or menstrual disorders.

There are several ways to extract endometrial particles. These include complete curettage of the uterine cavity, CUG biopsy (partial curettage), aspiration of the mucosa with a special syringe (aspiration biopsy), targeted extraction of material during hysteroscopy. The disadvantage of these methods is the need to dilate the cervix and introduce instruments into the cavity, which makes the procedure for collecting endometrial particles painful and traumatic.

Benefits of a pipel biopsy

When using a pipel biopsy of the endometrium, much simpler and safer manipulations are performed. The so-called "Paypel tool" 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 neck using a special device. By retracting the piston, the tube is approximately half filled with the sampled contents, which are then examined under a microscope.

A single introduction 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. She is practically painless. It is carried out on an outpatient basis, after which the woman can go about her usual activities. Because there is no risk of damage to tissues and blood vessels, this sampling method can be used for diabetes and even (with caution) for reduced blood clotting.

For the selection of endometrial particles, a disposable instrument is used, the possibility of infection during the procedure is excluded.

Video: How an endometrial biopsy is performed. Benefits of the procedure

In what cases is a pipel biopsy prescribed?

Diagnosis by the method of endometrial biopsy is prescribed in the following cases:

a woman has prolonged and painful menstrual bleeding;
there are heavy uterine bleeding between periods for an unknown reason;
dangerous bleeding appeared after hormone therapy or prolonged use of contraceptives;
there are discharge with blood during menopause;
Ultrasound showed the presence of a tumor or endometrial polyps in the uterus, while the patient had an excess of estrogen in the blood;
the woman has infertility, the pregnancy was repeatedly interrupted in the early stages;
a blood test for tumor markers when neoplasms are detected in the uterus shows the presence of cancer cells;
a woman is preparing for IVF.

Contraindications

Before performing a pipel biopsy of the endometrium, the doctor must be sure that the patient is not pregnant. The material sampling procedure is not carried out in the presence of inflammatory processes and various types of infection (fungi, causative agents of sexually transmitted diseases), as well as vaginal dysbacteriosis. The procedure is canceled if a purulent inflammatory process occurs in the uterus (endometritis) or inflammatory diseases of other pelvic organs are observed, from which the infection can enter the genitals.

A contraindication to the use of this diagnostic method is the presence in a woman of such blood diseases as hemophilia and anemia (in which life-threatening bleeding can open), as well as cardiovascular pathologies that can cause thrombosis. Pipel biopsy is not performed in the presence of congenital disorders in the development of the genital organs.

What days of the cycle is a pipel biopsy performed?

The procedure can be scheduled for 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 the absence of ovulation.
At the end of menstruation (about day 7 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 day 17-25). Pipel biopsy of the endometrium allows you to monitor the results of hormone therapy.
In the first phase of the cycle (in the absence of spotting). The study is carried out to detect the cause of intermenstrual bleeding.

To study the causes of amenorrhea and in case of suspicion of the formation of malignant tumors in the uterine cavity, a pipel biopsy is performed on any day.

Preparation for the procedure

Before the procedure, it is necessary to donate blood to analyze the hemoglobin content and determine coagulability, the level of estrogen, progesterone, pituitary hormones.

Analysis of a smear from the vagina and cervix makes it possible to detect the presence of a 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 carried out for syphilis, HIV, hepatitis viruses. If cancer is suspected, a blood test for tumor markers is done.

1 month before the procedure, a woman must stop taking hormonal drugs, 3 days before the use of anticoagulants. Avoid douching, tampons, vaginal medications, and sexual intercourse.

Within 12 hours before the pipel biopsy, you can not eat, and immediately before going to the doctor, you need to make a cleansing enema.

After a pipel biopsy

The impact on the endometrium with a pipel biopsy is associated with damage to small blood vessels, so a woman may experience minor spotting for several days. 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 the manipulations is very small, the state 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 is attached even to that part of the endometrium that remained after the pipel biopsy. A woman should take this into account. If pregnancy is not desired, a doctor should be consulted about the use of a suitable barrier contraceptive.

Doctors recommend refraining from sexual intercourse for a month after the endometrial examination. In addition, physical fatigue, strong feelings should be avoided. Visiting the sauna, staying in a hot room, bathing in a hot bath lead to bleeding.

If doubtful symptoms appear, in no case should you self-medicate, use folk remedies or drugs, except for those prescribed by the doctor.

When to see a doctor immediately

In rare cases, after a pipel biopsy, the nature of menstruation changes in a woman (for example, their volume and duration increase, they become painful). A formidable complication may be the occurrence of an inflammatory process. As a rule, the reason is non-compliance with the recommendations of doctors on hygienic care of the genital organs during the recovery period, sexual intercourse in the coming days after the endometrial pipel biopsy, hypothermia of the lower body.

You should consult a doctor for any symptoms of malaise, especially if purulent discharge or bleeding from the genitals occurs, body temperature rises, pains appear in the lower abdomen, and menstruation disappears.

Research results

Depending on the goals of diagnosis and the expected nature of the diseases, the study of the material taken for analysis and the interpretation of the results can be carried out urgently within 0.5 hours, but the answer can be obtained 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 the growth of the endometrium and restore the cycle. If it is necessary to perform surgical operations, a pipel biopsy makes it possible to assess the required amount of intervention and possible consequences.

Women often have to turn to gynecologists. These doctors monitor the health of the reproductive organs and manage the pregnancy. Often, a patient needs to be diagnosed to establish an accurate diagnosis. One of the research methods is a pipel biopsy of the endometrium. What it is, you can find out from the presented article.

Diagnostic procedures in gynecology

(what it is - will be described later) is one of the methods for diagnosing women's health. Also, gynecologists often prescribe an ultrasound examination. It is carried out more quickly and does not require special preparation. However, ultrasound may not always provide accurate information.

Diagnostic procedures that a gynecologist can prescribe also include curettage of the uterus, laparoscopy, hysteroscopy, metrosalpingography, and so on. Carrying out these manipulations has its indications in each individual case. In recent years, endometrial biopsy has become very popular among gynecologists and obstetricians. What it is? The article will talk about this further.

Pipel biopsy of the endometrium - what is it?

This study is very important in making the correct diagnosis. It is carried out within the walls of the hospital. Diagnosis must be carried out by a qualified technician.

The endometrium got its name from the name of the person who discovered the instrument for collecting material. This device is a short tube with a diameter of 2 to 4 millimeters. There is a beveled end at the end of the device. It is subsequently placed in the cavity of the reproductive organ. On the other hand, the equipment has a so-called piston. When it is removed, the material is taken from the uterus.

Indications for manipulation

A gynecologist or reproductologist can prescribe this study for many indications. Often these are various hormonal pathologies. These include, for example, endometriosis. Also, the study is carried out with a chronic inflammatory process in the cavity of the genital organ.

Manipulation is indicated for women after 40 years and during menopause. If a representative of the weaker sex suffers from uterine bleeding or heavy periods, then the study will help clarify the situation.

Diagnostics is always prescribed before in vitro fertilization. This helps to avoid complications during the embryo transfer period. A pipel biopsy of the endometrium is indicated for women suffering from infertility.

Contraindications

In what cases is a pipel biopsy of the endometrium prohibited? Reviews of doctors suggest that in the following cases it is worth postponing the manipulation indefinitely:

pregnancy of any term or suspicion of it;
inflammatory or infectious processes occurring in the vagina;
blood clotting disorder;
the presence of infections that were acquired during sexual contact, and so on.

It is worth saying that the diagnosis can lead to complications if the listed contraindications are neglected. That is why, before the procedure, a woman should visit an ultrasound room, take a blood test and a smear from the vagina to determine sterility.

How is material collected?

An endometrial biopsy, the price of which is in the range of 2 to 7 thousand rubles, should be carried out exclusively within the walls of the hospital. In this case, a woman does not need any specific preparation. Manipulation is worth in the period from 7 to 12 days of the menstrual cycle. It is at this point that the data obtained will be most informative.

Before the study, the patient may be given an anesthetic injection into the tissue of the cervix. However, this is done only when the gynecologist uses a pipe with a diameter of 4 millimeters. Also, some clinics offer the patient to take a sedative and a drug that suppresses the contractile function of the muscles before manipulation.

The material is taken on the procedure lasts an average of 30 seconds. It takes more time to prepare. Before starting the manipulation, it is necessary to determine the depth of the uterus. This is done using a special device under the control of an ultrasonic sensor. After that, the appropriate size of the pipel is selected, and the instrument is inserted into the cervix. Next, the doctor pulls the device by the piston, and at this time negative pressure is created in the cavity of the genital organ. Particles of the endometrium and other tissues fall into a sterile tube, which is immediately removed from the woman's body. lasts approximately 7-10 days. After that, the patient can receive a conclusion. For decoding and further appointments, you should contact your gynecologist.

After endometrial biopsy

What happens after the study? The doctor must give the patient appropriate recommendations. After taking the material, a woman may find spotting. They should pass within a few days. Also, for about two weeks, it is worth limiting physical activity. Sexual intercourse and hot baths are prohibited.

Complications from manipulation are very rare. Often the cause of their occurrence is non-compliance with the conditions and improper manipulation. A woman before the procedure should familiarize herself with possible problems. These include:

damage to one of the walls of the uterus (requires emergency surgery);
bleeding (often caused by pathologically altered tissues);
inflammation (infection is introduced from an infected vagina) and so on.

If after a pipel biopsy you feel unwell, then you should immediately contact a medical facility. Symptoms of a developing pathology include fever, pain in the lower abdomen, discharge of an unusual nature, prolonged brown daub, and so on.

Summarizing

You have now become aware of the endometrium. It is worth noting that this manipulation has a lot of advantages over. When performing a pipel biopsy, there is no expansion of the cervical canal. Because of this, a woman may well endure the manipulation without the use of anesthetics. If you are prescribed this study, then you should follow all the recommendations of the doctor. Health to you and good results!

In diseases of the uterus, it is often necessary to study its mucous membrane - the endometrium. For this, an endometrial biopsy is prescribed - curettage of the uterine cavity in order to take a small amount of tissue for diagnosis. The fact is that under the influence of hormones, the mucous membrane changes, and this can be detected when it is studied under a microscope. Biopsy refers to minor gynecological operations and is done under anesthesia. But today there are different options for performing the procedure. For the most accurate result, very good knowledge of how the endometrium changes under the influence of steroid hormones is necessary. Usually, the results of the study are analyzed by pathohistologists together with gynecologists.

In 1937, scientists identified the dependence of changes in the endometrium on the phase of the menstrual cycle, and later this feature was widely used to diagnose diseases of the uterus. For various diseases, the material for research is taken at different times.

Types of biopsy and features of its implementation

Initially, only diagnostic curettage of the uterus was done to obtain tissue fragments for research, but this method is unsafe. To date, there are several alternative ways to carry out the procedure:

Expanding and scraping is the classic method. The cervical canal is opened with the help of special tools and the cervical canal is scraped first, and then its cavity. Scrapings are made with a sharp instrument - a curette, so sometimes this type of material taking is called curettage. The procedure is done under local anesthesia or general anesthesia.
Scraping in the form of dashed scrapings - trains. To do this, use a small curette. The material is taken from the bottom of the uterus to the cervical canal. The method is not suitable for uterine bleeding.
An aspiration biopsy is performed by suctioning sections of the mucosa. It can cause discomfort, it is contraindicated in cancer of the uterine body, since it is impossible to determine the exact location of the tumor and the degree of its spread throughout the organ.
Jet douching - washing out part of the tissue, is rarely used.
Pipel biopsy of the endometrium is the most modern and safe method of taking tissue for examination. What it is? The tissue is taken with the help of a special soft tube - a pipel, inside it has a piston, like in ordinary syringes (pictured). The pipel is inserted into the uterine cavity and the piston is pulled halfway, this creates a negative pressure in the cylinder, and the endometrial tissue is sucked inward.

The procedure lasts several minutes, the cervical canal does not need to be expanded, since the diameter of the pipe is only 3 mm, anesthesia is not required, and possible complications after the study are also excluded. Pipel biopsy of the endometrium is simple and minimally invasive, moreover, it is cheaper than other methods of mucosal examination.

Before prescribing a study, the doctor determines the most favorable days of the menstrual cycle, with different pathologies they differ:

Infertility due to insufficiency of the corpus luteum or the presence of a large number of anovulatory cycles. An endometrial biopsy is done immediately before menstruation or at the very beginning of it.
With severe bleeding during menstruation due to the slow rejection of the uterine mucosa, the material is taken on the 5th-10th day of menstruation, depending on its duration.
If there is no menstruation, and there is no pregnancy, repeated biopsies are prescribed for patients within 3-4 weeks with breaks of 1 week.
With acyclic bleeding - metrorrhagia, scrapings are done immediately after the onset of bleeding or spotting.
To determine the day of the menstrual cycle, the study is done between the 17th and 24th day.
If endometrial cancer is suspected, the material can be taken on any day of the cycle.

The treatment of endometrial pathologies is additionally described in the video:

Indications and contraindications

A biopsy is indicated for:

Bleeding in women during menopause
Bleeding or spotting when using hormonal drugs
Menstrual irregularities
Suspicion of endometrial cancer, endometriosis, endometrial hyperplasia
Polyps of the endometrium
Myoma of the uterus
Inflammatory processes
infertility
Evaluation of the endometrium after undergoing a course of hormone therapy
The need for bacteriological examination of the uterine mucosa
Bleeding in premenopause.

There are a number of contraindications for the procedure:

Pregnancy
Inflammatory processes in the vagina and cervix
The presence of foci of inflammation in the pelvis
severe anemia
Hemophilia
Sexually transmitted diseases
Pathology of the homeostasis system.

The most positive feedback from patients about the pipel biopsy, this method practically does not cause discomfort, the risk of developing infectious complications is very small compared to other research methods, there is no risk of spreading cancer cells, after the manipulation, you can immediately start your usual activities, anesthesia is not required .

Before the procedure, tell your doctor about any allergies to medications, taking blood thinners, heart and lung diseases. Sometimes there are some complications.

Suspicion of the presence of any pathology makes a person worry. This is especially true for oncological processes. Cancer is a terrible diagnosis both for the person himself and for all his close people. However, there are currently many ways to deal with it. The effectiveness of the treatment of oncological pathologies is high in the initial stages of the disease. Therefore, in order to quickly detect cancer, it is necessary to be examined at the first sign of the disease. One of the diagnostic methods is an aspiration biopsy. It is performed quickly and almost painlessly. In some cases, this study acts as a medical procedure.

What is the purpose of an 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 is to perform a cut from the damaged organ, staining it and microscopy. This method is the standard for diagnosing cancerous tumors. consists in performing a smear from the surface of the biopsy. Next, microscopy of the glass preparation is carried out. To obtain material for research, an open biopsy is performed. This is a surgical operation that involves the partial or complete removal of an organ. Another way to collect cells is considered to be aspiration puncture biopsy. It can be used for histological and cytological analysis. For this purpose, biological material is obtained by puncturing the organ and splitting off small pieces of the affected area.

The advantages of the aspiration method include:

No skin incisions.
Painless procedure.
Ability to perform on an outpatient basis.
Speed of execution.
Reducing the risk of complications that may arise as a result of the procedure (inflammation, bleeding).

An aspiration biopsy can be performed with special instruments or with an ordinary thin needle used for injection. It depends on the depth and localization of the neoplasm.

Indications for a biopsy

An aspiration biopsy is performed when tumors of various organs are suspected. Among them are the thyroid and mammary glands, uterus, lymph nodes, prostate, bones, soft tissues. This diagnostic method is performed in cases where there is access to the neoplasm. The 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 establish 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 carry out therapeutic measures. In addition to cancerous tumors, there are benign neoplasms that must be removed. Before proceeding with surgical intervention, it is necessary to confirm that there is no oncological process. For this purpose, an aspiration biopsy is also performed.

Sometimes the treatment of inflammatory processes is ineffective, despite the adequacy of the therapy. In such cases, a histological examination of the tissue is required to exclude specific pathologies. In this way, tuberculous, syphilitic or other inflammation can be detected.

Preparation for the study

Depending on the location of the pathological site, preparation for the study may differ. 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 a tumor of external localization is suspected, no specific preparation is required. This applies to neoplasms of the thyroid and mammary glands, skin, and 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 tool and a thick needle. In this case, local anesthesia is required.

The preparation for an endometrial aspiration biopsy is somewhat different. In addition to the above tests, before it is carried out, it is required 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. In the postmenopausal period, the study can be carried out at any time.

Performing a thyroid biopsy

Aspiration biopsy of the thyroid gland is performed using a thin needle. It is required in the presence of nodular formations in the tissue of the organ. Before conducting the study, the doctor performs For this patient, they are asked to make a swallowing movement. At this point, the doctor determines the exact localization of the node. This place is treated with an alcohol solution for disinfection. The doctor then inserts a thin needle into the neck area. With the other hand, he fixes the knot in order to obtain cells from the pathological focus. The doctor pulls the plunger of the empty syringe towards himself to extract the biological material. Pathological tissue penetrates into the lumen of the needle, after which it is placed on a glass slide. The resulting material is sent to the puncture site with a cotton swab dipped in an alcohol solution and fixed with adhesive tape.

A fine-needle aspiration biopsy of the thyroid helps to determine if 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.

Endometrial aspiration biopsy technique

Indications for a uterine biopsy are: suspicion of cancer, hyperplastic processes (endometriosis, polyps), monitoring hormone therapy. The study is performed in a treatment room or a small operating room under ultrasound control. First of all, palpation of the pelvic organs is performed. Then the cervix is fixed with the help of gynecological mirrors. 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, an aspiration biopsy of the uterus is performed using a special vacuum device. It is necessary so that the material is taken under pressure. With its help, you can get several samples of biological material when performing 1 puncture.

Puncture and mammary gland

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 of its implementation is similar to aspiration biopsy of the thyroid gland. The same technique is used to obtain material from neoplasms in the breast. 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 not enough or it is not possible to confirm the diagnosis with its help, a trepanobiopsy of the mammary gland is performed. It is done for research. Thus, it is possible to track the course of the needle. In some cases, a vacuum aspiration biopsy is performed.

Contraindications to the study

There are practically no contraindications to 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 cannot always be performed. Aspiration vacuum or fine-needle biopsy of the endometrium is undesirable for inflammatory pathologies of the cervix and vagina. Also, the procedure is not performed during pregnancy.

Interpretation of study results

Ready in 7-10 days. Cytological analysis is faster. After microscopy of a smear or a histological preparation, 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 established. The prognosis and methods of treatment depend on this.

Aspiration biopsy: reviews of doctors

Doctors say that the method of aspiration biopsy is a reliable diagnostic study that is safe for the patient's health. With little information content of the obtained material, tissue sampling can be repeated. This study does not require hospitalization of the patient.

Endometrial biopsy is one of the most important diagnostic methods in gynecology. This procedure is necessary for further microscopic examination of the obtained tissue samples, which allows you to determine the existing morphological changes in the uterine mucosa.

Several types of endometrial biopsy are currently in use, each with its own goals, indications, and diagnostic capabilities.

Endometrial biopsy: what is it?

An endometrial biopsy is an intravital taking of a tissue sample of the lining of the uterus (endometrium) for subsequent histological and histochemical analysis. This procedure belongs to minor surgical interventions in gynecology and is most often performed as an independent study. But in some cases, it is included in the protocol of a "large" operation and is carried out on an emergency basis intraoperatively.

Biopsy most often pursues exclusively diagnostic tasks. But in some cases, it is a treatment and diagnostic manipulation that allows you to get the information the doctor needs and at the same time improve the condition of the woman. The type of biopsy used also depends on the preparation process, the amount of intervention, and whether the woman will be hurt or not.

Research types

The first documented sampling of the uterine lining for analysis was done in 1937 by Butlett and Rock. In this case, special instruments were used to expand the cervix and scrape (mechanically separate) the entire endometrium.

The main objective of this study was to determine the severity of cyclic changes in tissues due to the hormonal background of a woman. Subsequently, the indications for biopsy expanded significantly, and the method itself began to improve. This made it possible to reduce the trauma and pain of the procedure, reduce the risk of developing various undesirable consequences.

Currently, in clinical practice, several types of taking the uterine mucosa for research are used:

the classic version of the study is therapeutic and diagnostic curettage of the uterine cavity;
vacuum aspiration biopsy of the endometrium, performed using a special syringe or device (vacuum aspirator or electric suction);
pipell biopsy of the endometrium - a more modern version of the aspiration of the mucous membrane and the contents of the uterine cavity, while using a low-traumatic instrument in the form of a flexible suction tube (pipel);
Zug biopsy of the endometrium, during which tissue is taken in the form of dashed scrapings (trains).

A less common way to obtain a sample of the endometrium is to take it in the process (endoscopic examination of the uterine cavity). This biopsy is targeted. The doctor has the opportunity to take a small amount of biomaterial from several suspicious areas at once and simultaneously assess the severity, localization and nature of the existing changes.

However, despite the high information content, hysteroscopy is not included in the list of commonly used diagnostic procedures. Not all medical institutions have the opportunity to conduct such a modern high-tech study.

A very rarely used method for obtaining an endometrial sample is douching.

What does an endometrial biopsy show?

Biopsy (taking material) is only the first stage of the study, the basis of the method is microscopy and histological analysis of the obtained endometrial samples. What does such a diagnosis reveal?

The study may not show any deviations from the age norm. In this case, the conclusion will indicate that the uterine mucosa corresponds to the phase of the cycle and has no signs of atypia. But most often, the study reveals various deviations. It can be:

simple diffuse hyperplasia of the endometrium (growth of the mucous membrane), also called glandular or glandular cystic;
complex hyperplasia of the endometrium (with the formation of similar glands inside the hypertrophied mucous membrane), this condition can also be described as adenomatosis;
local hyperplasia of the endometrium (with or without atypia), which is regarded as single or polyposis;
atypical hyperplasia (simple or complex), in which the cells of the overgrown mucous membrane do not correspond in their morphofunctional characteristics to normal endometrial cells;
malignant degeneration of tissues;
atrophy or hypoplasia of the uterine mucosa;
- inflammation of the endometrium;
discrepancy between the thickness of the functional layer of the endometrium and the current phase of the ovarian-menstrual cycle.

The detection of atypia has an important prognostic value. Some forms of atypical hyperplasia are referred to as precancer.

The main diagnostic features in this case are cellular and nuclear polymorphism, impaired proliferation, changes in the structure of the endometrial glands, and invasion of the glandular tissue into the stroma. The key point for the definition of precancer and cancer is the violation of tissue differentiation.

Indications, contraindications and timing

An endometrial biopsy, if indicated, can be performed in women of any age, including those who have not given birth and are out of reproductive age.

The basis for the appointment of this study may be:

menometrorrhagia, acyclic scanty spotting, of unknown origin, scanty menstruation;
suspicion of and the presence of neoplasms.

An endometrial biopsy is performed before IVF and when the cause of infertility is identified. At the same time, a histological examination of the uterine mucosa is included in the program for a comprehensive diagnosis of a woman's reproductive health.

The study is also carried out after spontaneous abortions in the early stages and termination of pregnancy for medical reasons (with missed pregnancy, intrauterine death of the fetus, detection of malformations incompatible with life in the child). In such cases, biopsy samples are taken by curettage of the uterine cavity.

When is a biopsy done?

The endometrium is a hormone dependent tissue. And the informativeness of the results of his histological examination largely depends on the day of the cycle at the time of the biopsy. This takes into account the clinical situation and the main tasks of the biopsy. And in postmenopausal patients, the presence and time of its onset are taken into account.

What is the best day of the cycle for a biopsy in women of reproductive age? Currently, the following basic recommendations are adhered to:

when identifying the cause of infertility, with insufficiency of the luteal phase and anovulatory cycles, the study is carried out the day before the expected menstruation or on the first day after its onset;
with a tendency to polymenorrhea, the study is prescribed between 5 and 10 days of the cycle;
with acyclic bloody uterine discharge, a biopsy is performed in the first 2 days after the onset of menstruation or menstrual-like bleeding;
in the presence of hormonal imbalance, preference is given to a CUG biopsy, which is carried out several times during one cycle with an interval of 7-8 days;
to monitor the results of hormone therapy, a biopsy is performed in the 2nd phase of the cycle, between 17 and 25 days;
if a malignant tumor is suspected and there is no severe bleeding, the study can be performed on any day of the cycle.

What can limit the use of this method?

Some conditions are relative or absolute contraindications for a biopsy, if they exist, the decision on the possibility of conducting a study and its type is made by a doctor or even a medical commission on an individual basis.

Possible restrictions include:

pregnancy - at the slightest likelihood of conception during the last 2 menstrual cycles, it is necessary to make sure that there is no pregnancy, because an endometrial biopsy provokes rejection of the fetal egg;
disorders of the blood coagulation system;
constant use of drugs with disaggregation and anticoagulant effects (NSAIDs, Dipyridamole, Trental, Warfarin, Clexane and others);
severe degree of anemia;
active phase of infectious and inflammatory diseases of the urogenital system;
intolerance to the drugs used for anesthesia.

A biopsy is not a vital study; if it is impossible to conduct it, the doctor draws up another program for examining the patient. There is also the option of choosing more gentle endometrial sampling methods. But curettage in some cases performs a therapeutic function and therefore can be used even in the presence of relative contraindications.

Research Methods

Biopsy by scraping the uterine cavity

This method is the most radical and historically the earliest way to obtain a biopsy. Such a biopsy includes 2 main stages: the expansion of the cervical canal and curettage of the walls of the uterus. In this case, a set of special bougie (dilators of different sizes), forceps for removing and fixing the cervix and a uterine curette are used - a surgical spoon with a sharp edge.

Diagnostic curettage of the uterine cavity is a painful procedure and requires the mandatory use of anesthesia. Preference is given to short-term general anesthesia, while inhalation or intravenous anesthesia can be used. Therefore, this method requires compliance with the same rules of preparation as any "large" operation. To prevent the reflux of gastric contents and its aspiration into the respiratory tract, it is recommended to refuse to take water and food for at least 8 hours before the procedure.

Modern probe for endometrial biopsy

During curettage, the doctor tries to pass the curette over the entire surface of the walls of the uterus, including the corners near the mouths of the fallopian tubes. As a result, almost the entire endometrium is mechanically removed with the formation of an extensive wound surface.

Such curettage often allows, already at the diagnostic stage, to remove polyps, stop uterine bleeding and clear the uterine cavity from the pathological contents present in it. And the remaining open cervix does not interfere with the natural outflow of blood, although it can serve as a gateway for infection.

Important advantages of diagnostic curettage is the possibility of its use in case of suspected oncological diseases, with metrorrhagia and after an interrupted pregnancy.

Endometrial aspiration biopsy

Aspiration biopsy is a more gentle method of taking a biopsy. The separation of the functional layer of the endometrium is carried out under the action of a vacuum created in the uterine cavity. To do this, a Brown uterine syringe or a vacuum aspirator with an attached catheter can be used. Sometimes pre-irrigation of the uterine cavity is carried out for subsequent washings.

Bougienage of the cervical canal is not required, which significantly reduces the trauma and pain of the study. However, the suction method is also sometimes performed under a shallow general anaesthesia. This avoids severe discomfort, especially in nulliparous women.

Preparation for an endometrial aspiration biopsy includes sexual rest, douching and no vaginal tampons for 3 days before the procedure. The doctor also prescribes a preliminary examination to exclude STDs and acute inflammatory urogenital pathology. In addition, it is advisable to exclude any gas-forming products from the menu and make a cleansing enema the day before.

An aspiration biopsy is considered a technically simple procedure that does not cause obvious pain to a woman. It is often used as a screening study when obtaining questionable results of uterine ultrasound.

However, it is worth remembering that aspiration does not allow obtaining enough material to reliably exclude malignant neoplasms of the endometrium. Therefore, if the presence of malignant tumors is suspected, a more informative diagnostic curettage is performed.

Technique for performing a pipel biopsy of the endometrium

Pipel biopsy is an improved modern version of endometrial aspiration. In this case, the main device for taking part of the mucous membrane is the Paypel tip - a flexible thin disposable tube with a piston. The small diameter (only about 3 mm) and sufficient elasticity of this device allow it to be inserted through the cervical canal without the use of any dilators.

According to the principle of action, the Paypel tool resembles a syringe. After inserting its working tip into the uterine cavity, the doctor pulls the piston towards itself to the middle of the length of the tube, which creates enough negative pressure to aspirate a small amount of endometrium. At the same time, extensive wound surfaces are not formed, the cervix is \u200b\u200bnot injured, the patient does not experience pronounced physical discomfort.

Preparation for a pipel biopsy does not differ from that before classical vacuum aspiration of the endometrium. The procedure is performed on an outpatient basis and usually does not require anesthesia.

Features of the CUG biopsy

CUG biopsy is considered a low-traumatic option for taking a sample of the endometrium. It does not provoke massive bleeding and mucosal rejection and is usually performed up to 3 times during one menstrual cycle. The main objective of such a study is to determine the reaction of the endometrium to natural or artificially created changes in the hormonal background. It is not used to diagnose cancerous and precancerous conditions.

A special small curette is used to perform a CUG biopsy. It is carefully inserted into the uterine cavity without first expanding the cervical canal. Applying a little effort, the doctor scrapes off a narrow strip of mucous membrane with the working surface of the curette. This resembles streaks, so this diagnostic method is called “endometrial streak biopsy”.

It is very important to examine not a single area of the uterus, so strokes (TSUGi) are carried out from the bottom to the internal pharynx of the cervix. For a reliable diagnosis, it is enough to obtain 2 samples at a time.

What to expect and what to do after the study?

Any biopsy of the endometrium is accompanied by a violation of the integrity of the uterine mucosa and the appearance of spotting. Their volume and duration depend on the research method used by the doctor.

Diagnostic curettage leads to profuse menstrual-like and rather painful discharge. But their duration is usually much less than during normal menstruation, because the main part of the endometrium has already been removed during the procedure. Discharge after an endometrial biopsy should not be with clots, pus or an unpleasant odor. The appearance of any of these signs or fever is grounds for urgent medical attention.

Menstruation after an endometrial biopsy by other methods described above may begin on time or with a slight delay. Their volume and duration often differ from the usual. Most often, there is a delay in menstruation after a pipel biopsy of the endometrium for up to 10 days. In this case, it is necessary to do a pregnancy test and consult a doctor.

Pregnancy after the study is possible in the next cycle. During this period, there will be a complete renewal of the functional layer of the uterine mucosa. In addition, the biopsy does not affect the functioning of the ovaries. And with gentle methods, the remaining endometrial area may be sufficient for implantation of the ovum already in the current ovulatory cycle.

How long do results take to prepare?

Deciphering the results after an endometrial biopsy can take up to 2 weeks. Histological examination of biopsy specimens is carried out by a pathologist or histologist. If necessary, immunohistochemical analysis is also carried out.

The term for obtaining the results depends on the specific laboratory, the workload of the histologist and the urgency of the study. If it is necessary to conduct an emergency analysis, the doctor makes a note about this on the referral. Histological examination of samples taken during surgery is sometimes carried out within 20 minutes, the result obtained may affect the extent of the surgical intervention.

What is done after the biopsy?

Further diagnostic and therapeutic tactics depend on the results of the biopsy. When atypia and precancer are detected, the question of the need and expediency of surgical treatment is decided. When signs of inflammation are detected, its nature is determined and anti-inflammatory and antibacterial drugs are prescribed.

If an endometrial biopsy showed signs of hyperplasia or insufficient tissue response to cyclic hormonal changes, a further diagnostic search is performed. This is necessary to determine the existing endocrine disorders and secondary changes in other hormone-dependent tissues (primarily in the mammary glands).

Possible complications and consequences

A number of women after a biopsy complain of a temporary change in the duration of the menstrual cycle, painful menstruation and discomfort during intercourse.

The most dangerous complication of a biopsy is endometritis. It is characterized by a pronounced increasing intoxication, abdominal pain and the appearance of fetid uterine discharge with signs of suppuration. Fortunately, this complication is rare. Its development is usually associated with hypothermia, non-compliance with the doctor's recommendations regarding the hygiene of the genital organs and sexual rest.

But sometimes the cause of endometritis is an exacerbation of the existing one. Therefore, women with chronic urogenital diseases after an endometrial biopsy need to drink antibiotics on the advice of a doctor. The same tactics are followed if the patient has had an abortion.

When the biopsy will be performed, which method will be chosen and how to prepare for the procedure, you need to check with your doctor. Failure to follow the recommendations may adversely affect the reliability of the study and increase the risk of complications.

Do not refuse to conduct a biopsy, because no other diagnostic methods can replace a histological analysis. Only this examination makes it possible to diagnose endometrial cancer at an early stage, which significantly improves long-term results of treatment.