Features of the biopsy of the endometrium of the uterus. How is aspiration and pipell endometrial biopsy performed? Vacuum endometrial biopsy

It is done by a gynecologist using a special device that allows you to take the material without additional manipulations. The procedure is considered the safest and most gentle compared to other types of biopsies due to the fact that the cervix does not dilate.

An endometrial biopsy is a study of the inner layer of the uterus, in which the cervical canal is not opened. The gynecologist takes the material for analysis for further laboratory diagnostics at the end of the study. For a biopsy, the gynecologist will use a tube-pipel. At the end, it has a hole through which the material necessary for diagnostics gets inside. No additional manipulations for the collection of the endometrium are required due to the device of the tube.

A pipel biopsy allows you to carry out therapeutic measures during the procedure, when necessary.

What shows

Peipel endometrial biopsy shows:

• the presence of atypical (cancerous) cells;
• the presence of bacteria or viruses, as well as other infectious agents;
• hyperplasia (overgrowth of the endometrium).

The alleged diagnosis is confirmed or refuted after the examination of the material in the laboratory.

Advantages and disadvantages

The advantages of performing a Pipel biopsy are that:

• the procedure is carried out in the gynecologist's office, there is no need to register in a hospital;
• does not last long;
• it is allowed to do in the presence of various diseases, when other types of biopsy are prohibited;
• disposable instruments are used;
• traumatization is minimal;
• no need for anesthesia;
• high information content of the method;
• the cost varies within 3000 rubles.

But among patients who have undergone a pipel biopsy of the endometrium, there are also negative reviews. In most cases, they are associated with an incorrect procedure by a doctor when the fundus of the uterus is traumatized. There is also a lack of information in the material, the reason for which is the patient's failure to comply with the date of the procedure or other requirements. Many complaints about the severe pain of the procedure.

Indications

A Paypel biopsy is prescribed by a doctor to confirm or clarify the diagnosis.

The indications for the procedure are as follows:

• infertility;
• preparation for IVF;
• bleeding not associated with menstruation, or after taking hormonal drugs;
• long-lasting spotting after childbirth;
• myoma;
• the presence of polyps;
• endometriosis;
• hyperplasia;
• menstrual irregularities;
• suspicion of the presence of malignant cells.

Contraindications and restrictions

Pipel biopsy of the endometrium has a number of contraindications to the procedure:

• pregnancy;
• blood clotting disorder.

Among the time constraints, the active stage of inflammation of the genitourinary system should be distinguished.

On what day of the cycle and how often can a biopsy be done

Pipel biopsy of the endometrium is performed on the 25th or 26th day of the cycle before menopause. In case of heavy bleeding during menstruation, the doctor may prescribe an operation from 5 to 10 or from 17 to 20 days of the cycle. After the onset of menopause or if cancer is suspected, a biopsy can be performed any day.

A pipel biopsy of the endometrium is done on the day of the menstrual cycle, which is prescribed by the doctor. You cannot choose the day yourself. Days will vary for different diagnoses.

This type of examination can be done frequently if so prescribed by the attending physician. Sometimes, to clarify the diagnosis, the procedure is carried out twice in one menstrual cycle.

Study preparation

Preparation for a pipel biopsy of the endometrium must be observed in order to avoid complications.

Primary includes a number of examinations:

• smear at the gynecologist;
• coagulogram.

A smear is necessary to exclude infectious or other diseases. Ultrasound reveals the presence of pathologies and confirmation of the absence of pregnancy. It is necessary to make a coagulogram in order to exclude problems with blood clotting. This biopsy does not involve the use of a coagulant to cauterize vessels in case of bleeding.

How to prepare for an endometrial pipel biopsy when examinations allow the procedure:

• 3 days before the procedure, exclude sexual intercourse, douching and do not use vaginal suppositories;
• in agreement with the doctor, stop taking hormonal drugs and drugs that thin the blood.

Execution technique

The technique for performing the procedure resembles an examination by a gynecologist and looks like this:

1. The woman undresses and sits comfortably on a chair.
2. The doctor inserts a dilator with a mirror into the vagina.
3. Next, he measures the size of the uterus by introducing a special measuring device into it through the cervical canal. This is necessary for the correct selection of the tube.
4. A tube is inserted into the uterus and the material is taken in 3 different places.
5. The equipment is taken out, the woman can get up from the gynecological chair.

The video below shows the procedure in 3D animation. Taken from the Promatka channel. ru.

How material is collected

The procedure is as follows: the doctor creates a negative pressure using a piston at the bottom of the tube. Endometrial tissue enters the device through a hole at the end of the pipel. Equipment with material is removed and sent to the laboratory.

Is the procedure painful and how long does it take?

Whether it will hurt to do a pipel biopsy of the endometrium depends on your personal pain threshold. Doctors declare that the procedure is painless. Some gynecologists tend to prescribe pain medication before starting a biopsy. As a rule, complaints of soreness do not occur often and we are talking about short-term discomfort.

The duration of the biopsy is about 2 minutes.

What not to do after the procedure

After a pipel biopsy of the endometrium, it is impossible to:

• in the presence of spotting, use tampons;
• take a bath, overheat;
• supercool;
• have a sexual life;
• apply antibiotics;
• use hormonal contraceptives.

It is important to avoid strenuous exercise and stay in bed for 2 days. Restrictions are imposed for a period of 2-3 days, unless otherwise prescribed by the doctor. If during the procedure traumatization of the uterus occurs, they are extended for a period of up to 30 days.

Deadlines for obtaining results and their interpretation

Results are reported 7-10 days after endometrial tissue sampling. As a rule, the transcript contains one phrase, the meaning of which is clear to the gynecologist.

This may be, for example: the epithelium is normal in the proliferation phase. If the material was taken a few days before the onset of menstruation, such a diagnosis means hormonal disorders in the body.

Therefore, in order for the doctor to accurately diagnose, it is important to follow the recommendations and undergo a biopsy on the right day of the cycle. Otherwise, the diagnostic result will be incorrect.

Consequences and possible complications

After a biopsy, the following consequences are possible:

• 10-day delay, or scanty/heavy periods;
• perforation of the uterine fundus (if the procedure is performed in the presence of inflammation).

Complications are rare and look like this:

• bleeding associated with the patient's blood clotting or damage to the uterus;
• accession of a bacterial infection after a procedure that enters from the vagina;
• brown discharge;
• endometritis.

For a pipel biopsy, strong discharge is not typical, since traumatization is minimal. If a woman does not bleed, but bleeding is clearly noticeable - more than 3 pads within 2 hours - hospitalization is required. Any complications after surgery can be easily avoided by following the precautions.

The method of aspiration biopsy is one of the most progressive for the histological and cytological analysis of the uterine mucosa. Its essence lies in the introduction of a thin hollow tube into the uterine cavity, into which a small section of the endometrium is absorbed. The examination allows you to diagnose many diseases - benign and malignant changes in the uterus, polyps and other pathologies. The advantages of a biopsy are low trauma and less pain compared to traditional curettage.

Endometrial aspiration biopsy - what is it?

The tissue aspiration biopsy procedure is performed to take an aspirate from the uterine cavity. Endometrioid tissue from the inner surface of the uterus is aspirated with a special instrument called a "pipel". The pipel is a hollow silicone tube with an outer diameter of 3-4 mm. There are small holes at the end of the tube. A piston is inserted into the tube.

The taken samples are further examined in the laboratory (cytological analysis). This is a minimally invasive examination, unlike curettage, which is considered the "gold standard" for diagnosing the endometrium - the mucous membrane that lines the uterine cavity in women. The pipel allows you to quickly absorb pieces of the endometrium, while the risk of perforation of the uterus is practically absent.

Pipel biopsy is one of the most widely used methods for diagnosing the endometrium among women in Europe. According to the accuracy of the diagnostic results, it is not inferior to curettage. Aspiration biopsy has the following advantages:

• the possibility of carrying out on an outpatient basis;
• slight soreness;
• speed of conduction - from several seconds to several minutes;
• minimal trauma;
• the possibility of obtaining a tissue sample from any part of the uterus;
• low risk of inflammatory complications;
• absence of contraindications from other organs and systems;
• research can be done multiple times.

Indications

A biopsy is performed in patients in the following cases:

1. 1. With bloody discharge from the uterus.
2. 2. For the diagnosis of luteal phase deficiency.
3. With previously identified deviations in the process of ultrasound examination:
   • remnants of tissue after abortion;
   • polyps in the endometrium;
   • malignant tumors;
   • inflammatory processes in the surface layer of the endometrium;
   • hyperplasia;
   • uterine myoma.

Endometrial aspiration biopsy is also prescribed for nulliparous women who cannot conceive a child for a long time for dynamic diagnosis in the treatment of uterine diseases and hormone therapy. The diagnosis of chronic endometritis can be confirmed only after a histological and cytological analysis, a study of biological material.

Preparation for the procedure and contraindications

Aspiration biopsy is not performed in the following cases:

• during pregnancy;
• in the presence of an acute infectious disease in the female genital organs and pelvic organs;
• with blood diseases associated with a violation of its coagulability.

Preparation for a biopsy is minimal. Before the procedure, it is necessary to do an ultrasound screening of the walls of the uterus and pass tests:

• smear on flora;
• smear for oncocytology;
• general blood analysis;
• blood test for syphilis, HIV and hepatitis.

Immediately before the procedure, the use of vaginal ointments, tampons and suppositories is prohibited. Intimate relationships should be stopped 2-3 days before.

Methodology

You must first consult a gynecologist, during which the menstrual cycle is specified. In postmenopausal women, the procedure is carried out at any time. In menstruating women, a biopsy is usually taken on the 25-26th day of the menstrual cycle. To confirm the diagnosis of chronic endometritis, sampling is done in the first phase of the cycle, and in case of corpus luteum insufficiency, in the second.

The endometrial aspiration biopsy procedure is performed in the following order:

• A manual examination is performed to determine the size and position of the cervix.
• The cervix is ​​examined with the help of mirrors.
• The vagina, cervix, cervical canal are cleaned with antiseptics.
• The uterine cavity is examined with a hysteroscope in order to identify pathologies.
• The cervix is ​​fixed with surgical forceps.
• A catheter is inserted and aspiration is performed. When the piston is pulled out of the pipe, negative pressure is created in it. Particles of the endometrium are detached from the tissue and sucked into the silicone tube.
• The pipel is removed from the uterine cavity.
• The biopsy material is applied to a labeled glass slide previously degreased with ether and a thin smear is made, as in a blood test. If during the procedure a 0.9% solution of sodium chloride was introduced into the uterine cavity, then the resulting liquid is placed in a test tube and centrifuged to separate the precipitate from which the smear is made. After that, the material is sent to the laboratory for histological, cytological or histochemical examination.

Simultaneously with the examination, therapy can also be carried out - removal of polyps or curettage of residues after an abortion.

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 biopsy is performed harmlessly and has low morbidity.

Biopsy techniques:

• diagnostic curettage (classic);
• aspirate biopsy;
• CUG biopsy;
• targeted biopsy.

Aspiration biopsy Surgery with a hysteroscope

Classic mucosal scraping

This type of procedure involves taking a biological sample using a surgical instrument. The specialist collects the top 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 examination of the uterus and therapeutic procedures.

Scraping is done in these situations:

• violation of the menstrual cycle;
• 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;
• no 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 can 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 greatly reduced. The event 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, the doctor may suggest general anesthesia.

The advantages of the aspiration technique can be found in the video from the Medical Center channel.

Paypel endometrial biopsy

The sampling of biological fragments is carried out using a hollow catheter with a diameter of 3 mm with a slit at the end. Thanks to him, pressure is formed in the device and the tissue of the crypts and endometrium is taken into the cylinder. Pipepel is considered the most painless sampling method, which has almost no flaws.

During the process, the doctor places the Peipel tube into the uterus and pulls on the plunger. Due to the conditions, the technique does not cause injury to the mucous membrane, does not provoke infection. It is recommended for young women without children, with pathologies of the endometrium and infertility.

CUG biopsy

The operation is performed to push apart the cervical uterine canal with a special device. The surgeon scrapes the walls of the mucous membrane, slowly advancing to 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 collects biological segments in the form of strokes from several parts of the organ.

Targeted biopsy for hysteroscopy

The essence of the technique lies in the fact 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

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 neoplasms of a different nature;
• uterine fibroids;
• hyperplasia;
• ovarian cyst;
• ocytology of the cervix;
• in vitro fertilization (IVF).

Contraindications

Conducting any type of biopsy has its contraindications:

• pregnancy;
• inflammatory diseases of the reproductive organs;
• low blood clotting.

Dates

Features of the biopsy:

• with fears of cancer - any day of the menstrual cycle;
• if you suspect polyps or similar neoplasms - immediately after the end of the cycle;
• to establish the cause of non-cyclic bleeding - on the first menstrual day;
• with heavy monthly bleeding - a week after the end of menstruation;
• to diagnose the sensitivity of the endometrium to hormones - no earlier than two weeks later;
• with 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 the operation, refuse douching, sexual intercourse, vaginal preparations;
• on the eve of the procedure, do an intestinal lavage;
• to exclude complications after a surgical operation, it is necessary to do a number of special blood and urine tests in advance;
• in the morning before the procedure, the patient should take a shower and remove hair from the genitals;
• if the operation will be performed under anesthesia, then twelve hours before it is necessary to refuse food.

How is the procedure carried out

The main stages of the operation:

1. Treatment of the external genital organs with a special antiseptic agent.
2. Expansion of the vagina with a specialized surgical mirror.
3. After access to the cervix, treatment with alcohol is carried out.
4. The organ is fixed with bullet forceps.
5. All further actions are carried out depending on the choice of biopsy technique.

Consequences and complications

Consequences after surgery can be:

• change in the duration of menstruation;
• bloody issues;
• painful menstruation;
• severe toxicosis;
• pain and soreness in the abdomen;
• uterine discharge with pus and an unpleasant odor;
• exacerbation of vaginitis;
• temperature rise;
• fever;
• loss of consciousness;
• convulsions;
• migraine.

Deciphering the results

Diagnostics shows:

• adenomatosis of the uterus;
• hyperplastic processes;
• atrophy of a different nature;
• endometritis;
• tumors;
• discrepancy between the phase of the menstrual cycle of indicators of the thickness of the walls of the mucosa.

In the final document, the doctor fills out four parts:

1. Informativity of a biological sample. It may or may not be appropriate. In the first case, the diagnosis found an insufficient indicator of the endometrium (the sample was taken incorrectly). In the second case, there are enough endometrial cells to draw the following conclusions.
2. Macroscopic description of the preparation. At this stage, the weight of the fragments, their size and color are reported. The doctor indicates what the consistency of the samples is, as well as the presence of blood clots and mucus.
3. Microscopic description of the preparation. The doctor indicates the size and type of the 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 fixes the onset of inflammatory processes.
4. final diagnosis. Here, the specialist specifies which phase of the cycle is commensurate with the endometrium, the presence of its expansion. Indicates the characteristics of neoplasms (polyps). How thinned and reduced the walls of the mucosa. The presence of atypia and cancer cells. Degeneration of the epithelium and vessels of the chorionic villi.
5. Often, a specialist in the final diagnosis writes that the endometrium is normal in the phase of proliferation (secretion, menstruation). This phrase indicates that the patient does not have any signs of abnormal formations.

How much does an endometrial biopsy cost?

The cost of the procedure in different medical centers and cities is different.

Video

How to do an endometrial biopsy is shown in the video from the PROMATKA channel. RU.

Content

Problems with the endometrium in women are very common. They do not allow to conceive and bear a child, and in advanced cases they simply interfere with life - they cause pain, bleeding, menstrual irregularities.

The endometrium is the mucous layer that lines the inside of the uterus.

A biopsy is a medical procedure during which tissue is removed from the human body for further histological examination.

Thus, we understand that endometrial biopsy is a method of taking mucosal tissue from the uterine cavity for further study and results.

Methods

There are several options for biopsy today.

• Curettage of the uterine cavity with the expansion of the cervical canal is the oldest and most traumatic method of material sampling. Such a study is done using special surgical instruments. First, the cervical canal is opened, then its cavity and the uterine cavity are scraped with a special curette. This operation is usually performed under general anesthesia.
• Zug curettage is a more gentle method of endometrial biopsy compared to curettage. With a special tool, several movements (strokes) are carried out from the very bottom of the uterus to its canal. Use such a study only in the absence of bleeding from the uterus.

• Material sampling using an aspirator is a procedure during which the endometrium is “sucked” into a special device without physical impact on the walls of the uterus. This method is not used for suspected cancers and tumors. The results may be erroneous.
• Douching is a rare biopsy method during which the endometrium is washed out with a stream of a special solution.

• Pipeline biopsy is the safest and most modern method of endometrial biopsy. During the procedure, I use a special flexible tube with a piston (pipel), which is inserted into the uterus and the endometrium is collected using negative pressure in the cylinder. As a result of this procedure, the endometrium is torn off the walls of the uterus and sucked into the tube. The advantage of this method is that there is no need to put the patient into drug-induced sleep, and due to the very small diameter of the pipel, it is not necessary to dilate the cervical canal. All this eliminates the possibility of complications after surgery, minimizes the recovery period and does not cause any particular inconvenience to women.

The pipel method is not used in all public institutions, although it is the most minimally invasive and cheapest method of taking material from the uterus.

In what cases is the procedure indicated

An endometrial biopsy is ordered women of any age, if there are certain indications for this. In this case, such features as the absence or presence of childbirth in history and the onset of physiological menopause do not become a contraindication for the study and do not affect the results.

• there is a suspicion of the presence of neoplasms in the uterine cavity or cervical canal;
• preliminary diagnosis: adenomyosis or endometriosis;
• scanty bleeding during menstruation;
• disruption of the menstrual cycle;
• amenorrhea - absence of menstruation;
• bleeding from the uterus of an unclear nature;
• in preparation for in vitro fertilization to determine the quality of the endometrial layer and a more accurate prognosis for the attachment of the fetal egg;
• after an abortion, miscarriage, missed pregnancy;
• with problems with carrying a pregnancy;
• infertility.

On which day of the cycle is it correct to carry out

The endometrium is the tissue of the uterus, the thickness of which depends on the phase of the menstrual cycle and the amount of sex hormones.

Biopsy result directly depends on the day of the cycle on which the material was taken for analysis.

The appointment of the day of the biopsy and the results depend on the goals of the study:

• in case of insufficiency of the luteal phase and cycles without ovulation (anovulatory), to identify the causes of infertility, a biopsy is prescribed on the first day of menstruation or right before they begin;
• with a menstrual cycle length of less than 21 and suspicion of polymenorrhea, the study is carried out on the 5-10th day of the cycle;
• with uterine bleeding of an unclear nature, metrorrhagia, the endometrium is examined on the first or second day from the onset of abnormal bleeding;
• if a hormonal disorder is detected, a biopsy is usually prescribed by the zug method every eight days during one cycle (up to four per month);
• to control the implementation of hormonal treatment, an endometrial biopsy, in order to obtain the most accurate results, is prescribed in the middle of the cycle (17-25 days from the start of menstruation);
• for the detection of malignant neoplasms and endometrial cancer, the day of the cycle in conducting a biopsy does not matter.

Contraindications

A biopsy is not a vital study, although its results undoubtedly play a large role in the diagnosis and treatment of patients. Here is a list of contraindications when an endometrial biopsy can be performed only after consultation with specialized specialists or requires the procedure to be replaced with a more gentle study:

• inflammatory and infectious diseases of the genitourinary system;
• severe anemia;
• allergic reactions to drugs of local and general anesthesia;
• taking anticoagulants or antiplatelet agents when it is impossible to stop taking them;
• problems with blood clotting.

An endometrial biopsy is never done during pregnancy. The results of such a study of a woman in an interesting position will be invalid, and manipulation will lead to a threatened abortion or miscarriage.

results

The results of a biopsy are taught by examining the tissue taken under a microscope. Such a conclusion always consists of four parts.

• Informative value of the sample taken. The sample taken for examination may be informative (suitable for further research) or non-informative (when the results of a study taken by the biopsy of a tissue site cannot be obtained).
• The description of the sample is macroscopic - weight, fragment size, color, consistency, the presence of blood clots and blood clots, mucus.
• Microscopic description of the sample - the type of epithelial tissue, its dimensions, the number of layers, the stroma (base), the shape and size of the cell structure, the number of connective fibers, the amount of fluid and nutrients, the description of the shape and structure of the uterine glands, the lumen of the glands, the presence or absence of signs of inflammation (lymphoid accumulations).
• Diagnosis - indicates which phase of the cycle corresponds to the uterine mucosa, the presence or absence of polyps, hyperplasia, atrophy with a description of the tissue and its structure, the presence or absence of atypia (precancerous condition) and malignant cells in the endometrium.

With a biopsy after an abortion, curettage due to a fading pregnancy or miscarriage:

• In the microscopic description, edema or dystrophic changes in the chorion may be described (indicating a miscarriage or incomplete abortion).
• The presence of chorionic villi in the diagnosis indicates an interrupted pregnancy.
• Degeneration of the vessels or epithelium of the chorionic villi in the diagnosis indicates that the fetus was initially deprived of nutrients, which could provoke its death.

The results of an endometrial biopsy, when the conclusion says: “Normal endometrium in the phase ...”, indicate a good result of the study (absence of polyps, tissue growth, neoplasms and other disorders). It is worth paying attention only to the correspondence of the phase of the menstrual cycle on the day of the study and the phase of the cycle in conclusion (proliferation, secretion, menstruation). The discrepancy between the results and the day of the cycle may indicate hormonal disorders in the body.

The results of an endometrial biopsy should be interpreted by the attending gynecologist. If necessary, the doctor will immediately prescribe the necessary treatment that corresponds to the identified problem or, with good results, will offer to come for a scheduled examination after a while.

Biopsy of the endometrium of the uterus- a procedure during which samples of the lining of the uterus - the endometrium - are taken. Tissue samples are delivered to the laboratory, where histological analysis is carried out - the study of mucosal tissue and the identification of atypical signs in the cells.

Goals. Modern doctors widely prescribe a biopsy of the endometrium of the uterus. It is a mandatory study in preparing a woman for in vitro fertilization (IVF). This procedure not only provides information about the state of the endometrium, but also significantly increases the chances of attaching the embryo.
An endometrial biopsy is necessary to identify:

• causes of infertility and spontaneous abortion;
• hormonal abnormalities;
• causes of uterine bleeding not associated with menstruation;
• endometrial hyperplasia - growths of the mucous membrane of the uterus;
• malignant changes - uterine cancer.

• Paypel biopsy- the material is taken using a thin plastic tube with a side hole at the end. With the help of a piston, a negative pressure is created in the tube, due to which the tissue of the uterine glands and endometrium is sucked into the cylinder. It is considered the least traumatic method of taking material.
• Aspiration biopsy- The principle of the procedure is the same as for the Peipel biopsy, but a syringe or an electric vacuum apparatus is used to create negative pressure.
• Diagnostic curettage of the uterus- sampling of material using a surgical spoon - curette. The gynecologist scrapes off the top layer of the mucosa from certain areas or from the entire surface of the uterus. The mucosa is scraped off completely or in the form of dashed scrapings - trains.
• Biopsy during hysteroscopy- samples of the uterine mucosa are obtained during an endoscopic examination using a hysteroscope - a probe equipped with a miniature video camera and a miniature surgical instrument.

Biopsy study. In the laboratory, the biopsy is dehydrated, made fat-soluble, and then impregnated with paraffin, turning it into a solid cube in special forms. Using a microtome, it is cut into plates, 3-10 microns thick. These thin layers of tissue are placed on a slide, stained and covered with a second slide, which allows the material to be fixed and stored for a long time.
Histologists and pathologists examine tissue samples using a light microscope. The whole process takes 7-10 days, after which a conclusion is issued, which describes the structural features of the endometrium. The final diagnosis is made only in obvious cases. For most patients, the clinical diagnosis is made by a gynecologist, taking into account the results of a biopsy and other examinations (subjective symptoms, examination results, hysteroscopy, colposcopy).

The structure of the uterus

• outer layer or parametrium- connective tissue that covers the outside of the body. It also forms ligaments that provide attachment to the uterus.
• inner layer or myometrium- smooth muscles. A thick layer of muscle tissue provides protection to the fetus and uterine contraction during childbirth.
• inner layer or endometrium- a mucous membrane containing a large number of blood vessels. It contains the uterine glands, which secrete mucus that prevents the walls of the uterus from falling off.

• Proliferation phase- the growth of the functional layer of the endometrium, its recovery after menstruation. Duration from the 5th to the 14th day of the cycle. Reproduction of endometrial cells, their proliferation, stimulates the hormone estrogen.
• Secretion phase- active secretion by the uterine glands, which creates optimal conditions for the attachment and development of the embryo. It lasts approximately from the 15th to the 27th day of the cycle. Changes are stimulated by the corpus luteum hormone - progesterone.
• Bleeding phase- the period during which the functional layer of the endometrium exfoliates and is removed from the uterus during menstruation. Duration from the 28th to the 4th day of the cycle. Rejection of the functional layer is associated with a deficiency of progesterone. In its absence, the arteries that feed the upper layer of the endometrium shrink, causing the cells to not receive enough nutrients and die.

In the mucous membrane of the uterus, several components are distinguished. Their cellular structure can change depending on the phase of the menstrual cycle.

• Basal layer- the lower layer adjacent to the muscular membrane of the uterus. Its main function is to ensure the restoration of the functional layer after menstruation or other damage. Thickness 10-15 mm. Weakly responds to hormonal fluctuations. Cell nuclei are oval, stain intensely. Depending on the phase of the cycle, the shape of the cells and the location of the nuclei in them change. Here are large vesicle cells, which are immature cells of the ciliated epithelium.
• functional layer- superficial layer lining the uterine cavity. Its function is to ensure the adherence of a fertilized egg and its subsequent implantation. It is most sensitive to the effects of female sex hormones. During menstruation, it is completely rejected. In the first days after menstruation, its thickness is minimal. By the end of the cycle, it increases to 8 mm.
• uterine glands- simple unbranched tubular glands that secrete a mucous secret that ensures the normal functioning of the uterus. The glands originate in the basal layer. During the cycle, with the growth of the functional layer, the glandular tube lengthens and acquires a tortuous shape, but does not branch.

• in the basal layer the uterine glands are narrow, densely arranged and separated by narrow stroma strips. Their surface is lined in one row with a cylindrical epithelium, similar to that covering the surface of the mucosa.
• In the functional layer are the main parts of the tubes and their excretory ducts. In the first week after menstruation, the tube of the gland has a straight shape and a narrow lumen. Further, it lengthens, acquires a sinuous shape. At this stage, the cells of the gland begin to produce mucus, which initially accumulates in the duct, and then is excreted into the uterine cavity, moisturizing its mucosa.

• Stroma of the endometrium it is a connective tissue that provides strength to the mucous membrane and connects the endometrial cells to each other.

• in the basal layer the stroma is dense, consists of connective cells and a large number of thin collagen fibers. Stromal cells are small, rounded, less than endometrial cells. They are located in loose groups between the uterine glands. They have a rounded nucleus surrounded by a thin rim of cytoplasm.
• In the functional layer after menstruation, the stroma is represented by delicate argyrophilic fibers, which coarsen by the end of the cycle. The shape of the cells is spindle-shaped, they contain large nuclei. The cells are located at a distance from one another, so the stroma is loose. In the secretion phase, endometrial edema occurs and water and nutrients accumulate between stromal cells, increasing the gaps between them.

Indications for uterine endometrial biopsy

• Intermenstrual acyclic bleeding;
• Bleeding after the onset of menopause;
• Prolonged heavy bleeding during menstruation;
• Bleeding after spontaneous abortion or childbirth;
• Bleeding while taking hormonal contraceptives;
• Evaluation of the effectiveness of hormonal treatment;
• Lack of menstruation without pregnancy;
• Determining the causes of infertility;
• endometrial polyps;
• During the examination with uterine myoma, endometriosis, endometrial hyperplasia, ovarian cyst;
• Signs of atypia of the glandular epithelium, detected in a smear for cytology (Pap test);
• Changes determined by ultrasound of the uterus during 3 cycles;
• Tumors of the endometrium to determine malignancy;
• Preparation for artificial insemination.

• On any day of the cycle - if endometrial cancer is suspected;
• Immediately after menstrual bleeding with endometrial polyps;
• On the first day of bleeding or spotting to determine the cause of uterine bleeding not associated with menstruation;
• On the 7-10th day of bleeding - with prolonged heavy menstruation;
• On the 17-24th day of the cycle to determine the sensitivity of the endometrium to hormones;
• 2-3 days before the expected menstruation with infertility, corpus luteum insufficiency, with a large number of anovular cycles.

Contraindications to any type of endometrial biopsy are:

• Pregnancy;
• Acute urinary tract infections;
• Inflammatory diseases of the pelvic organs - genital and urinary;
• Significant bleeding disorders.

How to prepare for a uterine endometrial biopsy?

• Sexual contacts;
• douching;
• The use of any vaginal preparations without a doctor's prescription.

• Determination of blood clotting - coagulogram;
• Blood test for HIV, syphilis - RW, hepatitis B and C;
• Smear on flora - bacteriological examination of the contents of the genital tract;
• The test for human chorionic gonadotropin in the blood or in the urine is a pregnancy test.

Biopsy technique

At the preparatory stage, they carry out:

• Treatment of the external genital organs with an antiseptic;
• Expansion of the vagina with a speculum to gain access to the cervix;
• Treatment of the cervix with alcohol;
• Fixation of the cervix with bullet forceps.

1. Diagnostic curettage of the uterus

• With the help of Hegar dilators (which are metal cylinders with a diameter of 4-13 mm), the cervical canal is expanded. Its width should correspond to the size of the curette - a surgical spoon.
• A curette of the required size is inserted into the uterine cavity.
• Having pressed the curette to the anterior wall of the uterus, it is carried out from the bottom to the internal pharynx, scraping the functional layer of the mucosa.
• The spoon with the material is removed from the uterus and the material is collected in a container with formalin.
• The action is repeated, successively scraping the entire mucosa from the anterior, and then from the posterior wall of the uterus and the mouths of the fallopian tubes.
• When examining the reaction of the endometrium to hormones and establishing the cause of infertility, the doctor does not scrape the entire surface of the uterus, but is limited to 3 separate scrapings - trains.

• With complete curettage, the risk of missing foci of atypia or endometrial cancer is eliminated;
• It is possible to immediately remove pathological foci during the procedure.

• Performed in a hospital
• Requires intravenous anesthesia;
• Sufficiently high invasiveness of the procedure;
• Long recovery period - up to 4 weeks;
• There is a risk of complications if the procedure is performed incorrectly.

• A catheter (thin hollow tube) with a diameter of 2-4 mm is inserted through the cervical canal into the uterine cavity. It is pressed tightly into the wall of the uterus.
• A syringe is attached to the outer edge of the catheter.
• By pulling the plunger of the syringe, a sample of the epithelium of the uterine mucosa is obtained.
• The resulting material is applied in a thin layer on defatted glass slides.

• Using a thin catheter and a syringe, 3 ml of saline with the addition of sodium nitrate is injected into the uterine cavity. The latter is necessary to prevent the formation of blood clots.
• Immediately after administration, the liquid is removed with a syringe.
• The resulting washing liquid is placed in a test tube and sent to a centrifuge for 8 minutes. After that, a precipitate of cells forms at the bottom of the tube. This method allows you to obtain information about the characteristics of individual cells, but not about the structure of the mucosa as a whole.

• 30 minutes before the operation, drugs are taken to relax the cervix and reduce pain (baralgin, analgin, diphenhydramine) or an antispasmodic injection into the cervix of a 1-2% solution of lidocaine with adrenaline. A solution of lidocaine is also injected into the parauterine tissue.
• A probe is inserted into the uterine cavity to determine its depth.
• After removing the probe, an aspiration tube connected to an electric vacuum aspirator is inserted into the uterine cavity.
• The doctor, moving the catheter through the uterine cavity, collects material from different parts of it.
• The collected material is placed in containers with formalin solution.
• The procedure is performed blindly or under ultrasound guidance.

Advantages:

• Low invasiveness of I and II variants of the procedure;
• Short recovery period after I and II options.

• It is impossible to establish the structure of the endometrium.
• The recovery period after vacuum aspiration takes 3-4 weeks.

• The gynecologist inserts a probe through the cervical canal into the uterine cavity.
• When the piston is pulled, a negative pressure is created in the cylinder, and it sticks to the wall of the uterus.
• Through the hole at the end of the probe, the material enters its cavity.
• The procedure is repeated 3 times in different parts of the mucosa.
• The probe is removed from the uterine cavity.
• The contents of the probe are placed in a container filled with 10% formalin solution.

• It is possible to carry out in the gynecological office;
• No need for anesthesia;
• Painless and non-traumatic;
• Rapid healing of the mucosa;
• Sensitivity 60-90%
• It does not cause complications when the procedure is carried out correctly.

• Based on small fragments of the mucosa, it is difficult to establish the structure of the endometrium;
• Collection of material from limited areas of the uterus. There is a risk of missing pathological foci.

• Sterile saline is injected into the uterine cavity to obtain a high quality image.
• A hysteroscope is inserted through the cervical canal into the uterine cavity.
• The mucosa is examined with the display of the image on the monitor screen.
• Determine the areas from which to take samples of the material.
• A curette or other surgical instrument is inserted through the port of the hysteroscope. With its help, particles of the endometrium are taken by scraping or aspiration.
• The mucosal samples are placed in a container.
• The saline solution is removed from the uterine cavity, then the hysteroscope is removed.

• It is possible to remove identified pathologies - polyps, synechia;
• Short recovery period;
• High diagnostic accuracy.

• The need for intravenous anesthesia;
• The high cost of the procedure;
• Insufficient number of clinics equipped with appropriate equipment.

What are the results of the histology of the biopsy?

1. Informativeness of the sample.

• Uninformative, inadequate sample. This phrase in the histological conclusion indicates that the material obtained does not contain a sufficient number of endometrial cells. Blood cells, stratified squamous epithelium of the vagina, columnar epithelium of the cervical canal may be present. This situation is possible if the sample is taken incorrectly.
• Informative, an adequate sample - a sufficient number of endometrial cells are present in the biopsy.

1. Macroscopic description of the preparation.

• Weight of submitted samples;
• Fragment size (large, small);
• Color (from gray to bright red);
• Consistency (loose, dense);
• Blood clots, blood clots;
• Slime.

1. Microscopic description of the preparation.

• Type of epithelium (cylindrical, cubic, flat, indifferent), its size, number of layers;
• Stroma - its presence, density, uniformity.
• Size and shape of stromal cells;
• Fibroplasticity of the stroma - the number of connective fibers;
• Stroma decidua - accumulation of fluid and nutrients;
• Uterine glands, their shape, description of the epithelium lining them;
• The shape and size of the lumen of the glands, the presence of a secret inside the glands, branching;
• Lymphoid accumulations are signs of inflammation;
• Chorionic cells, the presence of edema or dystrophic changes in them - a similar option indicates that the woman had a missed pregnancy or an incomplete spontaneous abortion occurred.

1. Diagnosis

• It is indicated which phase of the cycle corresponds to the endometrium;
• The presence of hyperplasia - growth of the endometrium;
• The presence of polyps and a description of the tissue of which they are composed;
• The presence of endometrial atrophy - thinning of the uterine mucosa;
• Hypoplastic mixed endometrium is a borderline condition that is not a disease;
• Chorionic villi, which are particles of the fetal membrane, indicate an interrupted pregnancy.
• Degeneration of the epithelium or vessels of the chorionic villi - indicates that the fetus did not initially receive nutrients, which could cause its death
• The presence of atypia - cells with signs that are not characteristic of this tissue, indicates a precancerous condition of the endometrium;
• The presence of malignant (cancer) cells indicates endometrial cancer.

What diseases can be detected by this study

What to do after taking a biopsy

• Heavy bleeding - more than 3 pads in 2 hours;
• Severe pain in the lower abdomen and lower back that does not subside after taking painkillers;
• Prolonged spotting: more than 5 days after a pipel biopsy, more than 4 weeks after curettage;
• Discharge with an unpleasant odor;
• Temperature increase over 37.5 C.

• Take a shower instead of a bath;
• Carefully observe the hygiene of the genital organs - water procedures at least 2 times a day;
• Refuse sexual intercourse;
• Avoid physical activity;
• Avoid overheating and hypothermia;
• Take antibiotics after exploratory curettage and vacuum aspiration to prevent infections;
• Taking hormonal contraceptives as prescribed by a doctor to restore hormonal levels;
• It is desirable to observe bed rest for 2-3 days after diagnostic curettage and vacuum aspiration.