How is endometrial aspiration and pipette biopsy performed? What is aspirate from the uterine cavity? Analysis from the uterine cavity is called.

Vacuum aspiration of the uterine cavity is the easiest and most reliable way to extract the contents of the uterus for examination. Unlike diagnostic curettage, this method is much more gentle on the delicate mucous membrane of the uterine cavity, does not injure it, and leads to complications such as inflammatory processes much less often. Taking aspirate from the uterine cavity is indicated in the following cases:

• at ;
• for infertility;
• with endometriosis;
• at ;
• for ovarian tumors;
• if there is a suspicion of malignant tumors in the endometrium;
• when monitoring the effectiveness of hormone therapy.

Cytological examination of the aspirate helps to track whether the endometrium corresponds to the phase of the cycle, whether malignant formations are developing in it, and to identify uterine cancer at the earliest, preclinical stage.

How is aspirate taken from the uterine cavity?

A woman who is about to undergo aspiration of the contents of the uterine cavity is usually interested in how painful such a manipulation is, on what day of the cycle it can be performed and how to properly prepare for it.

Until recently, Brown syringes were used to take aspirate from the uterine cavity - plastic containers with a length of 300 mm and an outer diameter of 3 mm, and the woman could experience unpleasant, even acutely painful sensations. Now more advanced instruments are used for these purposes: vacuum syringes made in America and cannulas made in Italy. In order to minimize discomfort, you should take a painkiller 30-60 minutes before the procedure. The study is usually prescribed on days 20-25 of the menstrual cycle.

During the procedure for taking aspirate from the uterine cavity, the doctor performs the following manipulations:

1. Examines the patient.
2. Disinfects the external genitalia with iodonate.
3. Exposes the cervix using speculum.
4. Grasps the cervix using bullet forceps.
5. Probes the uterus to determine the size of its cavity.
6. Take aspirate using a vacuum syringe.
7. Removes instruments and re-treats the external genitalia with iodonate.

Vacuum aspiration of the contents of the uterine cavity is performed within the walls of a regular district antenatal clinic and takes only a few minutes. This procedure does not require any specific preparation, so the woman only needs to carry out ordinary hygiene procedures, as before an ordinary visit to the gynecologist.

Contraindications to vacuum aspiration of the uterine cavity

Taking aspirate from the uterine cavity should not be performed during acute and exacerbation chronic diseases genitourinary area, availability inflammatory processes in the area of ​​the cervix and vagina.

Complications after taking aspirate from the uterine cavity

In a small percentage of cases, in the process of taking aspirate from the uterine cavity, the mucous membrane of the uterine walls may be injured, which is manifested by abdominal pain that radiates upward to the collarbone. If blood vessels are injured during the procedure, internal bleeding may occur. As a result, blood loss decreases arterial pressure, there is a feeling of nausea and dizziness, bloody discharge from the genitals.

To others possible complication after aspiration of the uterine cavity, an inflammatory process in the uterus may develop. In this case, the woman experiences weakness, pain in the lower abdomen, and a rise in body temperature. Symptoms of inflammation may appear either a few hours after taking the aspirate or several days later.

Many gynecologist patients hear about such manipulation as aspirate from the uterine cavity. Let's talk about what this procedure is, why it is performed on women at different ages, and what are its advantages and disadvantages.

The term "aspiration" in literal translation means "to suck out." In medicine, aspiration biopsy is widely used - that is, obtaining tissue fragments using “suction”, usually based on a pressure difference. The procedure is carried out with a syringe, special probes, vacuum electric aspirators, and so on.

Such aspirate can be taken from the lungs, bronchi, stomach, sinuses, and large fluid formations. In gynecology, aspiration biopsy from the uterine cavity is very common.

There are three main types of this procedure:

• Aspiration biopsy of the endometrium using a vacuum aspirator;
• Aspiration biopsy using a syringe or manual (manual) vacuum aspiration;
• Pipelle endometrial biopsy or aspirate using a special uterine probe.

Recently, these manipulations have become widespread for various indications:

• Approximate and initial diagnosis for suspected various diseases of the uterine body. This manipulation can be performed to diagnose conditions such as uterine cancer, endometrial hyperplasia, chronic endometritis, various variants of abnormal conditions of the uterine cavity - hematometer, serosometer.
• Routine examination before various gynecological procedures and operations. An endometrial biopsy is performed before IVF, insemination, and stimulation of ovulation in women with infertility.

In gynecological patients, this manipulation is performed as a primary stage before planned operations, for example, before removal of uterine fibroids, pelvic floor plastic surgery. Previously, separate diagnostic curettage of the uterine cavity was used for these purposes, but last years in most cases there is no need for such traumatic examination.

• Diagnosis of the causes of infertility in women. In this case, endometrial tissue can be obtained for histological examination. This is important for assessing the usefulness of the endometrium, its correspondence to the phase of the menstrual cycle, and the presence or absence of an inflammatory response.
• Monitoring and evaluating the effectiveness of treatment for a particular condition. An aspirate from the uterine cavity can give an answer as to whether prescribed medications help, for example, for endometrial hyperplasia, or whether chronic endometritis has been treated with antibiotics.

Now let's look at each variety aspiration biopsy separately.

Vacuum biopsy

This is an older method, which, in addition to diagnosing the condition of the endometrium, has been and continues to be used to terminate short-term pregnancies and also to clean the uterine cavity from blood clots, hematometers, serozometers, remnants of the fertilized egg after abortion, and postpartum lochia when they are delayed.

Source: vashamatka.ru

The essence of the method is to use the principle of a vacuum cleaner. A vacuum aspirator is an electrical device consisting of a compressor, a thin aspiration probe or catheter inserted into the uterine cavity, and a container for the resulting aspirate.

This is the type of aspirator that is also used to terminate early pregnancies.

The aspiration procedure is as follows:

• The patient lies on the gynecological chair in a standard position.
• The cervix is ​​brought out in the speculum, fixed with forceps, using a button probe, the doctor passes through the cervical canal and inserts a catheter into the uterine cavity.
• The catheter is fixed, the doctor presses the pedal of the device, the “vacuum cleaner” creates negative pressure and the tissues of the uterine cavity are sucked into the container.
• The doctor removes the instruments and treats the vagina and cervix with antiseptics. The procedure is over.

The resulting tissues are fixed depending on their quantity. If there is a good, abundant aspirate, the biopsy can be placed in formaldehyde and sent for histological examination. When the aspirate is scanty, histology is usually uninformative. It is better to place such a biopsy on a cytological slide and send it to cytological examination cellular composition.

The manipulation, as a rule, is carried out without general anesthesia under local anesthesia; the cervix is ​​injected at certain points with a solution of novocaine or lidocaine. In young women who have given birth naturally, the procedure is sometimes carried out quietly without anesthesia at all, causing the patient a moment of minor discomfort.
Manual aspiration

The meaning of the procedure is generally similar, only instead of electrical power, manual force is used to “suck out”. A manual aspirator is a kind of large syringe with a tight piston and a container for collecting the resulting tissue.

Pipel biopsy

This is the most modern, technologically advanced and minimally invasive method of obtaining endometrial tissue. For this type of aspirate, special aspiration probes are used.

The operation technique is similar, but does not require dilatation of the cervix, nor the use of “brute” force - manual or electric. Pipe probes are very thin, flexible, easily enter the cervical canal, and are very convenient to use.

Advantages and disadvantages

Let's start with the positive points:

• Low invasiveness and almost complete absence of trauma to the mucous membrane of the uterine cavity, in contrast to separate curettage of the uterine cavity and hysteroscopy. This is very important and relevant for young nulliparous women, patients planning pregnancy, because the mucous membrane of the uterine cavity is one of the fundamental factors for the successful onset and course of pregnancy.
• There is no need for general anesthesia, and, therefore, no risks of anesthesia and its possible complications.
• Simplicity and speed. Unlike hysteroscopy, these methods are widespread, available in almost every institution, and are not expensive.
• No need for hospitalization or hospital stay.

In the USA, this kind of manipulation is called “office” or “office” because it is carried out not in a hospital, but in a purely outpatient setting - on a regular gynecological chair in a regular gynecologist’s examination room, and does not require special training, anesthesia and sick leave.

That is, the woman undergoes this procedure and can return to work, to the “office”.
Few complications. Considering its minimally invasive nature, the procedure has virtually no serious complications, unlike RDV or hysteroscopy.

The disadvantages of manipulation are:

• There is no “eye control”, that is, the procedure is, in principle, carried out blindly, in contrast to hysteroscopy, in which a biopsy can be taken under visual control, from the most suspicious area.
• Orientation of diagnosis. As a rule, in serious cases, for example, when cancer cells are detected in an aspirate from the uterine cavity, a clarifying diagnosis is indicated - hysteroscopy.
• Lack of significant therapeutic effect - that is, with aspiration biopsy it is impossible to stop the bleeding or remove the polyp. At most, vacuum aspiration can empty the cavity of liquid, blood, and exudate. When
• With pipel biopsy, a therapeutic effect is generally impossible due to the extremely thin diameter of the probe.

Preparation

Although the procedure is called “office”, a minimum examination is still required before it:

• Ultrasound of the pelvic organs, so that the doctor understands the picture and indications for the procedure, as well as in case of any structural features of the genital organs in this patient - for example, a bicornuate uterus or a septum in the uterus.
• General blood and urine tests to exclude acute inflammatory processes in the body.
• Gynecological smear for flora to exclude an inflammatory process in the vagina.
• A smear from the cervix for atypical cells - oncocytology.

Complications

Complications with this type of procedure are extremely rare, but it is important to know the possible ones:

• Perforation of the uterine walls with instruments or a probe is an almost casuistic situation, since in this version of manipulation there are no sharp, hard instruments, as in hysteroscopy or RDV.
• Secondary infection is acute or chronic endometritis, which can occur due to poor smears in the patient and violation of aseptic rules.

In conclusion, I would like to say that aspirate from the uterine cavity is an excellent alternative surgical methods diagnostics, a real salvation for patients with contraindications to anesthesia and invasive procedures.

The use of endometrial biopsy as a diagnostic method has a long history. In 1937, the American gynecologist, the founder of contraception, John Rock, first took the endometrium of the uterus for analysis and recorded this fact. The famous doctor used curettage of the mucous membrane - a method that is still used in gynecology.

What is an endometrial biopsy?

Removal of material from the uterine cavity and subsequent histology of the endometrium are included in the diagnostic minimum to determine the cause of the gynecological disease. An endometrial biopsy is the obtaining of samples of the mucous membrane of the inner layer of the uterus for subsequent histological examination.

In most cases, taking a biopsy is an independent, minimally invasive study. A situation may arise when a biopsy is performed as part of a large-scale surgical intervention, and the condition of the tissues is assessed on an emergency basis within 15-20 minutes after their removal.

Histological examination The taken endometrium helps to distinguish diseases of the uterus with similar symptoms from each other, and to select treatment individually.

Although in the vast majority of cases a biopsy is a diagnostic procedure, it is sometimes used in the treatment of endometrial pathologies. It takes from 7 to 12 days to study the biopsy in the laboratory, during which the histologist performs the following manipulations:

• Dehydrates tissues and makes them fat-soluble;
• Impregnates the biopsy material with paraffin, forming solid cubes;
• Cuts the cube using an extremely sharp instrument (microtome) into the thinnest plates;
• Layers with a thickness of 3 to 10 microns are laid out on a glass slide and stained;
• Covers with another glass, fixing for storage and study;
• Performs microscopic examination;
• Describes the structural features of the endometrium.

The histologist does not make a clinical diagnosis; this is done by the gynecologist based on a combination of data from biopsy, colposcopy, hysteroscopy, visual examination, medical history and patient complaints.

If the conclusion states that the endometrium has no signs of atypia, its structure corresponds to the phase of the menstrual cycle, this indicates the absence of deviations.

Pathologies detected during the study:

• Endometrial hyperplasia;
• Polyposis, single polyps;
• Malignant transformations;
• Endometritis;
• Discrepancy between the structure of the endometrium and the phase of the cycle.

The presence of atypia in a biopsy specimen in some forms of hyperplasia is considered a precancerous condition. Precancer is indicated by a violation of the structure of cells and the mechanism of cell division, the transformation of glandular epithelium into stroma, and changes in the structure of the endometrium.

Indications for the study

Biopsy is performed in women of different ages regardless of whether they gave birth or not. There must be reasons for prescribing manipulation.

Indications:

• Bleeding between periods;
• Metrorrhagia;
• Amenorrhea;
• Bleeding after childbirth, abortion, against the background hormone therapy;
• Bleeding after menopause;
• Preparation for IVF;
• Atypical cells detected during a smear cytology examination (Pap test);
• Presence of a uterine tumor;
• Infertility of unknown etiology;
• Pathological changes identified during an ultrasound scan of the uterus that have existed for at least three menstrual cycles.

For these studies to be most informative, it is important to perform the biopsy exactly at the appointed time. This period depends on the phase of the menstrual cycle.

If a woman is in menopause, manipulation is carried out at any time, or they are guided by the date of the onset of bleeding. If a cancerous tumor is suspected, aspirate from the uterine cavity is taken on any day of the cycle.

Timing of the manipulation:

• Uterine polyp - at the end of menstruation;
• Uterine bleeding - on the first day of its appearance;
• Metrorrhagia – 7-10 days from the onset of heavy bleeding;
• Infertility – 2-3 days before menstruation;
• Determination of endometrial sensitivity to hormones - 17-24 days of the cycle;
• Hormonal imbalance - several studies with an interval of 7-8 days.

A biopsy is prohibited at any stage of pregnancy, as it interrupts the development of the fertilized egg. Manipulation is not performed if the level of coagulation decreases, if there are inflammatory processes in the pelvic organs, or if you are allergic to pain medications.

How is a biopsy procedure performed in the uterine cavity?

The location of the diagnostic test depends on the chosen method of taking a biopsy sample. This can be either a procedure room in a gynecological office or a small operating room in a hospital.

Before the manipulation begins, the vaginal walls are expanded with the help of speculum, the entrance to the vagina and cervix is ​​treated with an antiseptic. Then the neck is fixed with bullet forceps. The doctor’s further actions depend on the chosen method.

Diagnostic curettage

Due to its informative nature, this radical method is still used in gynecology. Indications for its implementation: bleeding during menopause and after abortion, the possibility of developing oncological pathology.

At the first stage, the cervical canal of the cervix is ​​expanded by sequentially introducing bougies of different diameters into it. Next, a curette in the form of a narrow spoon with sharp edges is inserted into the uterus.

With this curette, the doctor scrapes the internal cavity of the uterus, moving the instrument from the fundus to the internal pharynx. The taken portion of the endometrium is placed in a container with formaldehyde, and the curette is reinserted to treat the posterior wall of the uterus and the mouth of the fallopian tubes.

Advantages:

• Curettage is at the same time a therapeutic manipulation, as it removes foci of pathology;
• The completeness of the picture allows you not to miss atypical processes.

• The painful and traumatic procedure requires the use of intravenous anesthesia;
• After it you have to recover within a month;
• A gynecologist's lack of experience increases the risk of complications.

A type of complete curettage is a CUG biopsy, performed to determine the cause of infertility or to study the response to hormonal therapy. Material from the walls of the uterus is obtained as a result of only 2-3 scrapings (trains). They are performed with a small curette without dilating the cervical canal.

Endometrial aspiration biopsy

To perform aspiration biopsy of endometrial areas, a Brown uterine syringe or a vacuum aspirator is used. This gentle method is used as screening for negative ultrasound results.

Expansion of the cervical canal is not required during manipulation, but anesthesia is still used to prevent discomfort. The doctor removes the material by inserting a catheter attached to an aspiration syringe into the uterine cavity, and then pulling the piston of the instrument towards himself.

For vacuum aspiration of endometrial samples, an electric device with a similar operating principle is used instead of a uterine syringe.

An aspiration tube is attached to it, which is passed along the walls of the uterus, collecting material for research. Before the procedure, the woman is given an antispasmodic injection, the cervix and peri-uterine tissue are anesthetized.

Advantages:

• Low trauma;
• Fast recovery in the first case;
• Minimal pain.

• Long-term recovery after vacuum aspiration;
• Difficulty in maintaining the structure of the taken material.

Pipelle endometrial biopsy

Low-traumatic and virtually painless pipel biopsy is a modern option for endometrial aspiration. To remove the material, use a flexible thin Pipel tip with a diameter of 3 mm, pressed tightly against the wall of the uterus.

It is attached to a piston, which the doctor uses to create negative pressure to remove endometrial samples. Taking a biopsy sample is repeated 3 times, after which the probe is removed.

Advantages:

• Allows you to obtain high quality material;
• Does not injure the uterine mucosa;
• Performed on an outpatient basis;
• Does not require anesthesia;
• Does not cause complications.

• Serious pathology may be missed due to limited tissue sampling sites;
• It is difficult to restore the structure of the endometrium using histology.

A biopsy performed during hysteroscopy has high diagnostic accuracy. The manipulation is performed under intravenous anesthesia and endoscope control. After it, the woman quickly recovers.

With high-quality anesthesia of any biopsy method, a woman does not experience pain, pipel aspiration is practically painless even without anesthesia.

Since diagnostic curettage and taking an aspirate from the uterine cavity by any method is a minimally invasive surgical intervention, they prepare for the manipulation following a single standard. Preoperative diagnosis includes:

• General blood and urine analysis;
• Blood chemistry;
• Coagulogram;
• Blood test for HIV, the presence of syphilis and hepatitis;
• Smear on the flora of the vagina and cervical canal.

To completely rule out pregnancy, women of fertile age donate urine or blood to be tested for the presence of hCG (human chorionic gonadotropin).

How to prepare for a biopsy?

To prepare for pipel biopsy and other methods of removing biopsy material, it is recommended to stop taking it 4-5 weeks before the procedure. hormonal drugs, 3-4 days before it, do not take medications that affect blood clotting.

Secondly.

The use of vaginal tampons, suppositories and vaginal tablets before surgery is prohibited. You should avoid intimate contact for 2-3 days before the biopsy.

Third.

On the day of the procedure or the day before, hair in the genital area is removed. When using general or intravenous anesthesia, you should not eat for 8-12 hours before the intervention; you should refuse water 6 hours before the biopsy. It is advisable to do an enema or take a mild laxative the day before.

Because biopsy cannot avoid damage blood vessels endometrium, for several days after the manipulation the woman will definitely experience slight bleeding. The discharge does not have an unpleasant odor and lasts no longer than 5-6 days.

It is optimal to follow the recommendations for 3-4 weeks after the procedure:

• After aspiration vacuum biopsy of the endometrium and diagnostic curettage, you need to remain in bed for several days;
• Cannot be accepted hot bath, swim in a pool, in an open pond, visit a sauna, bathhouse;
• It is important not to overcool and avoid excessive overheating;
• It is advisable not to overexert yourself physically and emotionally, you need to avoid stress;
• Intimate contacts are temporarily prohibited.

The time it takes for a woman to recover depends on how the biopsy was performed. For example, after a gentle pipel biopsy of the endometrial mucosa, you can return to your normal life within 2-3 days.

After curettage, complete regeneration may take 3-4 weeks. If there is heavy bleeding and severe pain If you have cramps in the lower abdomen or fever, you should immediately consult a doctor.

An endometrial biopsy, with proper preparation and full compliance with antiseptics, is an informative diagnostic study that helps restore reproductive health and avoid serious diseases.

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 loved ones. However, there are currently many ways to combat it. The effectiveness of treatment of oncological pathologies is high initial stages diseases. Therefore, in order to quickly detect cancer, it is necessary to be examined at the first signs of the disease. One of the diagnostic methods is aspiration biopsy. It is performed quickly and almost painlessly. In some cases, this study acts as a therapeutic procedure.

What is the purpose of aspiration biopsy?

In order to confirm or refute the presence of a malignant process, a study of the composition of the cells of the pathological formation is required. It is carried out using 2 diagnostic procedures. These include: The first involves making a section from the damaged organ, staining it and microscopy. This method is the standard for diagnosing cancer tumors. consists of performing a smear from the surface of the biopsy specimen. Next, microscopy of the glass slide is performed. To obtain material for research, an open biopsy is performed. This surgery, implying partial or complete removal of an organ. Another method of collecting cells is aspiration puncture biopsy. It can be used to perform histological and cytological analysis. For this purpose, biological material is obtained by puncturing the organ and breaking off small pieces of the affected area.

The advantages of the aspiration method include:

1. No cuts on the skin.
2. Painless procedure.
3. Possibility of performing on an outpatient basis.
4. Speed ​​of execution.
5. Reducing the risk of complications that may arise as a result of the procedure (inflammation, bleeding).

Aspiration biopsy can be performed using special instruments or an ordinary thin needle used for injections. This depends on the depth and location of the tumor.

Indications for biopsy

Aspiration biopsy is performed if a tumor is suspected various organs. Among them are the thyroid and mammary glands, uterus, lymph nodes, prostate, bones, soft fabrics. This diagnostic method is performed in cases where there is access to the tumor. Indications for the study include the following conditions:

1. Suspicion of a malignant tumor.
2. The inability to determine the nature of the inflammatory process by other methods.

In most cases, it is impossible to determine which cells the neoplasm consists of without cytological and histological examination. Even if the doctor is sure of the presence of a malignant tumor, the diagnosis must be confirmed. This is necessary to establish the degree of cell differentiation and carry out therapeutic measures. In addition to cancerous tumors, there are benign tumors that must be removed. Before proceeding with surgery, it is necessary to confirm that there is no oncological process. For this purpose, an aspiration biopsy is also performed.

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

Preparing for the study

Depending on the location of the pathological area, preparation for the study may vary. In all cases, diagnostic procedures are required before aspiration biopsy. These include: blood and urine analysis, determination biochemical parameters, coagulogram, tests for hepatitis and HIV infection. If tumors of external localizations are suspected, no specific preparation is required. This applies to neoplasms of the thyroid and mammary glands, skin, lymph nodes. In these cases, a fine-needle aspiration biopsy is performed. This method is completely painless and resembles an ordinary injection. If the tumor is deep, a trepanobiopsy is required. It is carried out using a special instrument and a thick needle. In this case, local anesthesia is required.

Preparation for an endometrial aspiration biopsy is somewhat different. In addition to the tests listed, before performing it, it is necessary to obtain the results of a smear from the vagina and cervix. If the patient is a woman childbearing age, the biopsy is performed on the 25th or 26th day of the menstrual cycle. During the postmenopausal period, the study can be carried out at any time.

Performing a thyroid biopsy

Aspiration biopsy thyroid gland performed using a thin needle. It is required in the presence of nodules in the organ tissue. Before conducting the study, the doctor performs. For this, the patient is asked to make a swallowing movement. At this moment, the doctor determines the exact location of the node. This area is treated with an alcohol solution for disinfection. After which the doctor inserts a thin needle into the neck area. With his other hand, he fixes the knot to obtain cells from the pathological focus. The doctor pulls the plunger of the empty syringe towards himself to extract biological material. The pathological tissue penetrates the lumen of the needle, after which it is placed on a glass slide. The resulting material is sent to the puncture site. A cotton swab soaked in an alcohol solution is applied to the puncture site and secured with an adhesive plaster.

A fine-needle aspiration biopsy of the thyroid gland helps determine whether there are malignant cells in the nodule. In their absence, conservative treatment of goiter is possible. If a doctor diagnoses thyroid cancer, removal of the organ and chemotherapy are required.

Technique for endometrial aspiration biopsy

Indications for uterine biopsy are: suspicion of cancer, hyperplastic processes (endometriosis, polyps), monitoring of hormone therapy. The study is performed in a treatment room or small operating room under ultrasound control. First of all, palpation of the pelvic organs is carried out. Then the cervix is ​​fixed using gynecological speculum. A special conductor - a catheter - is inserted into the cervical canal. Through it, the contents of the endometrium are aspirated into a syringe. The resulting material is sent to the laboratory to determine the cellular composition of the fluid.

In some cases, aspiration biopsy of the uterus is performed using a special vacuum device. It is necessary to ensure that the material is collected under pressure. With its help, you can obtain several samples of biological material by performing 1 puncture.

Puncture and breast

A lymph node biopsy is performed if the doctor suspects specific inflammation or regional spread of the tumor. The study is carried out using a thin needle. The technique for performing it is similar to aspiration biopsy of the thyroid gland. The same technique is used to obtain material from breast tumors. In addition, aspiration biopsy of the breast is performed in the presence of large cysts. In this case this procedure is not only diagnostic, but also therapeutic.

If the obtained material is insufficient or it is not possible to confirm the diagnosis with its help, a trepanobiopsy of the mammary gland is performed. It is performed for research purposes. In this way, it is possible to track the progress of the needle. In some cases, a vacuum aspiration biopsy is performed.

Contraindications for the study

There are practically no contraindications to performing a fine-needle biopsy. Difficulties may arise if the patient is a person with mental illness or child. In these cases, intravenous anesthesia is required, which is not always possible. Vacuum aspiration or fine-needle biopsy of the endometrium is not advisable for inflammatory pathologies of the cervix and vagina. Also, the procedure is not performed during pregnancy.

Interpretation of research results

Ready in 7-10 days. Cytological analysis is faster. After microscopy of a smear or histological specimen, the doctor makes a conclusion about the cellular composition of the neoplasm. In the absence of atypia, the tumor is benign. If the cells obtained during the study differ from normal elements, the diagnosis of cancer is confirmed. In such cases, the degree of tumor differentiation is determined. The prognosis and treatment methods depend on this.

Aspiration biopsy: reviews from doctors

Doctors say aspiration biopsy method is reliable diagnostic study, safe for the patient's health. If the obtained material has little information content, tissue sampling can be repeated. For execution this study the patient does not require hospitalization.

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 makes it possible to determine the existing morphological changes in the uterine mucosa.

Currently, several types of endometrial biopsy are used, each of which has its own purposes, indications and diagnostic capabilities.

Endometrial biopsy: what is it?

An endometrial biopsy is an intravital sampling of tissue from the lining of the uterus (endometrium) for subsequent histological and histochemical analysis. This procedure applies to small surgical interventions in gynecology and is most often carried out as an independent study. But in some cases it is included in the protocol of a “major” operation and is performed intraoperatively on an emergency basis.

A biopsy most often serves purely diagnostic purposes. But in some cases, it is a therapeutic and diagnostic manipulation that allows you to obtain the information the doctor needs and at the same time improve the woman’s condition. The preparation process, the extent of the intervention, and whether the woman will be in pain or not also depend on the type of biopsy used.

Types of research

The first documented collection of a sample of the uterine lining for analysis was performed in 1937 by Butlett and Rock. In this case, special instruments were used to dilate the cervix and scrape out (mechanically separate) the entire endometrium.

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

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

• 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);
• pipel endometrial biopsy is a more modern version of aspiration of the mucous membrane and contents of the uterine cavity, using a low-traumatic instrument in the form of a flexible suction tube (pipel);
• CG endometrial biopsy, during which tissue is collected in the form of line scrapings (trains).

A less common way to obtain an endometrial sample is to take it during an endoscopic examination of the uterine cavity. This type of 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 its high information content, hysteroscopy is not included in the list of frequently used diagnostic procedures. Not everyone medical institutions have the opportunity to conduct such modern high-tech research.

A very rarely used method of obtaining an endometrial sample is jet 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 more often than not, the study reveals various deviations. It can be:

• simple diffuse endometrial hyperplasia (proliferation of the mucous membrane), also called glandular or glandular-cystic;
• complex endometrial hyperplasia (with the formation of similar glands inside the hypertrophied mucous membrane), this condition can also be described as adenomatosis;
• local endometrial hyperplasia (with or without atypia), which is regarded as isolated or polyposis;
• atypical hyperplasia (simple or complex), in which the cells of the overgrown mucous membrane do not correspond in their morphofunctional characteristics normal endometrial cells;
• malignant tissue degeneration;
• 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.

Detection of atypia has important prognostic significance. Some forms of atypical hyperplasia are classified as precancer.

Main diagnostic signs This includes cellular and nuclear polymorphism, impaired proliferation, changes in the structure of the endometrial glands and invasion of glandular tissue into the stroma. The key point to determine precancer and cancer is a violation of tissue differentiation.

Indications, contraindications and timing

If indicated, endometrial biopsy can be performed on women of any age, including those who have not given birth and those who are past reproductive age.

The basis for prescribing this study may be:

• menometrorrhagia, acyclic scanty bleeding of unknown origin, scanty menstruation;
• suspicions and presence of neoplasms.

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

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

When is a biopsy performed?

The endometrium is a hormonal-dependent tissue. And the information content of the results of 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 objectives of the biopsy. And in postmenopausal patients, the presence and time of its onset are taken into account.

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

• when identifying the cause of infertility, in case of luteal phase deficiency and anovulatory cycles, the study is carried out the day before the expected menstruation or on the first day after its onset;
• if there is a tendency to polymenorrhea, the study is prescribed between 5 and 10 days of the cycle;
• in case of 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 CG biopsy, which is performed several times during one cycle with an interval of 7-8 days;
• to monitor the results of hormonal therapy, a biopsy is performed in phase 2 of the cycle, between 17 and 25 days;
• if the presence of a malignant tumor is suspected and there is no significant 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 the study and its type is made by the doctor or even a medical commission on an individual basis.

Possible restrictions include:

• pregnancy - if there is the slightest chance 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 fertilized egg;
• disorders of the blood coagulation system;
• constant use of drugs with disaggregation and anticoagulation effects (NSAIDs, Dipyridamole, Trental, Warfarin, Clexane and others);
• severe 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 examination; if it is not possible, the doctor draws up another program for examining the patient. There is also the option of choosing more gentle methods for collecting endometrial samples. 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 curettage of the uterine cavity

This method is the most radical and historically the earliest way to obtain a biopsy. This biopsy includes 2 main stages: dilation of the cervical canal and curettage of the uterine walls. In this case, a set of special bougies (expanders) are used different sizes), forceps for removing and fixing the cervix and a uterine curette - 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, and inhalation or intravenous anesthesia can be used. Therefore, this method requires compliance with the same preparation rules as any “big” operation. To prevent reflux of gastric contents and aspiration into Airways It is recommended to avoid drinking 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, forming an extensive wound surface.

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

An important advantage of diagnostic curettage is the possibility of its use in cases of suspected oncological gynecological diseases, with metrorrhagia and after an interrupted pregnancy.

Endometrial aspiration biopsy

Aspiration biopsy is a more gentle method of taking biopsy material. The separation of the functional layer of the endometrium is carried out under the influence of a vacuum created in the uterine cavity. For this, a Brown uterine syringe or a vacuum aspirator with an attached catheter can be used. Sometimes the uterine cavity is irrigated beforehand to obtain subsequent washouts.

Bougienage of the cervical canal is not required, which significantly reduces the trauma and pain of the examination. However, the aspiration method is also sometimes performed under shallow general anesthesia. This allows you to avoid severe discomfort, especially in nulliparous women.

Preparation for endometrial aspiration biopsy includes sexual rest, avoidance of douching and any 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 do a cleansing enema the day before.

Aspiration biopsy is considered a technically simple procedure that does not cause the woman any obvious pain. It is often used as a screening test when questionable results of uterine ultrasound are obtained.

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

Technique for performing pipell biopsy of the endometrium

Pipelle biopsy is an improved modern version of endometrial aspiration. In this case, the main device for collecting part of the mucous membrane is a Pipel 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 operation, the Peipel instrument resembles a syringe. After inserting its working tip into the uterine cavity, the doctor pulls the piston toward the middle of the length of the tube, which creates sufficient negative pressure to aspirate a small amount of endometrium. In this case, extensive wound surfaces are not formed, the cervix is ​​not injured, and the patient does not experience significant physical discomfort.

Preparation for 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 pain relief.

Features of the CG biopsy

CUG biopsy is considered a low-traumatic option for taking an endometrial sample. It does not provoke massive bleeding and rejection of the mucous membrane 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 hormonal levels. It is not used for diagnosing cancer and precancerous conditions.

To perform a CG biopsy, a special small curette is used. It is carefully inserted into the uterine cavity without first expanding the cervical canal. Applying slight force, the doctor scrapes off a narrow strip of mucous membrane with the working surface of the curette. This is reminiscent of drawing strokes, which is why this diagnostic method is called “stroke biopsy of the endometrium.”

It is very important to examine more than just a single area of ​​the uterus, so strokes (CUGs) are made from the fundus to the internal os of the cervix. For reliable diagnosis, it is enough to obtain 2 samples at a time.

What to expect and what to do after the study?

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

Diagnostic curettage leads to heavy menstrual-like and quite painful discharge. But their duration is usually much shorter than during normal menstruation, because the bulk of the endometrium has already been removed during the procedure. Discharge after endometrial biopsy should not contain clots, pus, or unpleasant smell. The appearance of any of these signs or fever is grounds for urgent medical attention.

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

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

How long does it take for results to be prepared?

Decoding 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 performed.

The time it takes to obtain results depends on the specific laboratory, the histologist’s workload and the urgency of the study. If an emergency test is necessary, 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 can affect the extent of the surgical intervention performed.

What is done after the biopsy?

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

If the 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 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 menstrual periods and discomfort during sexual intercourse.

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

But sometimes the cause of endometritis is an exacerbation of an existing one. Therefore, women with chronic urogenital diseases after an endometrial biopsy need to take antibiotics on the recommendation of a doctor. The same tactics are followed if the patient has undergone 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 comply with recommendations may negatively affect the reliability of the study and increase the risk of complications.

You should not refuse to perform a biopsy, because no other diagnostic methods can replace histological analysis. Only this examination makes it possible to diagnose endometrial cancer in the early stages, which significantly improves long-term treatment results.