Endometrial aspiration biopsy: how and why it is performed. Endometrial biopsy procedure: features of the technique, patient reviews Aspirate from the uterine cavity, timing of analysis

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

Although in the vast majority of cases a biopsy is diagnostic procedure, sometimes it is 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, the woman does not experience pain; pipe aspiration, even without anesthesia, is practically painless.

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 hormonal medications 4-5 weeks before the procedure, and not to take medications that affect blood clotting 3-4 days before the procedure.

Secondly.

The use of vaginal tampons, suppositories and vaginal tablets 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 you experience heavy bleeding, severe pain with cramps in the lower abdomen, or an increase in temperature, 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.

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 diagnostic and treatment procedure that allows you to get necessary for the doctor information 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 bloody issues, unknown origin, scanty periods;
• suspicions and presence of neoplasms.

An endometrial biopsy is performed before IVF and when identifying the cause of infertility. Wherein 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.

Preparing for aspiration biopsy endometrial treatment 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 of 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.

The collected aspirate from the uterine cavity allows you to quickly determine the presence of gynecological ailments that have just begun to develop. In what cases is uterine aspirate necessary? Are there any contraindications to it?

When a patient has pathological intrauterine processes, the gynecologist may prescribe taking an aspirate from the uterine cavity. Cytological examination is a method of obtaining important data about the pathological processes of the uterine endometrium, cellular atypia, or even the presence of cancer cells.

A cytological examination of aspirate from the uterine cavity is usually performed on an outpatient basis. The material is collected as follows:

1. When the uterine position and its size are determined, speculums are inserted and the cervix is ​​treated with alcohol. Then the catheter is lightly inserted, an aspirate is taken using a syringe, the catheter is removed, and the resulting material is applied to a special fat-free and labeled glass for the purpose of examining the smear.
2. Another method is carried out using a syringe, which already contains a couple of milliliters of sterile saline solution and 10% sodium nitrate in order to prevent blood clots in the material. First, the liquid is injected into the uterine cavity using a catheter, and then immediately aspirated into a syringe. Then the catheter is removed from the uterus, and the liquid is placed in a special tube for further centrifugation for 10 minutes. The sediment is left for cytological examination, and the liquid is washed off.
3. The best way is considered to be the synchronous introduction and removal of fluid from the uterine cavity using 2 catheters. Prepare 2 syringes, 1 of which contains a sodium nitrate solution, and the second is used for collecting material (aspiration). The fluid flushes the uterine cavity, but does not enter the fallopian tubes or peritoneum. Next, the liquid is placed in a centrifuge tube, the resulting sediment from the liquid is examined and the results of the manipulation are recorded, in which the presence or absence of diseases is noted.

For what purpose are such tests prescribed? The main purpose of the this study— determination of the state of the endometrium of the uterus. The results obtained make it possible to determine how well the endometrium corresponds to the norms in one or another phase of the menstrual cycle. Along with the this analysis allows you to quickly determine the presence of benign or malignant neoplasms.

Indications and contraindications for this procedure

Taking aspirate from the uterine cavity is currently considered the most gentle and informative way to study the endometrium. It does not injure the uterine mucosa as with curettage.

Inflammation and other complications occur extremely rarely. Just a couple of days after the manipulation, the woman can already collect the results. If cells of an atypical type are detected, the woman requires a biopsy and histological examination to determine the characteristics of the pathology and further treatment tactics.

Other indications for the study include: irregular menstrual cycle, infertility, diagnosis of endometriosis or hyperplasia, presence of malignant neoplasms, negative results ultrasound examination, the presence of atypical vaginal discharge in the patient, monitoring the condition of the uterine mucosa during treatment hormonal drugs, long-term wearing of the IUD and use of contraceptives.

The spiral cannot be worn for more than the prescribed period, otherwise the uterine mucous membrane may become thinner. As a result, the reproductive organs become inflamed.

The aspiration procedure is contraindicated in the following cases:

• acute or chronic gynecological or urological ailments;
• inflammation of the cervix or vagina;
• colpitis and cervicitis;
• pregnancy.

What complications may arise after collecting an aspirate?

Rarely, but still sometimes injury to the uterus occurs. In this case, the patient experiences severe pain in the abdominal area. Sometimes the pain radiates upward, almost reaching the collarbone area.

Injury to blood vessels can provoke the development of internal bleeding.

In this case, the patient experiences nausea, dizziness, decreased blood pressure, pain in the abdominal area, and in some cases, bleeding may appear.

In rare cases, inflammatory processes may begin to develop in the uterus. This situation causes a woman to experience general weakness, abdominal pain and sometimes an increase in body temperature. Signs of this inflammation may occur several days later or immediately after aspirate collection.

According to numerous reviews from patients, aspiration is most often absolutely harmless. No special preparation is required for the procedure; hygienic actions are sufficient.

An aspirate from the uterine cavity is taken to analyze the endometrial lining. Vacuum aspiration is a more gentle way of taking material for a biopsy compared to curettage; it does not injure the uterine mucosa and is much less likely to lead to various kinds of complications.

Indications for aspirate collection

Vacuum aspiration of the uterine cavity is performed in the following cases:

• For menstrual irregularities;
• For infertility of unknown etiology;
• With uterine bleeding;
• For various gynecological diseases, in particular, endometrial hyperplasia and endometriosis, ovarian tumors;
• If you suspect malignant processes in the organs of the reproductive system;
• For atypical vaginal discharge;
• If the results of ultrasound of the pelvic organs are unfavorable;
• For control when taking hormonal drugs.

An additional indication is the long-term use of a contraceptive such as an intrauterine device. Exceeding the period of use of the intrauterine device leads to thinning of the endometrium of the uterus and the development inflammatory process. Therefore, after removing the spiral, aspiration is necessary, followed by cytological examination of the material.

Goals of cytological examination

Cytological examination of the aspirate allows one to analyze the structure of the endometrium, determine its compliance (or non-compliance) with a given phase of the menstrual cycle, as well as timely identify possible malignant formations at a very early stage and differentiate them from other pathological conditions of the endometrium.

Other diagnostic studies, such as ultrasound, visual examination, blood test, do not provide such an accurate picture, since many gynecological diseases have similar symptoms.

The results of the cytological examination are prepared within 1-2 days. If, according to the results of the analysis, atypical cells were found in the uterine mucosa, then a histological examination of the tissues of the uterus and cervical canal is usually additionally prescribed, which helps to clarify the nature and extent of the pathological process.

The procedure for taking aspirate from the uterine cavity

Previously, so-called Brown syringes were used to take aspirate - plastic containers that were inserted into the uterine cavity. At the same time, women experienced some painful sensations. Currently, more advanced tools are used - vacuum syringes made in America and Italy. No special preparation is required for this procedure, but it is recommended that you take some kind of pain medication about an hour before the aspiration. The antispasmodic will relax the cervix, and this will make the procedure easier.

Typically, vacuum aspiration is prescribed on days 6-9 or 20-25 of the menstrual cycle. Douching should not be done during the day before the procedure.
The aspirate collection process includes:

• Disinfection of the external genitalia with iodonate solution;
• Exposure and fixation of the cervix using mirrors;
• Grasping the cervix with forceps;
• Probing the uterus to determine its size;
• Taking an aspirate with a vacuum syringe;
• Removal of instruments and re-treatment of organs with a disinfectant.

Since only uterine endometrial cells need to be taken for analysis, the movements of the syringe must be stopped before removing it, so that the cervical canal and vaginal cells do not get into the syringe.

In general, the procedure takes no more than 10 minutes, and taking the aspirate itself takes 10-15 seconds. After aspiration, some women experience nagging pain in the lower abdomen or spotting, but these symptoms pass fairly quickly.

Contraindications for vacuum aspiration

• Acute gynecological or urological diseases or exacerbation chronic diseases;
• Any inflammatory processes of the cervix and vagina;
• Pregnancy.

In this case, damage to the uterine mucosa and relapse of existing diseases is possible.

Possible complications after aspiration

If the blood vessels of the uterus are damaged during the procedure, there is a risk of internal bleeding. At the same time, there is a decrease blood pressure, rapid heartbeat, dizziness, feeling of nausea, dry mouth, bleeding from the vagina.

To others possible complication the development of an inflammatory process in the uterus may occur. In this case, the temperature rises, weakness and pain in the lower abdomen appear. These symptoms can appear either a few hours after the procedure or several days later. However, if the procedure is carried out correctly, using sterile instruments, this is excluded.

Since the uterine mucosa is slightly injured, minor painful sensations and discomfort in the lower abdomen.

In what cases can cytology results be incorrect?

• When taking an aspirate during menstruation;
• If vaginal antibacterial agents were used on the day of aspiration;
• If there is gel left on the internal genital organs after the ultrasound;
• If the procedure was performed during an exacerbation of a chronic infectious disease.

A study of aspirate from the uterine cavity is carried out to diagnose pathological processes occurring in the endometrium. The prerequisites for carrying out such a procedure are the presence of multiple disorders occurring in the uterus and ovaries in order to assess the effectiveness of the treatment with hormonal hormones. medicinal drugs, to identify the causes of infertility and the formation of malignant tumors in the endometrium.

The need for

The use of this technique makes it possible to detect the atypical component of aspirate cells from the uterine cavity on initial stages illness, which contributes timely treatment and guarantees a successful recovery. The need to use the method of aspiration from the uterine cavity appears in cases of bleeding during menopause, in the case of long-term use of the IUD, in cases of suspected hyperplasia of the mucous membrane, and much more.

If problems are discovered in the condition of the genital organs, the woman must be examined by a specialist and undergo the necessary tests. This is due to the fact that a successful outcome in the treatment of progressive pathology in cases of oncological formations is possible only in the early stages, which can only be diagnosed using the procedure for examining aspirate from the uterine cavity. Carrying out an analysis of aspirate in this way provides a detailed picture of the state of the endometrium and makes it possible to select effective methods treatment based on the individual characteristics of the patient.

The current level of medicine allows a graduate student to conduct an analysis of the uterine cavity during a visit to the antenatal clinic and, based on the study, determine the nature of changes in the endometrium for the presence of malignant formations in the shortest possible time. The results of the examinations, during which aspirate is collected from the uterine cavity, are usually ready within 2 days. If the presence of atypical cells is detected in the analysis results, additional biopsy and histological tests are prescribed to determine the nature of the pathological changes.

Contraindications for aspirate collection

The aspiration procedure is a gentle way of conducting an examination, however, there are some contraindications for its implementation. Aspirate is not recommended in case of exacerbation of chronic diseases of the reproductive organs, as well as their condition in an acute complicated form. Inflammation in the uterine cavity and the presence of pathological foci in the vagina are also an obstacle to analyzing aspirate from the uterine cavity. The use of such a procedure in cases of colpitis or cervicitis is strictly prohibited. Pregnant women are never given an aspirate.

Features of the method

The procedure for collecting aspirate from the uterine cavity is carried out on the twenty-fifth day from the start of menstruation. If there is menopause, patients can undergo this examination at any convenient time. Removing material from the uterine cavity for further research occurs in two ways, using a syringe and a catheter inserted into the uterine cavity. The second method uses a flushing method using a sterile sodium chloride solution injected through a syringe and then drawn back in. The resulting liquid, after a series of procedures using rotation, provides material for further study.

Modern medicine offers improved medical instruments for use to obtain material for research. For example, aspirate from the uterine cavity using the vacuum method differs in many ways from previously used options. Through the slightly open cervix, the depth of the fundus of the uterine cavity is measured, then the required amount of material is taken for further research using a vacuum syringe and cannula. The resulting sample is sent for final analysis.

Possible complications after examining an aspirate

The aspirate procedure does not require special preliminary preparation, it is enough to take normal hygienic actions. The use of the aspirate method rarely causes complications in the form of severe consequences. Sometimes injury to the mucous membrane occurs during the insertion of a catheter or careless use of a syringe when introducing and suctioning a solution from the uterine cavity. This may result in minor pain in the genital area. If blood vessels are damaged during the test, there is a risk of internal bleeding. The result of such a disorder can be a drop in heart pressure, dizziness and nausea. After some time, discharge mixed with blood may appear from the vaginal cavity.

If inflammatory complications occur as a result of the aspiration procedure, the temperature may rise, loss of strength, fever, and abdominal pain may occur. The manifestation of the listed symptoms is possible immediately after the end of the aspirate procedure, or they may manifest themselves within several days. However, the occurrence of such complications is rare and is the exception rather than the rule.

Aspirate from the uterine cavity is currently considered the most reliable method for obtaining high-quality material for research. With the help of this analysis, it became possible to apply more gentle examination methods to a woman without the use of traditional curettage. This procedure protects female organs from unnecessary injury and very rarely causes subsequent complications.