How to prepare for a pipell endometrial biopsy. Endometrial aspiration biopsy - what is it? Diagnostic procedures in gynecology

Article outline

For various pathological changes in the uterus or before the IVF procedure, a pipel biopsy of the endometrium is prescribed, that is specific research mucous membrane. What is a biopsy? This is a procedure in the form of curettage or tissue collection by other methods for further research, as a result of which pathological factors and causes of many diseases can be accurately determined.

Several methods are used for the procedure; their differences are associated with the characteristics of sample collection. But in any case, micro-operation is usually carried out under local anesthesia, it has practically no complications. The most gentle aspiration biopsy is considered to be performed in outpatient setting.

What is the biopsy procedure?

The most commonly prescribed diagnostic procedure is pipel biopsy - it is safe and painless procedure, as a result of which no harm is caused to the body. During the examination, a thin plastic tube is inserted into the uterine cavity, through which a particle of the mucous membrane is taken for examination. Tissues are sucked into the cavity of the tube, that is, scraping or other traumatic actions are not performed. The difference between this method and the aspiration method is that the tissue is collected using a tube rather than a vacuum instrument or syringe.

Indications for use

Indications for a biopsy include:

Availability uterine bleeding;
suspicions of the appearance of neoplasms, adenomyosis;
scanty acyclic discharge, amenorrhea, disorders menstrual cycle, menometrorrhagia;
infertility;
presence of miscarriages;
as part of general control during hormonal therapy.

What does a biopsy show?

Let's look at what it shows this procedure? Examination of tissues after surgery makes it possible to determine whether there is diagnostic signs sample polymorphism, structural disturbances. The procedure can show whether there is hyperplasia of the endometrial layer, the presence of local proliferation of mucosal tissue, malignant tissue overgrowth, discrepancy between the thickness of the mucous membrane and the norm, atrophy of the uterine lining, atypical hyperplasia or hypoplasia.

How to prepare for the procedure

Preparation for the procedure begins with determining the time, usually these are the days before menstruation. If there is a suspicion of mucosal rejection, then it would be optimal to schedule a biopsy on the 5th day of the cycle, and with hormonal therapy it will be 17-24 days. If the research is carried out under general anesthesia(for example, during complex diagnostics or in the form of a scraping), you need to prepare for anesthesia - do not drink or eat anything for eight hours, it is also forbidden to take medications. Tests are usually ordered as with any other surgical procedure.

Otherwise, there are no restrictions or special requirements; the study is carried out in an outpatient setting (with the exception of the classical method).

Research methods

Various techniques may be used for a biopsy, including:

classic with complete scraping of the mucous membrane, the most traumatic;
aspiration biopsy of the endometrium with sampling of materials using a vacuum instrument;
pipel, which is the safest and completely painless.

Scraping

This method is also called classical; it is usually performed under general anesthesia and involves complete curettage of the cavity with special instruments. cervical canal, uterus. The procedure is painful, it requires the patient to stay in the hospital, before the manipulation you should prepare and undergo tests.

Pipelle endometrial biopsy - what is it?

Preparation for a pipel biopsy is very simple:

the patient should undress, as during a routine examination by a gynecologist;
the vagina is expanded using a special instrument;
the cervix is treated with a solution, after which it is treated with an anesthetic;
Next, a tissue sample is taken.

How exactly the procedure takes place depends on the chosen method, but usually it does not require much time and takes a couple of minutes. The scraping may take approximately 10-15 minutes, after which the patient can go home. No hospital stay is required unless a biopsy is performed as part of general treatment or there are indications for this.

On what day of the cycle is it done?

A biopsy sample is usually taken on days 21-23 of the cycle, so it is recommended to maintain a personal menstrual schedule. Some types of studies are best done immediately before menstruation, about 5-7 days, but for long cycles this period may be different. If the patient does not know the length of her cycle, the time for the study is approximately scheduled, focusing on the usual duration, that is, between 21-23 days, counting from the date of completion of the last menstruation.

What is the price

The price of a pipell endometrial biopsy depends on the clinic where the procedure is performed. On average, the cost of this diagnostic procedure ranges from 1,600 to 8,000 rubles. Research is recommended to be carried out only in specialized clinics with appropriate conditions and equipment.

Reviews about pipel endometrial biopsy

Anastasia N.:

“I had miscarriages several times, and for a long time they could not determine the cause. One of the clinics offered to perform a pipel biopsy. The procedure itself did not take much time, it went well, although it was painful. As a result, hyperplasia was discovered, which was the reason for the impossibility normal pregnancy. I completed a course of treatment, now everything is fine, we are expecting our second baby.”

“An IVF procedure was prescribed, and before it it was recommended to undergo a biopsy to rule out any problems. Everything went quickly in an outpatient clinic, especially discomfort it wasn’t, fertilization was scheduled in a month.”

Svetlana D.:

“The observing gynecologist ordered a biopsy because endometriosis was suspected. I was terribly afraid, but in vain - everything took literally five minutes, practically no painful sensations did not have. The first couple of days I was bothered by a pulling sensation in the abdomen and light discharge, but everything went away without any consequences.”

Decoding the results

Decryption usually takes 10 days, this is done only by a qualified specialist. The results of the study reveal:

discrepancy between the thickness of the mucous layer and the norm;
the presence of endometritis;
malignant neoplasms;
atypical hyperplasia;
precancerous condition;
the presence of fibroids and other growths;
presence of endometriosis.

Endometrial aspiration biopsy

Vacuum aspiration of the endometrium is a minimally invasive micro-surgery, almost painless. The operation is performed in an outpatient setting; it does not require a long stay in the clinic or restrictions after a vacuum examination.

The procedure involves taking an aspirate from the uterine cavity using a specially designed syringe. In this case, a long tip or needle is inserted into the uterine cavity, through which the tissue sample is literally sucked inside. This histological examination does not require general anesthesia or serious preparation, it is practically painless and does not cause bleeding.

Price

The price of endometrial aspiration biopsy usually depends on the status of the clinic. The average cost for aspiration research is 1900-8000 rubles.

CUG biopsy

A CG biopsy is a type of examination during which tissue is removed using line-shaped scrapings. This method is considered the safest; it is not accompanied by bleeding or mucosal rejection. The use of bar biopsy is allowed up to three times during one cycle, without causing injury to the body, hormonal background does not change. This type of study is usually indicated when examining a precancerous condition, if there is tumor processes.

Hysteroscopy with biopsy

Diagnostic hysteroscopy with biopsy is used to accurately identify pathologies, the presence of fibroids, tumor processes, polyposis, and hyperplasia. The material is collected under anesthesia; intravenous anesthesia is usually used for this. The biopsy is taken using a special hysteroscope, after which tissue samples are sent for research.

Possible complications and consequences

Endometrial biopsy is a safe and virtually non-traumatic procedure, but there are a number of consequences, including:

in the lower abdomen may be observed nagging pain, but usually this goes away within a couple of days;
spotting also lasts only a couple of days, after which it goes away, the next menstruation will be normal;
may be observed general weakness, nausea, feeling of dizziness;
there is a slight rise in temperature, fever is possible.

Severe bleeding is not observed; this situation is possible only if the procedure was performed incorrectly. But even with a competently performed biopsy, a shift in the menstrual cycle may be observed; the first menstruation usually goes a little differently than always.

What to do after the procedure?

Usually a biopsy proceeds quickly and without any special consequences, but it is not prescribed in the following cases:

pregnancy;
blood clotting disorders;
presence of inflammatory organ diseases genitourinary system;
severe anemia;
taking medications such as Trental, NSAIDs, Clexane and others;
intolerance to drugs used for anesthesia.

In addition, a number of restrictions apply to intimate relationships, the use of sanitary tampons, pregnancy can only be planned for the next cycle, especially for the IVF procedure.

What should you not do after a biopsy?

After a pipel endometrial biopsy, the following actions cannot be performed:

have sex until the bleeding goes away;
lift weights, engage in work involving heavy loads;
take a bath, especially a hot one;
visit a sauna, bathhouse;
do douching;
use tampons.

Such activities are prohibited to prevent certain complications, including inflammatory diseases, heavy bleeding. Such restrictions are in effect for days, after which they are lifted. But, if bleeding continues or is observed purulent discharge from the vagina, you need to contact a supervising specialist.

Sex life after

It is better to postpone intimate relationships after a biopsy until the bleeding has completely passed. Then sex no longer has restrictions, but if pregnancy is not planned, it is better to use it at first barrier contraception, which will also protect the mucous membrane from infectious and bacterial lesions.

How do periods behave?

Immediately after the procedure, menstrual flow comes on time, there may be slight delays, but no more than 10 days, most often there are no delays at all. The discharge itself will be more scanty than usual; the presence of unpleasant odor discharge, the appearance of clots, the presence of pus, fever.

Biopsy and pregnancy

After a biopsy, some conditions are contraindicated, but pregnancy can be planned for the next cycle, when the endometrium has recovered. There is usually no delay in menstruation, although the discharge may be scanty immediately after the procedure. But over the full cycle, the functionality of the mucous membrane is completely restored, no problems with the arrival of menstruation occur, and the uterus itself will be fully prepared to receive the egg.

How long to expect results?

Results from an endometrial biopsy, as a rule, have to wait from 7 to 14 days, it all depends on the clinic where the research is carried out and the overall workload of the laboratory. It usually takes no more than 10 days to decipher the results, after which you can contact the supervising doctor to prescribe a therapy regimen or other treatment methods.

Endometrial biopsy before IVF

Preparation for IVF often requires a biopsy procedure, which allows you to solve the following problems:

identifying the cause of infertility;
identifying the cause too heavy menstruation, uterine bleeding;
exclusion of cancerous tumors if ultrasound results are poor or there is suspicion of a tumor process.

Before in vitro fertilization, careful preparation of the endometrium is necessary. If the results of the study show that the thickness of the mucosa is insufficient, appropriate therapy will be prescribed to quickly bring the endometrium back to normal.

Histological and other studies of endometrial tissue are very important, since the hormone-dependent nature of this tissue can lead to the formation of various tumors and tissue growths, including atypical ones. Therefore, for timely diagnosis and treatment of such processes, a biopsy is performed. It can be carried out various methods, and one of these is pipel endometrial biopsy. What it is and how a sample is taken during this process is described in this article.

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Definition

What is a biopsy? A biopsy of the endometrium of the uterus is the process of collecting tissue from this layer for subsequent study of their histological (cellular) composition. The intervention is considered surgical and can be considered, to some extent, traumatic, therefore it is performed under anesthesia. The main purpose of a biopsy is to examine the material in laboratory conditions in order to determine the presence of atypical cells in it.

Material sampling tools

Tissues can be collected for such a study in various ways. During curettage, the layer of mucous membrane is removed using a special loop. Sometimes sampling is carried out during diagnostic hysteroscopy. But the simplest and least traumatic method is pipel biopsy. Sometimes it is also called endometrial aspiration biopsy, since these methods are very similar - only the sampling tool is slightly different, but the principle and actions are the same.

The endometrium is sampled using a thin plastic tube called a pipel, which has a hole in the side at the end. At the other end of the tube there is a piston, which creates negative pressure in the cylinder. Under the influence of negative pressure, some of the endometrial tissue is “pulled” into the tube and remains there. Endometrial aspiration is also performed using negative pressure, but instead of a pipette, equipment more similar to a syringe is used. The process is shown in detail in the video at the end of the article.

Why is it carried out?

This type of intervention makes it possible to study cellular composition endometrial tissue. As a result, it is possible to install:

The presence or absence of atypical cells in the mucosa, which helps prevent the development of the oncological process;
The presence or absence of endometrial hyperplasia, which can cause a variety of unpleasant symptoms;
The presence or absence of bacterial, viral, infectious, fungal agents that potentially pose a danger to health and reproductive function.

The study helps to establish the possibility of conception when planning a natural pregnancy or in vitro fertilization. It also helps to make a particular diagnosis in cases where other diagnostic methods are ineffective and uninformative.

It may also be prescribed in some other cases.

Indications

What does a pipel biopsy show? For what conditions and diagnoses is it prescribed?

Pipel endometrial biopsy before IVF or natural pregnancy carried out in order to establish or refute the presence of obstacles to pregnancy;
In case of infertility or frequent miscarriages, especially during early stages, is considered a necessary and informative diagnostic procedure;
Performed for uterine bleeding unknown origin, as it helps to establish their cause;
Necessary if an oncological process is suspected;
Quite often it is also carried out if hyperplasia or endometriosis is suspected;
Sometimes it is carried out when viral, bacterial, or fungal infections are suspected;
It is often carried out for hormonal abnormalities in order to establish their effect, nature, and sometimes the cause, for further effective treatment.

In some cases, such a diagnosis is also carried out for other diagnoses and suspicions of them.

Contraindications

Despite the high efficiency, information content and low risk of injury of this procedure, it still has a number of contraindications. Most of them are associated with a complete ban on manipulations in the uterine cavity during certain periods. General contraindications are the following:

Pregnancy of any stage, including unconfirmed or suspected pregnancy. Taking material from the uterine cavity during such a period can lead to miscarriage or injury to the fetus. After childbirth, manipulation can be performed if still required;
Confirmed infectious, inflammatory, viral, fungal or other pathological processes, occurring in the vagina, since additional infection from it into the uterus is possible;
Low blood clotting is a contraindication because the technique for performing such an endometrial biopsy does not involve coagulation of damaged vessels, since usually there is no bleeding (at least significant) during such manipulation. However, if there is a clotting disorder, they can occur;
Presence of sexually transmitted infections.

Most of these restrictions impose only a temporary ban on manipulation. For example, it can be done after the disease has been cured. However, neglecting these contraindications may lead to unpleasant consequences.

Preparation

It is in order to exclude potential contraindications that a number of studies are carried out before prescribing this manipulation. You need to do the following:

Do ultrasonography to confirm or deny the presence of pregnancy;
Take a vaginal smear to determine sterility in order to exclude the presence of infections, including sexually transmitted ones;
A coagulogram is necessary for those who do not know exactly what their blood clotting ability is.

In addition to such research, a number of other measures need to be taken:

Avoid sexual intercourse for 3 days before the intervention;
Maintain good hygiene;
Stop taking medications that thin the blood at least a week before the intervention, as they reduce blood clotting, which may result in bleeding (cancellation is possible only in consultation with the doctor);
Cancellation of appointment hormonal drugs(strictly in agreement with the doctor) at least a week before the manipulation;
Carry out the procedure strictly on the established day of the cycle, as this can have important diagnostic significance.

On what day of the cycle is a pipel biopsy performed? It depends on the purposes for which it is carried out. Usually, the most optimal day of the cycle is prescribed by a specialist. Proper preparation for pipell endometrial biopsy is very important, as it affects the information content of the procedure.

Carrying out

Anesthesia is usually not used for this procedure, as it may be more unpleasant than the procedure itself. The collection of the material is almost painless. The pipel is inserted into the uterine cavity through the cervical canal under ultrasound guidance or blindly, after which the tissue is taken for laboratory testing, which lasts from 7 to 10 days. The patient can leave the medical facility immediately after the intervention.

results

The results of a pipell biopsy of the endometrium can only be correctly deciphered by a doctor, depending on what disease the study was conducted for (based on this, specialists Special attention pay attention to certain characteristics of the endometrium). In this case, there will be no single norm, since much depends on the woman’s age, her hormonal balance. Decryption is possible only taking into account these indicators.

The absolute norm is only complete absence atypical cells. But even their presence in minimal quantities is always considered a sign of a precancerous process.

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. 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 diagnostic minimum, allowing you to determine the cause gynecological disease. An endometrial biopsy is the obtaining of samples of the mucous membrane of the inner layer of the uterus for subsequent histological examination.

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

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

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

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

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

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

Pathologies detected during the study:

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

The presence of atypia in a biopsy specimen in some forms of hyperplasia is considered a precancerous condition. Precancer is indicated by a violation of the structure of cells and the mechanism of cell division, transformation glandular epithelium into the stroma, 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, during hormonal 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 you suspect cancerous tumor 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 onset 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

Thanks to its informative content, this radical way 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 internal cavity uterus, passing the instrument from the fundus to the internal os. The taken portion of the endometrium is placed in a container with formaldehyde, and the curette is reinserted for processing. back wall uterus and 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.

Flaws:

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 when determining the cause of infertility or studying the response to hormone 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.

When vacuum aspiration of endometrial samples is used instead of a uterine syringe electrical appliance with a similar operating principle.

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.

Flaws:

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.

Flaws:

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 person).

How to prepare for a biopsy?

Firstly.

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

Secondly.

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

Third.

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

Because biopsy cannot avoid damage blood vessels endometrium, for several days after the manipulation the woman will definitely experience slight bleeding. 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 stay 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.

Endometrial biopsy, with proper preparation and full compliance with antiseptics, is an informative diagnostic study that helps return reproductive health, avoid serious illnesses.

Any pathological changes in the structure of the endometrium have Negative influence on reproductive function women (cycle disorders, infertility and miscarriage, development of neoplasms).

One of the most modern diagnostic methods is a pipell biopsy of the endometrium. During the operation, a particle of the uterine mucosa is removed, then a histological examination is performed. The operation allows you to identify atypical changes and establish the cause of menstrual irregularities or infertility.

Depending on the technique, there are several ways to extract tissue: partial curettage, surgery, hysteroscopy.

The purpose of an endometrial biopsy is to study to identify the causes of infertility, miscarriage, and menstrual irregularities. The procedure is also used in preparation for IVF. Lets get full information about the condition of the mucous membrane.

Aspirate from the uterine cavity is also taken in case of hormonal abnormalities, a history of miscarriages, uterine bleeding that is not associated with menstruation, hyperplasia, and malignant neoplasms.

During the procedure, mucous particles are surgically removed. Depending on the execution tactics, tissue sampling is performed using a tube, vacuum apparatus or syringe. In conventional curettage, a surgical curette is used for diagnostic purposes. Material for research can also be obtained during hysteroscopy using a probe. Equipped with a video camera, the device has a small surgical instrument that takes precise samples from the lining of the uterus (endometrium).

Modern equipment allows you to take a sample of the mucous membrane in the desired area - the uterus, the cervical canal - without damaging healthy tissue. The possibility of complications and discomfort during the operation is minimized. A biopsy is considered minor surgical intervention. It is usually carried out as planned diagnostic purposes, but in rare cases it is carried out as part of the main operation or on an emergency basis.

Carrying out diagnostics

Diagnosis using aspiration biopsy or another type of material collection is carried out for various uterine defects, absence of menstruation, and bleeding during menopause.

If the study is carried out as planned, the operation is preceded by the following diagnostic measures:

taking a smear for cytology and flora;
Ultrasound of organs located in the woman’s pelvis;
General analysis of urine and blood.

An emergency biopsy is performed in case of suspicion or precise establishment of the presence of a malignant neoplasm in the uterine cavity or cervix, and the day of the cycle is not taken into account.

refusal to take drugs that affect blood clotting and anticoagulants;
temporary abstinence from sexual activity (at least three days before surgery);
refusal to douche;
exclusion from the menu of dishes that cause gas formation.

Improper preparation for surgery can cause various complications, for example, vascular damage (resulting in bleeding), endometrial rejection, cycle disruption.

When to take aspirate from the uterine cavity

An endometrial biopsy is performed according to indications determined by the doctor observing the woman. Taking an aspirate from the uterine cavity is necessary in the following cases:

suspicion of tumor growth;
scanty menstruation or uterine bleeding, including dysfunctional;
in the presence of inflammatory processes endometrium;
determining the cause of infertility, spontaneous abortions or missed pregnancies;
amenorrhea without pregnancy for unknown reasons;
preparation for the IVF procedure;
pregnancy pathologies.

Scraping the endometrium allows you to determine its structure and identify atypical cells. Its thickness and exact location are also determined.

The procedure is used if, after a standard gynecological examination and ultrasound, the doctor detects pathological changes in the endometrium. Diagnosis is always carried out before removing fibroids or myomas, polyps, or malignant neoplasms.

Contraindications

The list of contraindications is the same for all variants of this diagnostic procedure. Pipelle biopsy is not performed in the following cases:

Pregnancy. Even in the presence of unprotected sexual intercourse before the operation, when determining conception is impossible with a standard home test, a test is done to determine the level of hCG to accurately determine the fact of fertilization.
Blood clotting disorders. In such cases, aspiration biopsy is not performed. Sometimes diagnostic measure precedes treatment of the underlying pathology.
Presence of infection (chronic or acute process). Pathology is indicated by pain, itching, bleeding not associated with menstruation, and purulent discharge.
Contraindications also include hemophilia, high degree anemia, some chronic diseases in the acute stage.

The list of contraindications is strictly taken into account before diagnosis in order to avoid the occurrence of side effects after operation.

Suspicion of cancer pathology is a direct indication for diagnostics, and an emergency one at that. In this case, the biopsy is performed with a minimum number of contraindications.

What is the procedure

Endometrial biopsy is performed using different methods, but the aspiration option is most often used. It is less traumatic, there is absolutely no discomfort during the procedure, the risk of complications and side effects is minimized, and the information content of the study is quite high.

The analysis is taken after appropriate preparation for the procedure, which begins 3 days before the procedure. Immediately before the examination, the intestines are cleansed with an enema.

A biopsy of the mucous membrane of the cervical canal or uterus lasts no more than 3 minutes (on average 30–60 seconds depending on the qualifications of the doctor). Rarely, a woman may need anesthesia. The absence of nerve fibers allows manipulation to be performed with minimal use of painkillers.

It involves collecting material from the cervical or uterine canal using a vacuum/syringe/tube/curette. Additionally, the doctor can remove polyps.

Curettage of the uterine lining and further histological examination of the material are carried out for women of any age, including during menopause, before or after childbirth and pregnancy.

Timing and technique of performing a biopsy

Endometrial biopsy is performed at certain periods of the cycle depending on the diagnostic goals pursued:

When clarifying the factors of infertility against the background anovulatory cycles and the minimum luteal phase, the analysis is done one day before the start of menstruation or on the first day of bleeding.
In the case of acyclic bleeding not associated with menstruation, curettage of the mucous membrane is prescribed on the first or second day of menstruation.
When diagnosing polymenorrhea, manipulation is carried out between the fifth and tenth days of the cycle.
To determine the cause of hormonal imbalance, a sample is taken in the second phase of the cycle between the 17th and 25th days.
If you suspect the presence of benign and malignant neoplasms The scraping is taken regardless of the day of the cycle (emergency).

Any study involves the insertion of a special device into the vagina to collect a sample of the endometrium. The methods differ in duration, possible side effects, and information content.

Scraping

Biopsy curettage is both a diagnostic and therapeutic procedure. Curettage was previously used not only to identify endometrial pathology, but also to emergency assistance with bleeding.

Curettage of the cervix is used less frequently today than other methods, since it is performed blindly, sometimes under the control of an ultrasound machine or visualization of the organ using a hysteroscope. The manipulation is performed under general anesthesia, often intravenous.

This procedure not only makes it possible to identify the cause of changes in the structure of the mucous membrane, but also has a therapeutic effect:

emergency stop of bleeding from the uterus;
removal of the damaged area of the mucosa;
removal of glandular polyps and other neoplasms (except malignant ones).

The optimal time for curettage is considered to be the 3-4th day before menstruation, and in case of cycle disorders, the first day of the appearance of acyclic blood discharge.

The total time of the operation takes up to 20 minutes; it is preferable for pain relief intravenous anesthesia. During the operation, the external genitalia are disinfected with iodine-containing preparations, and urine is removed using a catheter.

After a short-term anesthesia is administered, the cervical canal is opened with a special instrument, the material is scraped out with a surgical curette and placed in a special bottle. After this, a hysteroscope is used to examine the mucous membranes of the uterus, then a curette bigger size once again take the material from inner surface organ. The resulting sample is placed in a separate bottle and sent for histology.

Aspiration biopsy

The aspiration technique for obtaining tissue samples is used more often than curettage. With this technique, expansion of the cervical canal is not required, since the procedure is quite painful. The flexible tube used during the procedure reduces the risk of trauma to the uterine wall to zero.

The aspiration tube allows you to obtain material from any part using sterile devices, which reduces the risk of infection. Also, if an aspirate is used, the biopsy is taken almost painlessly, the uterus recovers faster, and the woman can return to her normal life immediately after scraping.

Negative factors of performing aspiration biopsy include the impossibility of simultaneously examining the structure of all areas of the endometrium. There is a risk that local small areas of damage will remain unexamined.

The results of histological examination of material selected in this way are highly informative.

The collection of particles from the uterine mucosa is carried out in different days depending on the tasks:

to remove a polyp immediately after the end of menstruation;
on the 1st day of the cycle with atypical blood discharge;
when conducting hormonal treatment– on the 17th–24th day of the cycle (including to monitor the prescribed treatment);
in case of long and painful periods - on the 7th–10th day;
to clarify the factors of infertility - 2–3 days in advance;
regardless of the day after/before menstruation when determining a malignant neoplasm.

Aspiration biopsy is carried out using several methods: collecting tissue particles directly into a syringe, placing tissue samples in saline solution, or using a vacuum unit.

Pipelle biopsy

This diagnostic method is preferable to aspiration biopsy and curettage. During diagnosis, the catheter replaces a small plastic cylinder. At one end, placed in uterine cavity, there is a small hole on the side, on the other there is a piston. When the material is removed, a vacuum is created, the hole is attached to the wall of the uterus, and mucosal cells are literally sucked into the device.

The procedure is also performed at certain periods of the menstrual cycle, depending on the type of examination. The technique has a number of advantages:

painless, no anesthetics are used;
no side effects;
carried out without dilation of the cervix;
most informative;
a flexible tube allows you to control the depth of insertion, which reduces the risk of injury to the internal walls of the uterus;
no hospitalization required;
fewer contraindications, possible use in women with serious chronic or acute diseases.

This technique also makes it possible to identify the causes of hormonal disorders, infertility, and assess the growth of tumors.

Zug biopsy

This technique is one of the least dangerous and least traumatic compared to endometrial aspiration biopsy or curettage. Can be executed a maximum of three times per loop.

This technique is not used to diagnose cervical precancer or malignant neoplasms.

To determine the cause of uterine diseases, the cervical canal is artificially expanded, and a small curette is carefully inserted into the organ cavity. With its help, tissues are collected from the surface of the inner layer.

Line scraping of the endometrium is carried out from the depths outward up to the internal os of the cervix. Two samples of material are collected at a time.

The procedure is performed on the 1st–2nd day of menstruation or after it. The taken uterine material is also sent for histology, which makes it possible to accurately identify the causes of infertility, hormonal changes, uterine bleeding, and the location of tumors.

Infertility procedure

Endometrial biopsy is considered one of the leading methods for clarifying the factors causing infertility, miscarriage, spontaneous abortions, interruption of fetal viability and other reproductive disorders. female function. In addition, it is possible to establish the causes of uterine diseases with a biopsy, and increase the chances of embryo implantation during IVF.

The procedure helps not only to identify factors of infertility. Even pregnancies that occur as a result of in vitro fertilization are observed more often. A high percentage of successful IVF was noted. Positive effects were recorded when the biopsy was performed in the month preceding fertilization.

To clarify the factors of infertility, the operation is performed according to the same scheme as the usual diagnostic procedure. Examination of the material allows us to identify the presence or absence of atypical cells, including precancerous conditions, hormonal disorders, inflammatory processes, hyperplasia and other factors leading to lack of conception.

Complications and consequences

Aspiration biopsy for professional behavior practically does not cause side effects. The most dangerous in terms of risks is conventional curettage, since after it bleeding may develop due to injury to the walls of the uterus and other complications. In general, the following undesirable consequences are possible:

heavy bleeding - may occur due to trauma to the walls of the uterus or cervix;
dizziness and other signs of weakness;
nagging or sharp pain;
development of the inflammatory process after infection with insufficient sterility of the instrument (during curettage);
fever.

A woman receives biopsy results no earlier than 6–7 days after the procedure. Histological examination of a fragment of the endometrium allows us to identify various pathological processes: oncology, diffuse and atypical hyperplasia, atrophy, endometritis, hormonal disbalance. Based on the results, appropriate therapy is prescribed.

Manipulations are always carried out before surgery to remove uterine fibroids and malignant neoplasms.

Biopsy is the most effective method determining the causes of endometrial pathologies. This minimally invasive technique most accurately reflects the processes occurring inside the uterus and allows early detection of growth. malignant tumor or polyps, serves to clarify hormonal status, identifies the causes of infertility and other reproductive function disorders.

Biopsy is one of the most important diagnostic methods used in gynecology. At various diseases uterus, suspected of atypical development of the endometrium, this method makes it possible to obtain the most accurate information. Based on this, a decision is made on how complex the treatment is needed. There are several methods for carrying out such a procedure. Among them, the aspiration method of collecting material is the least traumatic. When choosing a date for a biopsy, the nature of the pathology and the characteristics of the state of the endometrium on different days of the cycle are taken into account.

Content:

What is aspiration biopsy

An endometrial biopsy is the removal of a sample of the mucous membrane from the uterine cavity using mechanical devices. The resulting material is examined in the laboratory to determine the structure of endometrial cells and detect deviations in its condition. The method allows you to diagnose mucosal hyperplasia and the formation of polyps. Study of the extracted material is necessary to detect precancerous changes in the structure of cells, as well as their malignant degeneration.

Endometrial particles are collected in various ways:

By scraping the entire endometrium (after artificial expansion of the cervical canal).
By scraping the mucous membrane from the inner surface of the uterus in the form of separate strips (CUG biopsy).
Suction of tissue particles under vacuum.

For last method a flexible catheter is used, through which the material is collected into a syringe or thin tube with a piston at the end (pipel). Sometimes aspiration is performed using an electric vacuum device.

Advantages and disadvantages of aspiration

Using the endometrial aspiration biopsy method allows you to do without dilating the cervical canal of the cervix - painful procedure necessary for inserting instruments into the uterine cavity when performing curettage. The use of a flexible tube significantly reduces the risk of wall damage and the development of an inflammatory process.

The material can be removed from any part of the uterus using disposable, sterilely packaged devices (there is no chance of infection from insufficiently sterilized instruments).

Compared to traditional curettage and CG biopsy, aspiration is a virtually painless procedure that can be performed on an outpatient basis. The likelihood of complications is very low, so after such a procedure the functionality of the uterus is quickly restored. The patient can return to her normal lifestyle almost immediately.

Due to its advantages, this method is especially often used when examining women planning a pregnancy (for example, before IVF). Despite its simplicity, the method is quite informative and does not require special preparation.

Among other aspiration techniques, the most modern is pipel biopsy.

Disadvantages include the inability to simultaneously study the structure of the entire endometrium. Since samples are taken from only selected areas, there is a risk that individual areas of damage will go undetected.

Indications for aspiration biopsy

Indications for endometrial aspiration biopsy are:

the need to establish the degree of endometrial hyperplasia and endometriosis;
examination of the condition of the uterine mucosa during chronic endometritis;
detection of endometrial polyps and the need to confirm their type;
studying the causes of menstrual disorders (amenorrhea, painful heavy or scanty periods, intermenstrual bleeding);
establishing the causes of infertility;
examination of women with bleeding during the postmenopausal period;
presence of suspicion of the formation of benign or malignant tumors in the uterus.

This is the most preferred method when examining the condition of the endometrium after hormonal therapy.

Video: Why aspiration biopsy is performed. Preliminary analyzes

Contraindications

Aspiration biopsy is not performed during pregnancy.

Its use is contraindicated in the presence of acute inflammatory processes in the genital and urinary organs, as well as in infectious diseases.

The procedure is not prescribed if the patient has low blood clotting due to diseases of the hematopoietic organs. If reduced viscosity blood is caused by the use of anticoagulants, then aspiration biopsy is performed only if the intake similar drugs You can cancel it for a while.

A contraindication to aspiration biopsy is the woman's allergy to medications used for local anesthesia.

Preparing for a biopsy

Before prescribing the aspiration procedure, the patient must undergo an examination ( gynecological examination, ultrasound, colposcopy). In addition, it is necessary to examine the microbiological composition of smears from the vagina and cervix to detect infectious agents.

Blood tests are also performed for leukocytes and the hCG hormone (its level is increased during pregnancy and some diseases). The absence of antibodies in the blood to the pathogens of syphilis, HIV, viral hepatitis B and S.

The doctor asks the patient what medications she is taking and warns her about the need to avoid them for several days before the procedure. Before a biopsy, a woman should not douche, use vaginal ointments, or suppositories. It is necessary to abstain from sexual intercourse 2 days before the biopsy. Foods that cause bloating should be excluded from your diet. On the eve of the procedure, the stomach is cleansed with an enema.

On what days of the cycle is the material collected?

In young women, the day of the procedure is selected depending on the purpose of the examination.

How is the procedure performed?

There are several options for performing an endometrial aspiration biopsy procedure.

Aspirating material directly into the syringe

A catheter with a diameter of 2-4 mm is inserted into the uterine cavity until it touches the wall. Using a thin syringe attached to the outer end of the tube, mucous particles are removed. The resulting sample is then applied to a microscope glass for histological examination.

Sampling of material using saline solution

Through a catheter using the same syringe, 3 ml is injected into the uterus saline solution. The presence of sodium nitrate in it prevents the formation of blood clots. The liquid is immediately drawn back into the syringe. It is transferred to a test tube and placed in a centrifuge for several minutes. Endometrial cells settle at the bottom, after which they can be examined.

Aspiration using a vacuum unit

The procedure is more informative, but requires prior use of painkillers that relax the cervix (baralgin, analgin) or injection of lidocaine directly into its muscle.

A probe is first inserted into the uterine cavity to examine the depth of the organ and select an aspiration tube of the appropriate length. Then the probe is removed and a flexible tube connected to a vacuum pump is inserted. By moving it into the uterine cavity, material is collected from several areas, and then it is transferred to a container with a formaldehyde solution.

You can control the selection process using ultrasound. When performing such aspiration, healing of the surface of the uterus occurs more slowly, taking 3-4 weeks.

Pipelle biopsy

Instead of a catheter, a thin plastic cylinder is used. At one end, inserted into the uterine cavity, there is a side hole, at the other - a piston. With its help, a vacuum is created inside the cylinder, the hole sticks to the wall, and endometrial particles are sucked into it.

Period after the procedure

Complications after aspiration (endometritis or bleeding) occur extremely rarely if the preparation rules are followed. A woman must follow the doctor’s recommendations: do not lift anything heavy, refrain from other physical activity, bathing, visiting the sauna. Over the next few weeks, it is necessary to avoid sexual intercourse, hypothermia, and especially carefully observe the rules of personal hygiene.

Warning: Because when using this method there is no significant change in the structure of the endometrium, then in the absence serious pathologies pregnancy can occur already in the current or next cycle. However, you should plan to conceive only after receiving the results of the biopsy.

In some cases (if the procedure is performed after recovery from chronic inflammatory processes in the organs of the genitourinary system) in for preventive purposes antibiotics are prescribed. If symptoms such as fever, purulent or bloody discharge with an odor, or abdominal pain appear, a woman should immediately consult a doctor.

Deciphering the results takes up to 2 weeks.

Menstruation usually comes on time after such a biopsy, sometimes with slight delay(up to 10 days). Their duration and volume may change slightly, and subsequently the nature of menstruation will depend on the type of treatment performed.