Pipelle endometrial biopsy method decoding. Endometrial aspiration biopsy. When to take aspirate from the uterine cavity

Pipelle biopsy of the endometrium of the uterus (aspiration biopsy) is a modern minimally invasive method for diagnosing endometrial diseases. The procedure allows you to obtain samples of the uterine mucosa for further cytological, histological or histochemical analysis.

At the REMEDI clinic, you can undergo examination by qualified specialists with extensive experience in performing biopsies and receive accurate results diagnostics

Preparation for pipel biopsy

On preliminary consultation the doctor determines the indications and possible contraindications to a biopsy. If it is recommended, the patient needs to be prepared for a pipell endometrial biopsy.

During the cycle during which the study will be conducted, prohibited additional dose hormonal drugs . Gynecologists advise against using oral contraceptives.
A few days before the study, the patient preliminarily takes blood and urine tests, she is given gynecological smear for flora and pelvic ultrasound.
For prevention discomfort Can take an analgesic tablet or an antispasmodic 30-40 minutes before the test (by prior agreement with the doctor).

10 minutes before the study, the patient is already in the clinic give an injection of an antispasmodic to prevent spasm cervical canal and ensure easy insertion of the catheter into the uterus. General anesthesia is not required for pipel biopsy, since the procedure does not require preliminary dilation of the cervical canal before insertion of the instrument.

Indications for pipel biopsy

The endometrium changes significantly over the course of menstrual cycle and in various pathological processes, and also significantly responds to hormonal changes. Therefore, its examination in many cases suggests the disease and its causes.

Pipelle biopsy is performed only as prescribed by a doctor.

Oncological diseases of the endometrium;
Endometrial polyp;
Endometrial hyperplasia.

The method is also used to identify the causes of infertility and miscarriage: for example, chronic endometritis.

Aspiration biopsy appropriate if available the following symptoms(changes):

Intermenstrual bleeding;
Uterine bleeding in postmenopause;
Prolonged and heavy menstrual bleeding;
Prolonged bleeding after abortion and childbirth;
Irregular menstrual cycle;
Thickening of the endometrium according to ultrasound;
Infertility;
Miscarriage.

Also, a study may be prescribed in order to prepare for IVF. It needs to be done to assess the condition of the endometrium before starting preliminary hormone therapy.

Pipelle biopsy of the uterine cavity – high precision method diagnostics to identify many types of endometrial pathology.

Timing of aspiration biopsy

Most often, aspiration biopsy is performed on certain days of the cycle so that the study is as informative as possible. Usually a pipell biopsy of the endometrium carried out on days 9-10 of the cycle, it is possible to conduct a study on days 21-25 of the cycle. Postmenopausal – at any time.

Contraindications for pipell endometrial biopsy

The study is not indicated for:

Pregnancy at any stage;
Acute infectious and inflammatory processes of the cervix and body of the uterus, appendages;
Pathologies of blood clotting.

How is a pipel biopsy performed?

The aspiration biopsy device resembles a syringe with a thin flexible tube (catheter) at the end. The diameter of the tube is only 3-4 mm, which ensures gentle and painless manipulation. A centimeter scale is applied along the entire length of the tube, which allows the doctor to adjust the depth of penetration of the catheter into the uterus. There is a hole on the upper side of the tube into which tissue samples are collected. The instrument is disposable, which eliminates the risk of infection and bacterial complications.

The study is performed on an outpatient basis. Many patients ask how long a pipel biopsy takes. The procedure lasts only about 5 minutes, and the actual time of sampling is limited to 1 minute.

During a pipel biopsy, the patient is positioned on a gynecological chair.
The doctor performs bimanual (manual) vaginal examination, during which it determines the position and size of the uterus for greater accuracy in the further procedure.
The cervix is exposed using gynecological speculum.
The cervix is treated with an anesthetic solution and fixed using bullet forceps.
The doctor will probe the uterus to determine the length of the uterine cavity.
An instrument catheter is inserted through the cervical canal so that its end reaches the fundus of the uterus.
Having placed it in the uterus, the doctor carefully pulls the piston of the instrument towards himself and makes “scraping” movements with the tube along the walls of the uterus, taking samples of the mucous membrane into it.
After the collection of material is completed, the catheter is removed.
A portion of the sample is placed on a glass slide to microscopic examination, the part is placed in a special chemical composition and goes to the laboratory. There, a cytological and histological examination of the endometrial biopsy is carried out.
The patient can leave the clinic 20-30 minutes after the procedure.

Pipelle biopsy can be performed as a stand-alone test or as part of a surgical procedure.

After the procedure

The patient should be prepared for the possibility that for 2-3 days after the study there may be slight nagging pain in the abdomen, reminiscent of the sensations in the first days of menstruation. On the day after the pipel biopsy, a small amount of scarlet blood (a few drops) and spotting may be discharged from the genital tract Brown are stored for up to 3 days.

After the study, the patient does not need observation and can leave. Pipel biopsy does not impair performance, does not affect the ability to drive vehicles, and does not require lifestyle changes or sick leave.

After performing a pipell biopsy of the endometrium, the following are recommended:

Sexual rest for a week after the study;
A single dose of a broad-spectrum antibacterial drug (only as prescribed by a doctor).

Possible complications

Exists hypothetical probability of infection entering the uterine cavity. However, during the procedure, disposable sterile instruments are used, the manipulation is performed according to a standard protocol in compliance with all rules of asepsis, and to perform a biopsy there is no need to further expand the cervical canal, creating an “entry gate” for infection. Before the procedure, smears from the cervical canal and vagina are assessed for the presence of inflammatory process. Only patients with no pathological changes based on smear results are allowed to be examined.

Patients often fear damage to the cervix and uterus itself from instruments. But the catheter of the biopsy device is flexible and thin, its hole is located on the side, and the end is gently rounded, so it cannot damage the organ. The procedure, performed by an experienced specialist, is always carried out carefully and accurately, which minimizes the risk of injury.

Complications after pipel biopsy occur extremely rarely.

Advantages of the method

Compared to other methods of endometrial biopsy, pipel biopsy has a number of advantages:

Takes very little time;
Does not require the patient to be placed under anesthesia and the presence of an anesthesiologist during the procedure;
Does not require lengthy and labor-intensive preparation;
It causes virtually no discomfort (or is completely painless);
Does not create the need for preliminary expansion of the cervical canal;
Performed on an outpatient basis;
In the vast majority of cases it does not cause complications.

Pipelle biopsy is gentle, minimally invasive and quite reliable method diagnostics The accuracy of disease detection is 60-90%, depending on the pathology.

Interpretation and results

The resulting tissue sample is examined under a microscope after preliminary staining and processing. In this case, you can determine:

Cellular composition of the biopsy;
Presence of signs of hyperplasia and other hormonal-dependent changes in the endometrium;
The state of the endometrial receptor apparatus, the presence of signs of autoimmune damage to the endometrium;
Presence of microorganisms in the material (bacteria, fungi);
The presence of malignant cells in the material.

The result is given to the patient or transferred to her attending physician in the form of a conclusion on paper. The interpretation of the results is carried out by the attending physician.

We provide wide range services for the diagnosis and treatment of infertility and diseases leading to it, we successfully implement programs of assisted reproductive technologies. We employ highly qualified specialists, which allows us to perform each procedure with the best results.

Content

Endometrial problems in women are very common. They prevent you from conceiving and bearing a child, and in advanced cases they simply interfere with life - they cause pain, bleeding, and menstrual irregularities.

The endometrium is the mucous layer lining the inside of the uterus.

Biopsy – medical procedure, during which tissue is taken from the human body for further histological examination.

So we understand that endometrial biopsy is a method of taking tissue from the mucous membrane from the uterine cavity for further study and obtaining results.

Methods

Today, several types of biopsy are performed.

Curettage of the uterine cavity with expansion of the cervical canal is the oldest and most traumatic method of collecting material. This study is done using special surgical instruments. First, the cervical canal is opened, then its cavity and the uterine cavity are scraped with a special curette. This operation is most often performed under general anesthesia.
Curettage is a more gentle method of endometrial biopsy compared to curettage. A special instrument is used to carry out several movements (strokes) from the very bottom of the uterus to its canal. This study is used only in the absence of bleeding from the uterus.

Taking material using an aspirator is a procedure during which the endometrium is “sucked” into special device without physical impact on the walls of the uterus. This method is not used if there is a suspicion of cancerous formations and tumors. The results may be erroneous.
Douching is a rare biopsy method during which the endometrium is washed out with a stream of a special solution.

Pipelle biopsy is the safest and most modern method endometrial biopsy. During the procedure, I use a special flexible tube with a piston (pipel), which is inserted into the uterus and the endometrium is collected using negative pressure in the cylinder. As a result of this procedure, the endometrium is torn away from the walls of the uterus and absorbed into the tube. The advantage of this method is that there is no need to put the patient into medicated sleep, and due to the very small diameter of the pipe, there is no need to dilate the cervical canal. All this eliminates the possibility of complications after surgery, shortens the recovery period as much as possible and does not cause any particular inconvenience for women.

The pipel method is not used in all government institutions, although this is the most minimally invasive and cheapest method of collecting material from the uterus.

In what cases is the procedure indicated?

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

there is a suspicion of the presence of neoplasms in the uterine cavity or cervical canal;
preliminary diagnosis: adenomyosis or endometriosis;
scanty blood discharge during menstruation;
disruptions of the menstrual cycle;
amenorrhea – absence of menstruation;
bleeding from the uterus of unknown origin;
in preparation for in vitro fertilization to determine the quality of the endometrial layer and a more accurate prognosis for the attachment of the fertilized egg;
after an abortion, miscarriage, frozen pregnancy;
for problems with pregnancy;
infertility.

On what day of the cycle is it correct to do it?

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

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

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

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

Contraindications

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

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

An endometrial biopsy is never done during pregnancy. The results of such a study of women in interesting position will be invalid, and manipulations will lead to the threat of termination of pregnancy or miscarriage.

results

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

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

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

The microscopic description may describe swelling or dystrophic changes in the chorion (which indicates a frozen pregnancy or incomplete abortion).
The presence of chorionic villi in the diagnosis indicates an interrupted pregnancy.
Degeneration of blood vessels or chorionic villi epithelium in the diagnosis indicates that the fetus initially received less nutrients, which could have caused his death.

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

The results of an endometrial biopsy should be deciphered by the attending gynecologist. If necessary, the doctor will immediately prescribe necessary treatment, corresponding to the identified problem or, if the results are good, will offer to come for a scheduled inspection after some time.

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 refers to minor surgical interventions in gynecology and is most often performed as an independent study. But in some cases it is included in the protocol of a “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 improve. This made it possible to reduce the trauma and pain of the procedure, and reduce the risk of developing various undesirable consequences.

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

the classic version of the study is therapeutic and diagnostic curettage of the uterine cavity;
vacuum aspiration biopsy of the endometrium, performed using a special syringe or device (vacuum aspirator or electric suction);
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 the process ( endoscopic examination 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 all 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 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 glandular tissue into the stroma. The key point for determining precancer and cancer is impaired tissue differentiation.

Indications, contraindications and timing

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

The basis for prescribing this study may be:

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

An endometrial biopsy is performed before IVF and when identifying the cause of infertility. In this case, histological examination of the uterine mucosa is included in the program complex diagnostics reproductive health women.

The study is also carried out after spontaneous abortions on early stages and termination of pregnancy medical indications(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 you suspect the presence malignant tumor and in the absence of 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 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 if there is relative contraindications.

Research methods

Biopsy by curettage of the uterine cavity

This method is the most radical and historically the most in an early way obtaining 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 the uterine cavity is painful procedure and requires mandatory use of anesthesia. Preference is given to short-term general anesthesia, and inhalation or intravenous anesthesia. That's why this method requires compliance with the same preparation rules as any “big” operation. To prevent reflux of gastric contents and their aspiration into the respiratory tract, 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 mouth fallopian tubes. As a result, almost the entire endometrium is mechanically removed, forming an extensive wound surface.

Such curettage often makes it possible, already at the diagnostic stage, to remove polyps, stop uterine bleeding and cleanse the uterine cavity of the pathological contents present in it. And the remaining open cervix The uterus does not interfere with 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 avoids significant discomfort, especially in nulliparous women.

Preparation for endometrial aspiration biopsy includes sexual rest, avoidance of douching and any vaginal tampons for 3 days before the procedure. The doctor also prescribes Exploratory survey 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 obvious complications to the woman. 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 malignancy. 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 a pipel biopsy is no different from that before a classical one. vacuum aspiration endometrium. The procedure is carried out in outpatient setting 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 the working surface of the curette narrow strip mucous membrane. This is reminiscent of drawing strokes, which is why this diagnostic method is called “stroke biopsy of the endometrium.”

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

What to expect and what to do after the study?

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

Diagnostic curettage leads to heavy menstrual-like and quite painful discharge. But their duration is usually much shorter than with normal menstruation, because the main part 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 can begin on time or with 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 depends on the results of the biopsy. When atypia and precancer are identified, the question of the need and advisability of surgical treatment is decided. When signs of inflammation are detected, its nature is determined and anti-inflammatory and antibacterial drugs.

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 the available 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 allows diagnosing endometrial cancer at early stages, which significantly improves long-term treatment results.

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 in the early stages, it is considered a necessary and informative diagnostic procedure;
It is carried out for uterine bleeding of 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);
Stop taking hormonal medications (strictly in consultation with your doctor) at least a week before the procedure;
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 Pipeline 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.

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 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 tactics of execution, tissue sampling is performed using a tube, a vacuum apparatus or a syringe. In conventional curettage, a surgical curette is used for diagnostic purposes. Material for research can also be obtained during hysteroscopy using a probe. The device equipped with a video camera has a small surgical instrument, which 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, such as vascular damage (resulting in bleeding), endometrial rejection, and 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 of the 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 applied if, after standard gynecological examination and performing an 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 according to different methods, however, the aspiration option is more 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 the presence of benign or malignant neoplasms is suspected, a 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 operation time takes up to 20 minutes; intravenous anesthesia is preferable for pain relief. 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 larger curette is used to 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 carrying out 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 performed using several methods: collecting tissue particles directly into a syringe, placing tissue samples in saline, 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 the uterine cavity, there is a small hole on the side, at 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, localization 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 a regular one. 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, allows early detection of the growth of a malignant tumor or polyps, serves to clarify hormonal status, and identifies the causes of infertility and other reproductive disorders.