Aspiration biopsy: description of the procedure. Pipel biopsy of the endometrium - what is it? Diagnostic procedure in gynecology Endometrial aspiration biopsy should be done every year

With uterine pathologies, patients often require a specific study of the mucous tissues of the uterus - the endometrium. For this purpose, patients are prescribed an endometrial biopsy.

This is not a particularly pleasant procedure, which involves scraping the cavity of the uterine body in order to obtain a small piece of tissue for further examination.

The bottom line is that the endometrium can change under the influence of a number of pathological factors, and such changes can only be detected by microscopic examination of the shell sample.

A biopsy is essentially a gynecological micro-surgery, which is performed under local anesthesia. The endometrium changes in accordance with the phase of the cycle, therefore, if various diseases are suspected, the biopsy is taken at different times.

Indications

Indications for endometrial biopsy are the following factors:

Hormone-dependent pathological processes like fibroids, etc.;
Uterine abnormal bleeding of unclear etiology;
Abortive or postpartum bleeding;
To determine the causes of a woman's infertility;
The presence of tumors of an incomprehensible nature;
Suspicion of;
Bleeding with menopause;
Detection of pathological endometrial changes during ultrasound examination of the pelvic region.

Most often, a biopsy is taken on the 21-23rd day of the menstrual cycle. An endometrial biopsy performed in the traditional way can cause some complications, so there are a number of specific contraindications for this procedure.

Contraindications

The procedure for endometrial biopsy is contraindicated in the following cases:

If pregnancy is suspected;
Purulent cervicitis of an acute form;
Inflammatory processes in the pelvic region, which can cause the spread of the infectious process;
Sexual infections and other infectious pathologies.

With special care and only if absolutely necessary, the procedure is performed for women with blood pathologies such as hemophilia or severe anemia, because there is a high probability of developing severe bleeding.

Types of endometrial biopsy

An endometrial biopsy helps the specialist determine the exact diagnosis and prescribe the right treatment in a timely manner. Such a procedure can be carried out in several ways: traditional, aspiration, hysteroscopic and pipel biopsy.

Classic method

The classic technique for obtaining an endometrial biopsy is the expansion of the cervix and curettage of the mucosa.

The uterine cervix is moved apart by means of specialized instruments, then the cervical canal is scraped, and then the uterus itself. Curettage is carried out with a curette, so the procedure is often called curettage.

The procedure is performed using local or general anesthesia. This can happen in a doctor's office or in a hospital.

Aspiration

Vacuum aspiration biopsy is a minimally invasive surgical micro-operation, a virtually painless procedure performed on an outpatient basis.

The essence of the procedure is the introduction into the uterine body of a special syringe or a long tip attached to an electric suction device.

Paypel

The most modern and preferred today is a biopsy performed by the Paypel method. This biopsy procedure among women is known to be painless and safe.

A thin plastic tube is inserted into the uterine cavity, through which endometrial particles are sucked.

The difference between the Paypel biopsy and the aspiration method is that when using the first method, the biomaterial is obtained through a thin tube, and during aspiration larger diameter tips or special syringes are used.

Pipel biopsy is usually performed before menstruation, although the final date of the study depends on the purpose of the diagnosis.

Diagnostic hysteroscopy with endometrial biopsy

The procedure of hysteroscopy with obtaining biomaterial helps to accurately identify the presence of uterine pathology such as myoma formations, hyperplastic changes, endometrial cancer, adenomyosis and polyposis, cancer of the uterine body, etc.

Even if the above pathologies have already been identified, diagnostic hysteroscopy with biopsy may be necessary to determine the degree of malignancy, the stage of the pathological process, etc.

The procedure is performed using intravenous anesthesia. A biopsy specimen is taken using a hysteroscope, after which it also undergoes microscopic examination.

Preparation

The procedure does not require special preparation. The main thing is to exclude sexual contacts, the use of hygienic tampons and vaginal suppositories a couple of days before taking a biopsy.

Before the biopsy, the woman needs to go to the toilet. The time of the procedure depends on the goal pursued by the doctor.

If a biopsy is performed to identify the causes of infertility, which is often associated with an anovulatory cycle or a lack of a corpus luteum, then premenstrual days are the ideal time for the procedure.
With menorrhagic disorders, when there are suspicions of a belated rejection of mucous tissues, the 5th day of menstruation is considered the most optimal.
In case of amenorrhea (and the patient is not pregnant), additional streaking scrapings are necessary.
To determine the response to hormone therapy, a biopsy is prescribed on days 17-24 of the cycle.
In the presence of dysfunctional acyclic bleeding, endometrial biopsy is performed before bleeding begins.
When diagnosing formations, there are no temporary requirements for a biopsy.

If the procedure is carried out in the traditional way, then the patient is shown the introduction of intravenous anesthesia, therefore, 8 hours before the biopsy is taken, it is forbidden to eat, drink, take medicine.

How is the procedure carried out?

The endometrial biopsy process takes several minutes.

First, the patient undresses, as in a traditional gynecological examination.
The gynecologist then inserts a special instrument to expand the vagina.
The uterine cervix is treated with special means, after which it is treated with a local anesthetic.
Then, with a special tool, depending on the method of the procedure, a sample of uterine tissue is taken.

The whole process takes 10-15 minutes, no more.

After that, the patient can be free. In order to avoid the likely consequences of an endometrial biopsy, the patient must follow all medical recommendations, otherwise bleeding may open or an inflammatory process will begin.

What can not be done after the procedure?

To avoid all sorts of complications such as heavy bleeding or purulent-inflammatory processes, some recommendations will help - within a two-week period after taking the biomaterial, it is strictly forbidden:

Live sexually;
Lift and drag heavy things;
Take lying baths;
Douching;
Visit a bath or sauna;
Use sanitary tampons.

By adhering to these rules, you can not worry about the consequences of the procedure.

Consequences

After an endometrial biopsy, patients often complain of symptoms such as:

Drawing soreness in the lower abdomen;
Small spotting bleeding;
Vaginal discharge;
Signs of general weakness;
slight dizziness;
Nausea;
The temperature may rise slightly, fever may begin;
If the procedure for obtaining a biopsy was carried out with some violations, inaccurately or unprofessionally, or the patient did not comply with the regimen after the biopsy, then there is a high risk of severe bleeding.

Such manifestations are not dangerous and soon disappear on their own. The procedure itself is associated in women with painful discomfort and cramps, as during menstruation.

If more than 2 weeks have passed after the procedure, and the bleeding has not stopped, then you need to contact a gynecologist.

Since the biopsy involves damage to endometrial tissue, the first menstruation after the procedure may look a little different. In addition, there is a high probability that the timing of the onset of menstruation will slightly shift.

results

The duration of the procedure is only a few minutes, after which the resulting biopsy is sent to the laboratory for further research.

Typically, laboratory diagnostics is carried out no longer than a week, and the results are issued within 10 days.

There is no need to even try to decipher the results, since only a qualified specialist can competently understand this. And in the absence of appropriate education, you can make an erroneous opinion about the picture of the disease.

The endometrium is the mucous membrane of the mucous layer of the uterus, which changes cyclically under the stimulation of female reproductive hormones. The endometrium is extracted using special techniques, each of which involves penetration into the uterus using surgical instruments. Currently, endometrial biopsy is performed harmlessly and has low morbidity.

Biopsy techniques:

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

Aspiration biopsy Surgery with a hysteroscope

Classic mucosal scraping

This type of procedure involves taking a biological sample using a surgical instrument. The specialist collects the top layer from the surface of the uterine cavity. The gynecologist can collect the material completely or make several scrapers - trains. The purpose of the event is diagnostic examination of the uterus and therapeutic procedures.

Scraping is done in these situations:

violation of the menstrual cycle;
pathological changes in the endometrium;
neoplasms;
hyperplasia;
polyps;
cysts;
abundant or poor menstrual flow;
the presence of intermenstrual discharge;
diagnosis of cervical tumors;
spontaneous abortion;
no fetal movements.

If the procedure is carried out on time, the doctor will be able to determine the exact causes of the disease. In this case, competent treatment can slow down the disease and heal the reproductive organ.

Aspirate biopsy with vacuum or aspirator

Aspiration biopsy is a more gentle method compared to curettage. It is not so traumatic, because it does not involve a strong expansion of the uterine canal. The risk of complications is greatly reduced. The event is carried out using a thin Brown syringe or a vacuum apparatus.

For women who have never had a child, the procedure may cause some discomfort. To reduce it, the doctor may suggest general anesthesia.

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

Paypel endometrial biopsy

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

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

CUG biopsy

The operation is performed to push apart the cervical uterine canal with a special device. The surgeon scrapes the walls of the mucous membrane, slowly advancing to the internal os of the uterus.

CUG biopsy is considered a safe and low-traumatic technique, and is prescribed during one menstrual cycle.

At this time, the surgeon collects biological segments in the form of strokes from several parts of the organ.

Targeted biopsy for hysteroscopy

The essence of the technique lies in the fact that fragments of the mucosal layer are obtained during endoscopic examination using a hysteroscope. This probe is equipped with a special video camera and an instrument for surgical interventions. The size of the device does not exceed 4 mm in diameter.

Advantages and disadvantages of the research method

Procedure	Advantages	Flaws
Scraping	the ability to diagnose cancerous tumors of the endometrium; making curettage, the doctor can immediately eliminate the foci of pathological lesions.	the procedure takes place in stationary conditions; the introduction of anesthesia; traumatic injuries; the wound healing period lasts at least a month; there is a risk of complications.
Aspiration biopsy	fast recovery; minimal inconvenience; low risk of complications; saving time and money; Patient reviews are only positive.	the disadvantage of the procedure can be considered a smaller volume of aspirate; difficult to study the structure of the endometrium.
Paypel biopsy	can be done without anesthetic; harmless and painless biopsy method; rapid healing of the Fallopian tubes; rarely causes complications.	it is difficult to study the constitution of the mucous membrane; it is possible to miss the foci of malignant diseases.
CUG biopsy	the most harmless manipulation; prescribed for the diagnosis of hormonal disorders.	not performed in the diagnosis of cancer and precancerous conditions.
targeted biopsy	during the event, benign formations can be removed; fast recovery; high performance accuracy.	anesthesia is needed; high cost of the operation.

Indications

An endometrial biopsy is prescribed in the following cases:

causeless bleeding;
hemorrhage after menopause;
severe and prolonged bleeding during the cycle;
hemorrhage after childbirth or abortion;
bleeding after taking hormonal contraceptives;
causeless absence of menstruation;
diagnosis of infertility;
surgical removal of neoplasms of a different nature;
uterine fibroids;
hyperplasia;
ovarian cyst;
ocytology of the cervix;
in vitro fertilization (IVF).

Contraindications

Conducting any type of biopsy has its contraindications:

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

Dates

Features of the biopsy:

with fears of cancer - any day of the menstrual cycle;
if you suspect polyps or similar neoplasms - immediately after the end of the cycle;
to establish the cause of non-cyclic bleeding - on the first menstrual day;
with heavy monthly bleeding - a week after the end of menstruation;
to diagnose the sensitivity of the endometrium to hormones - no earlier than two weeks later;
with infertility - three days before the expected menstruation.

How to prepare for a uterine endometrial biopsy?

When preparing for an inspection, it is important to adhere to some rules:

three days before the operation, refuse douching, sexual intercourse, vaginal preparations;
on the eve of the procedure, do an intestinal lavage;
to exclude complications after a surgical operation, it is necessary to do a number of special blood and urine tests in advance;
in the morning before the procedure, the patient should take a shower and remove hair from the genitals;
if the operation will be performed under anesthesia, then twelve hours before it is necessary to refuse food.

How is the procedure carried out

The main stages of the operation:

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

Consequences and complications

Consequences after surgery can be:

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

Deciphering the results

Diagnostics shows:

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

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

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

How much does an endometrial biopsy cost?

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

Video

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

Paypel endometrial biopsy- this is a procedure in which a doctor, using an instrument of the same name (a pipel is something like a very thin plastic syringe with a diameter of 3 mm without a needle), takes endometrial cells (the inner mucous layer of the uterus) from the patient for analysis. Histological, more precisely, cytological analysis of a sample of the obtained tissue can show cancerous and precancerous changes in uterine cells, a chronic inflammatory process (endometrium), and reveal dyshormonal changes.

The material is taken in the gynecologist's office without the use of anesthesia. As a rule, this takes about 10 minutes.

The effectiveness of this method of taking cellular material from the uterus is quite high. However, it is significantly lower than with curettage (curettage) of the uterus, when the entire endometrium is taken for analysis. Nevertheless, the pipel method allows diagnosing endometrial cancer and hormonal disorders at an early stage. It is recommended for young and nulliparous women in non-difficult situations when there is no oncological alertness, for example, before removal of uterine fibroids. During the procedure, the doctor does not expand the cervix with the help of medical instruments, which means that it does not injure it. This is a big plus.

If we compare the pipel biopsy and hysteroscopy, then each method has its own advantages. With a conventional hysteroscopy, the doctor can visually examine the uterine cavity and remove tumors in it. Take material from a specific area for analysis. Paypel - the procedure is simpler, faster and does not require general anesthesia, but is carried out "blindly".

At the same time, there is a method of office (mini) hysteroscopy, which is performed without cervical dilation and without anesthesia, but the doctor sees everything and can take tissue for histology. This study is deeper and more effective.

Indications and contraindications for endometrial aspiration

Analysis of endometrial cells is performed to diagnose uterine abnormalities and rule out various diseases.

Your doctor may take a biopsy to:

find the cause of postmenopausal bleeding or abnormal uterine bleeding;
identify or rule out endometrial cancer;
assess fertility (ability to conceive a child);
test the response of the endometrium to hormone therapy.

Do not take aspirate from the uterus under the following conditions:

pregnancy;
inflammation of the pelvic organs;
cervical or vaginal infection;
cervical cancer;
cervical stenosis (strong narrowing of the cervix).

What painkillers to take before the procedure

Whether or not it hurts to take a pipel biopsy depends on the woman's pain threshold, the doctor's skill, and the presence or absence of pain relief. Since the procedure is performed on an outpatient basis, in any antenatal clinic, it is not advisable to do intravenous anesthesia.

It is recommended to take a non-steroidal anti-inflammatory drug 30-60 minutes before the procedure, for example, "Ibuprofen". It will provide an analgesic effect. Some women take before "No-shpu", since it is a good antispasmodic, the uterus will not contract too much and painfully and will open more easily for the introduction of the pipel.

In addition, the physician may use lidocaine spray, sprinkle them with the cervix, this will also somewhat reduce pain.

Sometimes there is a need to take a mild sedative. It can cause drowsiness, so you should not drive until the effect has completely worn off. Ask a friend or family member to drive you home after your procedure.

The most severe pain is felt at the time of taking the material for research. The uterus reacts to the actions of the doctor with a spasm. The pain is similar to that which happens shortly before the critical days. Some women feel dizzy and have stomach pain. This is called a vasovagal reaction.

How to prepare for an endometrial biopsy and what day it is performed

Biopsy of the endometrium during pregnancy can lead to miscarriage. Tell your doctor if you are, or likely to be, pregnant. Your gynecologist will ask you to take a pregnancy test before the biopsy to make sure you don't have one.

Sometimes it is necessary to keep a record of menstrual cycles before the biopsy so that the doctor schedules the procedure for the most suitable day.

If this is a woman of reproductive age, then most often prescribe an intrauterine biopsy on the 25-26th day of the cycle, that is, 2-3 days before the critical days.

In case of infertility, when luteal phase anomalies are considered the culprit, the procedure is recommended for the second half of the cycle. With this pathology, a woman ovulates, but by the time the fertilized egg enters the uterus, the endometrium is too thin and cannot “accept” it. This feature is successfully detected by histological analysis.

After the onset of menopause, the analysis is taken on any day.

24 hours before the diagnosis, you can not:

use hygienic tampons;
insert vaginal suppositories and tablets;
douche;
have sex.

Before starting the manipulation, you will be asked to sign a consent form stating that you understand the risks and agree to this.

Talk to your doctor about the need for a biopsy, the risks involved, what results may be obtained, and how useful they are for you.

How it all goes

You will be asked to lie down on a gynecological chair. The doctor will perform a manual examination of the uterus. Then he will insert a mirror into the vagina to straighten its walls and open access to the cervix. It will be fixed in a comfortable position with the help of a clamp. Everything will be treated with an antiseptic. After fixing the neck, you will feel discomfort, pressure on the rectum is normal.

Your doctor will insert a thin, flexible tube into your cervical canal. It will go a few millimeters into the uterus. It will then pull the piston towards itself to create a suction effect. The entire procedure usually takes about 10 minutes.

The tissue sample will be placed in a liquid and sent to a laboratory for analysis. Results will be ready in approximately 7-10 days.

After the procedure, you will have bloody discharge from your vagina. Don't forget to bring a sanitary napkin with you. Blood may appear within a few days, until the very beginning of menstruation, if the biopsy was taken shortly before its expected start.

Within a few hours, pulling sensations in the uterus, spasms are considered normal. Painkillers are allowed.

Consequences and complications of the procedure

Sometimes a woman does not wait for the result of a histological examination, because too few endometrial cells were transferred for analysis. This happens with a thin endometrium or a violation of the material sampling technique. In this case, you will have to agree to curettage of the uterine cavity.

Rarely, but there is an inflammatory process provoked by taking an aspirate. It can be avoided if you take a healthy test and before that get a good result of a gynecological smear on the flora. A very rare complication is perforation of the uterus with an instrument.

Signs of trouble are:

increase in body temperature;
increased bleeding;
severe pain in the abdomen;
discharge from the vagina with a putrid odor.

Taking a biopsy does not affect the duration of the menstrual cycle. Does not lead to delays in menstruation and infertility. It will be possible to get pregnant almost immediately after the procedure, unless the attending physician has a different opinion on this matter.

On the day of the aspiration biopsy, you should not expose yourself to heavy physical exertion, play sports, or lift weights. Until the complete disappearance of bloody and spotting discharge, you should avoid taking a bath. At the same time, you should stop having sex.

Endometrial aspiration biopsy results - transcript

We give here some of the terms that doctors write in their conclusion.

Normal endometrium in the proliferation phase- corresponds to the first phase of the menstrual cycle.

Normal endometrium in the secretion phase- corresponds to the second half of the cycle.

Endometrial atrophy- thin endometrium due to age-related changes (decrease in the production of sex hormones) or injury to the germ layer as a result of rough.

Hyperplasia without atypia- excessive growth of the uterine mucosa (normally, its maximum thickness in women of reproductive age on the 19-23rd day of the cycle is 21 mm), there is no risk of oncology at this time.

endometritis- acute or chronic inflammation of the uterine cavity, one of the causes of infertility.

Hyperplasia with atypia- not cancer yet, but there is a bad trend, treatment and further observation are required.

Adenocarcinoma- malignant tumor, cancer.

Real reviews

Content

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

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

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

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

Methods

There are several options for biopsy today.

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

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

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

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

In what cases is the procedure indicated

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

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

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

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

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

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

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

Contraindications

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

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

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

results

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

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

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

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

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

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

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

Endometrial aspiration biopsy - what is it?

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

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

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

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

Indications

A biopsy is performed in patients in the following cases:

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

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

Preparation for the procedure and contraindications

Aspiration biopsy is not performed in the following cases:

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

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

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

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

Methodology

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

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

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

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