Pipel biopsy Endometrial - as and why take aspirate from the uterus. Pipel biopsy Endometrium - What is it? Diagnostic procedure in gynecology Aspiration Endometrial

Date: 21.10.2019

Endometrial biopsy is one of the most important diagnostic methods in gynecology. This procedure is necessary for further microscopic studies of the resulting fabric samples, which allows you to determine the existing morphological changes in the mucous membrane of the uterus.

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

Endometrial biopsy: What is it?

Endometrial biopsy is a lifetime taking sample of the uterine mucosa tissue (endometrial) for subsequent histological and histochemical analysis. This procedure relates to small surgical interventions in gynecology and is most often carried out as an independent study. But in some cases it is included in the "Big" operation protocol and is implemented in an emergency order intraoperative.

Biopsy most often pursues exclusively diagnostic tasks. But in some cases, it is therapeutic and diagnostic manipulation that allows you to get the necessary doctor information and at the same time improving the state of the woman. From the method of preparation, the volume of intervention, and that will be painful or not the woman or not.

Types of research

For the first time, the documented sample of the sample of the uterine mucous membrane on the analysis was produced in 1937 by Batlette and Rock. At the same time, special tools were used, allowing to expand the cervix and squeeze the (mechanically separating) the entire endometrium.

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

Currently, in clinical practice, several species of taking mucosa for the study are used:

the classic version of the study is therapeutic and diagnostic scraping of the uterine cavity;
vacuum-aspiration biopsy Endometrial, carried out using a special syringe or device (vacuum aspirator or electric cover);
pipel biopsy Endometrial is a more modern option for aspiration of the mucous membrane and the contents of the uterine cavity, while a small-acting tool is used in the form of a flexible suction tube (Pipel);
Tsug biopsy Endometrium, during which the fabric fence is made in the form of bargain scrapings (CGS).

Not such a common way to obtain an endometrial sample is to take it in the process (endoscopic study of the uterine cavity). This biopsy is aiming. The doctor has the ability to take a small amount of biomaterial at once from several suspicious sites and at the same time evaluate the severity, localization and nature of the changes.

Nevertheless, despite high informativeness, hysteroscopy is not included in the list of frequently used diagnostic manipulations. Not all medical facilities have the opportunity to conduct such a modern high-tech research.

A very rarely applied method for obtaining an endometrial sample is inkjet douching.

What shows biopsy Endometrial

Biopsy (Taking Material) is only the first stage of the study, the basis of the method is microscopy and histological analysis of the obtained samples of endometrial. What does such a diagnosis reveal?

The study may not show any deviations from the age norm. In this case, the conclusion will indicate that the mucous membrane of the uterus corresponds to the cycle phase and does not have signs of atypics. But most often the study allows you to identify various deviations. It can be:

easy diffuse endometrial hyperplasia (the growth of the mucous membrane), also called ferrous or iron-cystic-cystic;
complex endometrial hyperplasia (with the formation of the similarity of the gland inside the hypertrophied mucous membrane), this state can also be described as adenomatosis;
local endometrial hyperplasia (with or without atyphea), which is regarded as unit or polyposis;
atypical hyperplasia (simple or complex), in which the cells of the resulting mucous membrane do not correspond to its morphofunctional characteristics of the normal cells of the endometrium;
malignant rebirth of fabrics;
atrophy or hypoplasia of the mucous membrane of the uterus;
- inflammation of endometrial;
mind of the thickness of the functional layer of the endometrium of the current phase of the ovarian-menstrual cycle.

Identification of atypics has an important prognostic value. Some forms of atypical hyperplasia refer to the prejudice.

The main diagnostic features are cellular and nuclear polymorphism, the proliferation disorder, the change in the structure of the endometrium glands and the invasion of iron fabric in stroma. The key point for determining the prejudice and cancer is a disturbance of tissue differentiation.

Indications, contraindications and timing

Endometrial biopsy in the presence of indications can carry out women of any age, including those who did not give birth and left the reproductive age.

The basis for the purpose of this study can be:

menometrorrhigue, acyclic meometric bleeding, unclear genesis, scarce periods;
suspicions on and presence of neoplasms.

Endometrial biopsy is carried out before ECO and when identifying the cause of infertility. At the same time, histological examination of the uterus mucous membrane is included in the program of comprehensive diagnostics of the woman's reproductive health.

The study is also carried out after spontaneous abortions in the early periods and interrupting pregnancy under medical testimony (when measuring pregnancy, the intrauterine death of the fetus, identifying the child incompatible malformations from the child). In such cases, biopsy samples are taken by scraping the uterus.

When are biopsy?

Endometrium is a hormonally-dependent cloth. And the information content of its histological research is largely depends on the day of the cycle at the time of the biopsy. At the same time, the clinical situation and the main tasks of biopsy takes into account. And in postmenopausal patients take into account the presence and time of its start.

What kind of cycle day is the best biopsy in women of reproductive age? Currently adhere to the following basic recommendations:

when identifying the cause of infertility, in case of lack of lutein phase and anoint cycles, the study is carried out a day before the intended menstruation or in the first day after its start;
with a tendency to polymeter, the study is prescribed between 5 and 10 days of the cycle;
with acyclic bleeding uterine discharges, the biopsy is carried out in the first 2 days after the start of menstruation or menstrual-like bleeding;
in the presence of hormonal imbalance, the preference is given to the Tsug-biopsy, which is carried out several times during one cycle with an interval of 7-8 days;
to monitor the results of hormone therapy conducted, biopsy is performed in 2 phases of the cycle, between 17 and 25 days;
in suspected of the presence of a malignant tumor and the absence of pronounced bleeding, the study can be carried out on any day of the cycle.

What can limit the use of this method?

Some states are relative or absolute contraindications for biopsy, if available, a decision on the possibility of conducting a study and his form takes a doctor or even the medical commission individually.

Possible restrictions include:

pregnancy - with the slightest probability of conception during the last 2 menstrual cycles, it is necessary to make sure in the absence of pregnancy, because the endometrial biopsy provokes the rejection of the fetal egg;
blood coagulation disorders;
constant reception of drugs with disaggregation and anticoagulant action (NSAIDs, Dipyridamol, Trental, Warfarin, Kleksan and others);
severe degree of anemia;
active phase of infectious inflammatory diseases of the urogenital system;
the intolerance of the used drugs for anesthesia.

Biopsy is not a vital study, if it is impossible to carry out a doctor, the doctor is another patient survey program. There is also the possibility of choosing more gentle methods for the fence of endometrial samples. But the scraping in some cases performs therapeutic function and therefore can be used even in the presence of relative contraindications.

Methods of research

Biopsy by scraping the uterus

This method is the most radical and historically very early method of obtaining a biopsy. Such a biopsy includes 2 main stages: expanding the cervical canal and scraping the walls of the uterus. At the same time, a set of special buzzles (different size extends), nippers for the removal and fixation of the cervix and the uterine curette is a surgical spoon with a sharp edge.

Diagnostic scraping of the uterus of the uterus is a painful procedure and requires the mandatory use of anesthesia. Preference is given to short-term general anesthesia, and inhalation or intravenous anesthesia can be used. Therefore, this method requires compliance with the same preparation rules as any "big" operation. To prevent the gastric content and its aspiration in the respiratory tract, it is recommended to abandon water and food for at least 8 hours before the procedure.

Modern probe for biopsy Endometrial

During the scraping, the doctor tries to pass the curette along the entire surface of the walls of the uterus, including the angles near the mouth of the uterine pipes. As a result, almost all endometrium is mechanically removed to form an extensive wound surface.

This scraping often allows for the diagnostic stage to remove the polyps, stop the uterine bleeding and clean the uterine cavity from the pathological content of it. And the remaining open cervix does not interfere with the natural outflow of blood, although it can serve as a gate for infection.

Important advantages of diagnostic scraping is the possibility of its use in suspected oncological diseases, in metrophics and after chopped pregnancy.

Aspiration biopsy Endometrium

Aspiration biopsy is a more sparing method of a bioptate. The separation of the functional layer of endometrial is performed under the action of a vacuum-generated in the cavity. To do this, a brown uterine syringe or a vacuum aspirator with an attached catheter can be used. Sometimes the irrigation of the uterine cavity is pre-carried out for the subsequent production of washes.

The cervical channel's bunning is not required, which significantly reduces the injury and pain of the study. Nevertheless, the aspiration method is also sometimes held under shallow general anesthesia. This makes it possible to avoid expressed discomfort especially in boring women.

Preparations for the aspiration biopsy Endometrial includes sexual rest, refusal of sinking and any vaginal tampons within 3 days before the procedure. The doctor also appoints a preliminary examination to exclude STDs and acute inflammatory urogenital pathology. In addition, it is desirable to exclude from the menu any gas-forming products and make the day before the cleansing enema.

Aspiration biopsy is considered a technically simple procedure that does not deliver obvious pain. It is often used as a screening research when gaining dubious results of ultrasound uterus.

Nevertheless, it is worth remembering that aspiration does not allow to obtain enough material for a reliable exclusion of malignant endometrial neoplasms. Therefore, if suspected the presence of malignant tumors, more informative diagnostic scraping is carried out.

Effective Technique Pipel Biopsy Endometrium

Pipel biopsy is an improved modern version of the endometrium aspiration. In this case, the main adaptation for the fence part of the mucous membrane is the PiPel tip - a flexible thin disposable tube with a piston. Small diameter (about 3 mm) and sufficient elasticity of this device allow you to enter it through a cervical channel without using any extends.

According to the principle of operation, Piypel's tool resembles a syringe. After the introduction of its working tip into the uterine cavity, the doctor sips the piston until the middle of the tube length, which creates a sufficient negative pressure to aspiration a small amount of endometrial. It does not form extensive wound surfaces, the neck of the uterus is not injured, the patient does not experience pronounced physical discomfort.

Preparations for Piypel biopsy is no different from that in front of the classic vacuum aspiration of the endometrium. The procedure is carried out in outpatient conditions and usually does not require anneasiating.

Features of the CUG-biopsy

TSU Biopsy is considered a small-acting embodiment of the endometrium sample. It does not provoke massive bleeding and rejection of the mucous membrane and is usually carried out up to 3 times during one menstrual cycle. The main task of such a study is to determine the endometrium reaction on natural or artificially created changes in the hormonal background. It is not used to diagnose cancer and precancerous states.

For curing biopsy use a special small curette. It is neatly injected into the uterus, without expanding the pre-cervical canal. Applying a slight force, the doctor scraps the working surface of the cureti narrow strip of the mucous membrane. It resembles strokes, so such a diagnostic method is called "Bar Biopsy Endometrial".

It is very important to investigate not a single portion of the uterus, so the touches (TsUGO) are carried out from the bottom to the inner zea of \u200b\u200bthe cervix. For reliable diagnostics, it is enough to get 2 samples at once.

What to expect and what to do after the study?

Any biopsy of endometrial is accompanied by a violation of the integrity of the mucous membrane of the uterus and the appearance of bleeding. Their volume and duration depend on the method applied by the doctor.

Diagnostic scraping leads to abundant menstrual-like and sufficiently painful disclaimers. But their duration is usually much less than during normal menstruation, because the main part of the endometrium has already been removed during the procedure. Options after biopsy endometrial should not be with clots, admixture of pus or an unpleasant odor. The emergence of any of these signs or fever is the basis for urgent appeal to the doctor.

Monthly after the biopsy of the endometrium by the other methods described above may begin on time or with a small delay. Their volume and duration often differ from the usual. Most often there is a delay of monthly after Pipel biopsy endometrial for up to 10 days. In this case, you need to make a pregnancy test and consult with your doctor.

Pregnancy after research is possible in the next cycle. During this period there will be a complete update of the functional layer of the uterine mucous membrane. In addition, biopsy does not affect the functioning of the ovaries. And with the remaining methods of the remaining area, the endometrium can be enough to implant the fetal egg already in the current ovulatory cycle.

How much time is the results are preparing?

Deciphering results after biopsy Endometrial can take up to 2 weeks. Histological research of bioptats conducts a pathologist or histologist. If necessary, an immunohistochemical analysis is also carried out.

The term of obtaining results depends on the specific laboratory, the volume of the load of the histologist and urgency of the study. If you need an emergency analysis, the doctor makes a note about this in the direction. Histological examination of samples taken during surgery is sometimes carried out for 20 minutes, the result obtained may affect the volume of surgical intervention.

What do after biopsy?

Further diagnostic and therapeutic tactics depends on the results of biopsy. When identifying atypics and the prejudice, the question of the need and appropriateness of surgical treatment is solved. When identifying signs of inflammation, its nature is determined and anti-inflammatory and antibacterial drugs are prescribed.

If the endometrial biopsy showed signs of hyperplasia or an insufficient tissue reaction to cyclic hormonal changes, a further diagnostic search is made. This is necessary to determine the existing endocrine disorders and secondary changes in other hormone-dependent tissues (first and foremost in the mammary glands).

Possible complications and consequences

A number of women after the biopsy complain to the temporary change in the duration of the menstrual cycle, the pain of coming monthly and discomfort during sexual intercourse.

The most dangerous complication of biopsy is endometritis. It is characterized by severe increasing intoxication, pain in the abdomen and the appearance of silent uterine discharge with signs of suppuration. Fortunately, such a complication is rare. Its development is usually associated with the supercooling, non-compliance with the recommendations of the doctor relative to the hygiene of the genital organs and sexual rest.

But sometimes the cause of the endometritis is the aggravation of the existing one. Therefore, women with chronic urogenital diseases after biopsy Endometrium need to drink antibiotics on the recommendation of the doctor. The same tactics adhere to the patient suffered an abortion.

When biopsy is to be held, what method will be chosen and how to prepare for the procedure, it is necessary to clarify the attending physician. Failure to comply with the recommendations may adversely affect the reliability of the study and increase the risk of developing complications.

Do not refuse biopsy, because no other diagnostic methods can replace histological analysis. Only this examination allows you to diagnose endometrial cancer in the early stages, which significantly improves the remote results of treatment.

The formation of the mucous membrane of the uterus affects the ratio of hormones produced by ovaries. The impaired structure of the endometrium, the deviation of its thickness from the norm causes serious problems in the state of reproductive health of the woman. In order to establish the cause of menstrual disorders, infertility, the emergence of neoplasms in the uterus, it is necessary to carefully examine the condition of its cavity, to identify possible pathologies for the development of epithelial cells. An efficient method that allows the study of endometrial is biopsy.

Content:

What is a procedure

The procedure allows you to extract endometrial particles for subsequent research by the histological method. In this way, it is established which structure the cells of the uterine cavity mucosa have, whether it does not have atypical changes. According to the results of the study, there are conclusions about the nature of pathological processes in endometrial, the cause of infertility or menstrual disorders.

There are several ways to extract particles of endometrial. These include complete scraping of the uterus, Zug biopsy (partial scraping), aspiration of the mucous membrane using a special syringe (aspiration biopsy), targeted extraction of material with hysteroscopy. The disadvantage of these methods is the need to expand the cervix and the introduction of tools into the cavity, which makes the procedure for the fence of particles of endometrial painful and traumatic.

Advantages of Pipel biopsy

When using Pipel biopsy Endometrial, much simpler and safe manipulations are made. The so-called "Pipel Tool" is used, which is a soft elastic narrow tube with a special tip. Inside the tube there is a piston. The tube is introduced into the uterus cavity. It does not require an extension of the neck with a special device. By pulling out the piston, the tube is approximately filled with the selected content, which is then investigated under the microscope.

One-time introduction of the tool allows you to select endometrium from extensive sections of the uterine. The duration of the procedure is 0.5-1 minutes. It is almost painless. It is carried out in an outpatient basis, after which a woman can do its usual affairs. Due to the lack of risk of damage to the tissues and blood vessels, this method of sampling can be used in diabetes mellitus and even (with caution) with reduced blood coagulation.

To select the endometrial particles, a disposable tool is used, eliminating the possibility of infection during the procedure.

Video: How the endometrial biopsy is held. Advantages of the procedure

In what cases is Pipel biopsy appointed

The diagnosis of the Endometrial Pipel biopsy method is assigned in the following cases:

a woman has long and painful menstrual bleeding;
there are abundant uterine bleeding between the monthly for an unknown reason;
hazardous bleeding appeared after hormonal therapy or long-term use of contraceptives;
there are discharges with blood during menopause;
Uzi showed the presence in the uterus of the tumor or polyps endometrial, while the patient detected an excessive content of estrogen in the blood;
the woman has infertility, pregnancy has been repeatedly interrupted in the early stages;
blood test to oncomarcresses when neoplasses are found in the uterus shows the presence of cancer cells;
woman preparing for eco.

Contraindications

Before holding the Pipel biopsy, the endometrium doctor must be confident in the absence of pregnancy in a patient. The material selection procedure is not carried out in the presence of inflammatory processes and various types of infection (fungi, causative agents of venereal diseases), as well as vaginal dysbiosis. The procedure is canceled if an purulent inflammatory process occurs in the uterus (endometrite) or there are inflammatory diseases of other organs of a small pelvis, of which the infection can get into the genitals.

Contraindication to the use of this diagnostic method is the presence of blood diseases such as hemophilia and anemia (in which life-threatening bleeding can be opened), as well as cardiovascular pathologies capable of becoming the cause of thrombosis. Pipel biopsy is not conducted in the presence of congenital violations of the genital organs.

What days of the cycle, Pipel biopsy is held

The procedure can be appointed on different days of the cycle depending on which pathologies require diagnostics:

Before menstruation, if it is necessary to find out the reason for infertility due to the presence of hormonal disorders and the absence of ovulation.
At the end of the menstruation (about 7th day of the cycle), to identify the cause of too long menstruation, which may be incomplete rejection of the endometrium.
In the second phase of the cycle (for 17-25 days). Pipel biopsy Endometrium allows you to monitor the results of hormone therapy.
In the first phase of the cycle (in the absence of bleeding). The study is carried out to detect the cause of intermented bleeding.

To study the causes of amenorrhea and in suspected formation of malignant tumors in the uterine cavity, Pipel biopsy is carried out on any day.

Preparation for procedure

Before conducting the procedure, it is necessary to pass the blood for analyzing the hemoglobin content and the definition of coagulation, estrogen level, progesterone, pituitary hormones.

Analysis of the vaginal smear and cervical makes it possible to detect the presence of fungus and other types of infection. A general analysis of urine allows you to determine the level of leukocytes and detect inflammatory diseases of the urinary organs.

The blood test is carried out on syphilis, HIV, hepatitis viruses. In suspected cancer, blood test is being taken to oncomarkers.

1 month before the procedure, a woman needs to stop the reception of hormonal drugs, for 3 days - from the use of anticoagulants. Screening, tampons, the use of vaginal drugs, and to refrain from sexual intercourse, should be abandoned.

Within 12 hours, it is impossible to eat, and immediately before going to the doctor, it is necessary to make a cleansing enema before going to the doctor.

After Pipel biopsy

The impact on the endometrium in Pipel biopsy is associated with damage to small blood vessels, so for several days a woman can appear minor bleeding. Normally should not arise any pain.

After such a procedure, menstruation, as a rule, occur with a delay of up to 10 days. Since damage during manipulations is very insignificant, the endometrium state is rapidly restored.

A warning: The delay may be associated with the onset of pregnancy, since the egg cell is fertilized after the nearest ovulation is attached even to the part of the endometrium, which remained after Pipel biopsy. A woman should take into account. If pregnancy is undesirable, it is necessary to consult a doctor about the use of a suitable means of barrier contraception.

Doctors recommend to refrain from sexual intercourse within a month after the endometrium study. In addition, physical fatigue, strong experiences should be avoided. A visit to the sauna, staying in a hot room, bathing in a hot tub lead to bleeding.

With the appearance of dubious symptoms, in no case cannot be engaged in self-medication, use folk remedies or drugs, except for those that prescribe a doctor.

When you should immediately consult a doctor

In rare cases, after conducting Pipely biopsy, a woman changes the nature of menstruation (for example, their volume and duration increases, they become painful). Grozny complication may be the emergence of the inflammatory process. As a rule, the reason is non-compliance with the recommendation of doctors on hygienic care for the sexual bodies in the recovery period, entering into sexual relations in the coming days after Pipel biopsy endometrial, hypothermia of the lower body.

To the doctor, it is necessary to apply for any symptoms of malaise, especially if purulent discharges or bleeding from the genitals arise, the body temperature rises, pains appear in the lower abdomen, the periods are disappeared.

Results of research

Depending on the purpose of the diagnosis and the intended nature of the disease, the study of the material taken to analyze the material and the decoding of the results can be carried out more than 0.5 hours, but the answer can be obtained in 2 weeks.

After receiving an accurate answer about the nature of the pathology, treatment with anti-inflammatory agents or antibiotics, hormonal drugs to regulate the growth of endometrial and cycle recovery is carried out. If it is necessary to carry out surgical operations, Piypel biopsy makes it possible to assess the necessary amount of intervention and possible consequences.

Endometrium is the mucous membrane of a mucous layer of the uterus, modifying cyclically under the excitation of female reproductive hormones. Endometrium is mined using special techniques, each of which implies penetration into the uterus using surgical instruments. Currently, the endometrial biopsy is carried out harmlessly and has low soreness.

Biopsy techniques:

diagnostic scraping (classical);
aspirate biopsy;
Tsug-biopsy;
aiming biopsy.

Aspiration biopsy Operation with hysteroscope

Classic scraping mucous

This type of procedure implies a fence of a biological sample using a surgical instrument. The specialist collects the top layer from the surface of the uterine cavity. Gynecologist can collect material fully or make several scrapers - Tsugov. The purpose of the event is the diagnostic study of the uterus and therapeutic procedures.

Scraping make in these situations:

impairment of the menstrual cycle;
pathological changes endometrial;
neoplasms;
hyperplasia;
polyps;
cysts;
abundant or poor menstrual discharge;
the presence of intermenstrument secretions;
diagnostics of cervical tumors;
spontaneous abortion;
no fetal movements.

If the procedure is carried out on time, the doctor will be able to establish the exact causes of the disease. In this case, competent treatment will be able to slow the disease and heal the native body.

Aspirate biopsy vacuum or aspirator

Aspiration biopsy is a more sparing method compared to scraping. It is not so traumatic because it does not imply a strong expansion of the uterine channel. The risk of complications is significantly reduced. The event is carried out with the help of a thin brown syringe or a vacuum apparatus.

Women who have never had a child, the procedure can cause some discomfort. To reduce it, the doctor may offer general anesthesia.

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

Pipel biopsy Endometrial

The fence of biological fragments is carried out using a hollow catheter with a diameter of 3 mm with a slot at the end. Thanks to him, pressure is formed in the adaptation and crypt fabrics and endometrial is absorbed into the cylinder. Pipel is considered the most painless method of taking a sample, which almost does not have flaws.

During the process, the doctor puts the Piypel tube in the uterus and pulls for the piston. Due to the conditions, the technique does not cause injury of the mucous membrane, does not provoke infection. It is recommended by young women who do not have children, with endometrial pathologies and infertility.

Tsug-biopsy

The operation is carried out to spread the cervical uterine channel with a special device. The surgeon scraps the walls of the mucous membrane, slowly moving to the inner state of the uterus.

Tsug-biopsy is considered a safe and small-acting technique, and is prescribed during one menstrual cycle.

At this time, from several sites of the body, the surgeon takes a fence of biological segments in the form of strokes.

Aiming biopsy with hysteroscopy

The essence of the technique is that the fragments of the mucous layer are obtained during an endoscopic study using a hysteroscope. This probe is equipped with a special camcorder and a tool for surgical interventions. The size of the device does not exceed 4 mm in diameter.

The advantages and disadvantages of the research method

Procedure	Dignity	disadvantages
Scraping	the ability to diagnose endometrial cancer tumors; by making scraping, the doctor can immediately eliminate the foci of pathological defeat.	the procedure takes place in stationary conditions; the introduction of anesthesia; traumatic damage; the period of wound healing lasts at least a month; there is a threat to the development of complications.
Aspiration biopsy	rapid restoration; minimum inconvenience; low risk of complications; saving time and money; patient reviews are only positive.	the disadvantage of the procedure can be considered a smaller amount of aspirate; it is difficult to explore the structure of the endometrium.
Pipel biopsy	can be carried out without an anesthetic; harmless and painless biopsy method; fast healing of phallopy pipes; rarely causes complications.	it is difficult to explore the constitution of the mucous membrane; there is an opportunity to skip the foci of malignant diseases.
Tsug-biopsy	the most harmless manipulation; assigned to diagnose hormonal violation.	it is not carried out when diagnosing cancer and precancerous state.
Aimicious biopsy	during the event, you can remove benign education; rapid restoration; high performance accuracy.	anesthesia is needed; high cost operation.

Indications

Endometrial biopsy is appointed in the following cases:

caught bleeding;
hemorrhogium after Klimaks;
strong and long-term bleeding during the cycle;
hemorrhage after childbirth or abortion;
bleeding after the adoption of hormonal contraceptives;
unbreakable lack of menstruation;
diagnosis of infertility;
surgical removal of neoplasms of various nature;
myoma uterus;
hyperplasia;
ovarian cyst;
cervical window cervical
extracorporal fertilization (ECO).

Contraindications

Conducting any type of biopsy has its own contraindications:

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

Dates of carrying

Features of the biopsy:

in case of concerns on oncological diseases - any day of the menstrual cycle;
with suspected polyps or similar neoplasms - immediately after the end of the cycle;
to establish the cause of non-cyclic bleeding - in the first menstrual day;
with abundant monthly bleeding - a week after the completion of menstruation;
to diagnose endometrial sensitivity to hormones - no earlier than in two weeks;
with infertility - three days before the alleged menstruation.

How to prepare for biopsy endometrial uterus?

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

three days before the operation, abandon the scriptures, sex contacts, vaginal preparations;
on the eve of the procedure to make the intestine;
to eliminate complications after the surgery, it is necessary to make a number of special blood and urine tests in advance;
in the morning before the procedure, the patient must take a shower and remove hair from the genitals;
if the operation is carried out under anesthesia, then in twelve hours to it it is necessary to abandon food.

How the procedure is carried out

The main stages of the operation:

Processing of external genital organs with a special antiseptic agent.
Expansion of the vagina by a specialized surgical mirror.
After accessing the cervix, alcohol is processed.
The organ is fixed using bullery tongs.
All further actions are carried out depending on the choice of biopsy techniques.

Consequences and complications

The consequences after the operation can be:

change of duration of menstruation;
bloody issues;
soreness of menstruation;
pronounced toxicosis;
thread and pain in the abdomen;
uterine discharge with a fit and unpleasant odor;
aggravation of vaginitis;
temperature increase;
fever;
loss of consciousness;
convulsions;
migraine.

Decoding results

Diagnostics shows:

adenomatosis of the uterus;
hyperplastic processes;
atrophy of a different character;
endometritis;
tumors;
mind of the phase of the menstrual cycle of the thickness of the walls of the mucous membrane.

In the final document, the doctor fills four parts:

Informativeness of the biological sample. It can be inadequate and adequate. In the first case, the diagnostics found an insufficient endometrial indicator (the sample fence is incorrect). In the second case, endometrial cells are sufficient to draw the following conclusions.
Macroscopic description of the drug. At this stage, the weight of fragments, their size and color. The doctor indicates which consistency of the samples, as well as the presence of blood clots and mucus.
Microscopic description of the drug. The doctor indicates the size and type of epithelium, as well as the number of layers. The presence of stroma, its density and homogeneity. Uterine glands: their form and description of the component of the epithelium. If there are lymphoid clusters, the doctor records the beginning of inflammatory processes.
Final diagnosis. Here, the specialist clarifies which phase of the cycle is commensurate with endometrium, the presence of its expansion. Indicates the characteristics of neoplasms (polyps). How thinned and the walls of the mucous membrane decreased. The presence of atypics and cancer cells. Degeneration of the epithelium and vessels of the village of Chorion.
Often, the specialist in the final diagnosis writes that the endometrium is normal in the proliferation phase (secretion, menstruation). This phrase says that the patient has no signs of abnormal formations.

How much does Endometrial biopsy cost?

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

Video

About how the endometrial biopsy makes is shown in the video from the Promatka channel. RU.

Women often have to turn to gynecologists. These doctors monitor the health of the reproductive bodies and are pregnant. Often the patient to establish an accurate diagnosis is required to be diagnosed. One of the research methods is the Endometrial Pipel biopsy. What it is, you can learn from the submitted article.

Diagnostic procedures in gynecology

(What it is - will be described below) is one of the methods of female health diagnostics. Also, gynecologists often prescribe an ultrasound study. It is carried out more quickly and does not require special training. However, ultrasound can not always provide accurate information.

The diagnostic procedures that a gynecologist may apply also include scraping of uterus, laparoscopy, hysteroscopy, metrosalpingography and so on. Conducting data of manipulations has its own testimony in each case. In recent years, Pipel Biopsy Endometrium is gaining great popularity among gynecologists and obstetricians. What it is? The article will tell further.

Pipel biopsy Endometrium - What is it?

This study is very important in the setting of the correct diagnosis. It is carried out within the hospital walls. Diagnostics should qualified specialist.

Endometrium received its name by the surname of the person who opened the tool for the fence of the material. This appliance is a short-lived tube with a diameter of 2 to 4 millimeters. At the end of the device there is a bevelined end. It subsequently placed in the cavity of the eleven body. On the other hand, the equipment has the so-called piston. When it is removed, the fence of the material from the uterus begins.

Indications for manipulation

The gynecologist or reproductist may assign this research in many indications. Often these are various hormonal pathologies. Such can be attributed, for example, endometriosis. The study is also carried out in a chronic inflammatory process in the cavity of the elementar body.

Manipulation is shown to women after 40 years and during menopause. If a representative of a weak floor suffers from uterine bleeding or abundant monthly, the study will help clarify the situation.

Diagnostics are always assigned before carrying out an extracorporeal fertilization. It helps to avoid difficulties during the eMbin transplant period. Pipel biopsy Endometrium is shown to women suffering from infertility.

Contraindications

In which cases is prohibited by Pipel biopsy Endometrial? Medikov reviews are suggested that in the following cases it is worth postponement of manipulation for an indefinite period:

pregnancy of any time or suspicion of it;
inflammatory or infectious processes flowing into the vagina;
blood coagulation disorders;
the presence of infections that were purchased during sexual contact, and so on.

It is worth saying that the diagnosis can lead to complications in case of neglect of those listed by contraindications. That is why a woman must visit the Ultrasound Cabinet, to hand over the blood test and smear from the vagina to the definition of sterility.

How is the material fence?

Endometrial biopsy, the price of which is in the range from 2 to 7 thousand rubles, should be carried out exclusively within the hospital walls. At the same time, a woman does not require some kind of defined preparation. It is worth carrying out the manipulation in the period from 7 to 12 day of the menstrual cycle. It was at this point that the data obtained will be most informative.

Before studying the patient, an anesthetic injection can be made in the cervical tissue. However, this is done only when a gynecologist uses Pipel with a diameter of 4 millimeters. Also, some clinics are offered to the patient to take a sedative agent and a preparation that overwhelms the contractile function of the muscles.

The material fence is performed on the procedure last on average 30 seconds. More time takes training. Before starting manipulation, you must define the depth of the uterus. This is done using a special device under the control of an ultrasonic sensor. After that, the corresponding papel size is selected, and the tool is entered into the cervix. Next, the doctor pulls the device for the piston, and at this time a negative pressure is created in the cavity of the eleven organ. Particles of endometrial and other tissues fall into a sterile tube, which is immediately removed from the body of a woman. It lasts about 7-10 days. After that, the patient can get a conclusion. Deciphering and further appointments should appeal to their gynecologist.

After biopsy Endometrial

What happens after the study? The doctor must provide the patient with the relevant recommendations. After the fear of the material, the woman can detect bleeding. They must pass within a few days. Also about two weeks it is worth limiting physical activity. Sexual contacts and hot baths are prohibited.

Complications from manipulation are very rare. Often the reason for their occurrence becomes non-compliance with the conditions and improper manipulation. A woman before the procedure should familiarize himself with possible problems. To those can be attributed:

damage to one of the walls of the uterus (requires emergency surgery);
bleeding (often caused by pathologically changed tissues);
inflammation (infection is entered from infected vagina) and so on.

If after Pipely biopsy you felt bad, then you should immediately contact the medical institution. The symptoms of developing pathology include an increase in temperature, pain in the lower part of the abdomen, highlighting an unusual nature, a long brown lady and so on.

Summarizing

You now became known, endometrial. It is worth noting that this manipulation has a lot of advantages before when conducting a biopsy does not extend the cervical canal. Because of this, a woman can well move manipulation without using anesthetics. If this study is prescribed, then you should comply with all the recommendations of the doctor. Health to you and good results!

Earlier, in some gynecological diseases for the collection of endometrial samples, only traumatic methods of biopsy of the muculence layer of the uterus were used, which implied its scraping (i.e., procedures similar to a classic surgical abortion). However, due to the appearance of aspiration biopsy (or Pipel biopsy), such a study has become more painless and safe.

This minimally invasive surgical method of the endometrial tissue fence is carried out using a special tube of plastic - PiPel. The thickness of this device is 3 mm, and the principle of its operation is similar to the syringe mechanism. Inside the tube there is a piston, and at one end there is a side opening for admission by means of an endometrial aspiration inside the PiPel tip.

In this article, we will introduce you to testimony, contraindications, the method of preparing the patient to the procedure, the advantages and methodology for performing an aspiration biopsy of the endometrium. This information will help to understand the essence of this diagnostic technique, and you can ask the questions that have encountered your doctor.

In contrast to the classical surgical methodology for the fence of the endometrial tissues, with an aspiration biopsy, the cervical canal is not required. The tip of the disposable tube is introduced into the uterine cavity without the use of additional devices. The doctor pulls the piston on itself, creating a negative pressure for the necessary aspiration of a small portion of the endometrium. At the same time, an extensive wound surfaces are not formed on the inner layer of the uterus, the cervix does not suffer from mechanical exposure, and the patient does not experience pronounced uncomfortable sensations.

Indications

Indications for this study are pathological processes localized in endometrials - inner layer of uterus.

Aspiration biopsy is appointed in cases where, after a gynecological examination and ultrasound, the doctor arises an assumption about the presence of pathological changes in the patient in the state of the inner layer of the uterus - endometrial. The resulting tissue samples allow to carry out histological analysis of the mucous membrane of the uterus and put the correct diagnosis.

Aspiration biopsy Endometrial is appointed in the following clinical cases:

endometrial hyperplasia;
disorders (acyclic scarce bleeding, menometromragia, poor monthly, obscure origin);
chronic endometritis;
suspicion of infertility;
abundant bleeding in women in the period;
suspections for the presence of a benign or malignant tumor (, endometrial cancer).

Pipela biopsy can be performed not only for the diagnosis of endometrial pathologies, but also to assess the effectiveness of the hormone therapy.

Contraindications

The implementation of aspiration biopsy Endometrial cannot be carried out in the following cases:

in acute phase;
pregnancy.

The following clinical cases include possible restrictions on Pipel biopsy include:

blood coagulation disorders;
severe forms;
permanent reception and (kleksan, warfarin, trental, etc.);
individual intolerance to the applied.

When identifying such states, the aspiration biopsy can be carried out after special training of the patient or is replaced with another study.

How to prepare for the procedure

The aspiration biopsy of the endometrium is although there is a minimally invasive procedure, but during its country, the tools are introduced into the uterus and occurs, albeit slightly, damage to the integrity of the inner layer of this body. That is why to eliminate possible complications of such a study, the patient needs to be properly prepared for the performance of the material fence.

To eliminate possible contraindications to the implementation of aspiration biopsy of the endometrium, it is necessary to carry out the following diagnostic studies:

gynecological examination;
mazzok on the microflora;
cytological smear from the cervix (dad test);
Uzi small pelvis organs;
blood test for hCG;
blood test for hepatitis B and C, syphilis and HIV;
(preferably).

When appointing Pipel biopsy, the doctor must receive all information about the drugs taken by it in the patient. Particular attention is paid to the reception of the inflation of the blood (clopidogrel, aspirin, warfarin, etc.). If necessary, the doctor may change the order of their reception a few days before the procedure.

Special attention in the appointment of aspiration biopsy endometrial is given to the selection of the date of the study. If the woman has not yet entered the period of menopause, the period of the procedure depends on the day of the menstrual cycle. If the patient does not menstruate, then the fence of the tissue is performed depending on the start of pathological uterine bleeding.

Usually aspiration biopsy Endometrial is performed on such days:

18-24 day - to establish a cycle phase;
on the first day with pathological bleeding - to identify the cause of bleeding;
for 5-10 days of the cycle - with overly abundant monthly (polymeter);
on the first day of the cycle or a day before the monthly - with suspected infertility;
once a week - in the non-mixture of pregnancy and the absence of menstruation;
for 17-25 days - to control the effectiveness of hormone therapy;
any day of the cycle - if suspected the presence of malignant neoplasms.

Direct preparation for Pipel biopsy is carried out 3 days before the study. These days, a woman needs to fulfill the following recommendations of the doctor:

Refuse sex contacts.
Do not spend dick, do not enter candles, ointments and cream into the vagina.
Exclude products contributing to increased gas formation from the menu.
In the evening before the study spend a cleansing enema.

The procedure for aspiration biopsy Endometrial can be performed under a specially equipped cabinet in the clinic. As a rule, it does not require the use of local anesthesia, but sometimes this method of anesthesia is performed for particularly sensitive patients. In such cases, before studying the study, the doctor must make sure the absence of an allergic reaction to the drug used (history or executed).

How the procedure is carried out

During the procedure, the patient is located on a gynecological chair.

On the appointed day, the patient with the direction comes to the Cabinet for the inspiration biopsy. The endometrium tissue fence procedure is as follows:

A woman falls on a gynecological chair, and the doctor enters the mirror in the vagina. If necessary, local anesthesia of the cervical cervix is \u200b\u200bcarried out by irrigating the solution of local anesthetic.
The PiPel tip is introduced into the uterine cavity through the cervical canal.
The gynecologist pulls the piston, and a negative pressure is created in the tube. As a result of this effect, part of the endometrium enters the Piypel cavity. The doctor holds a fence material from different sites.
After obtaining a sufficient amount of material, tissue samples are sent to the laboratory to perform histological analysis.
Pipel is removed from the uterus. The duration of the procedure is 1-3 minutes.

The results of histological analysis of endometrial tissues are obtained 7-14 days after the biopsy. After their assessment, the gynecologist makes a diagnosis and is a plan for further surveys and treatment.

After the procedure

After performing aspiration biopsy endometrial, the patient feels satisfactory and can go home. Its health does not violate in any way, and the need for hospitalization does not arise.

In the next 1-2 days, the patient can feel minor painful sensations of a pulling nature at the bottom of the abdomen. To eliminate spasming pain, delivering significant inconvenience, a woman can take antispasmodics (but-shpa, Papaverin, Spasmalgon). As a rule, such uncomfortable sensations will not last more than 1 day.

In the first few days after the procedure of aspiration biopsy, women have non-human discharge of a bleeding character from sex tract. Most experts recommend their patients these days to refrain from sex contacts. After the cessation of bloody secretions, a woman can resume sex life and use to prevent pregnancy barrier means of contraception.

After the study, menstruation may occur on time or with some delay (up to 10 days). In such cases, a woman is advised to spend a pregnancy test and visit the doctor.

After the aspiration biopsy, the pregnancy can occur already in the current or subsequent cycle. This method of fence endometrial does not affect the operation of the ovaries and the remaining area of \u200b\u200bthe mucous membrane of the uterus is enough to implant the fetal egg.

Possible complications

The endometrium aspiration biopsy procedure is minimally invasive and in rare cases leads to the appearance of complications. After the study, the gynecologist necessarily faces the patient with the symptoms, with the appearance of which it should immediately consult a doctor:

increasing body temperature;
bleeding from the vagina (thick allocations of bright red color);
incessant pain at the bottom of the abdomen;
dizziness or fainting;
cramps.

Advantages of aspiration biopsy Endometrial

Piypel biopsy has a number of significant advantages:

small risk of injury to the walls of the uterus;
there is no need to expand the cervical channel for the introduction of tools;
the possibility of obtaining endometrial tissues from an impartial region of the uterine cavity;
minimum risk of infection;
minimum risk of complications;
no pain during the procedure;
fast recovery of the patient after a biopsy;
the ability to perform a study on outpatient conditions and the lack of need for hospitalization of the patient;
high informativeness;
lack of a negative impact on the body of a woman pregnant (for example, in front of Eco);
simple preparation for the procedure;
low cost of research.

What will show the result of histological analysis after aspiration biopsy

In the absence of pathological deviations in the structure of the mucous membrane, as a result of the analysis, it will be indicated that the endometrium corresponds to the age norm and phase of the menstrual cycle, and there were no signs of atiphy.

When detecting deviations in the structure of the mucous meter of the uterus, the following pathological changes can be indicated in the analysis results:

adenomatosis (or complex endometrial hyperplasia);
easy diffuse (or iron, ironist-cystic) endometrial hyperplasia;
local Endometrial hyperplasia with or without (or polyposis, single polyps);
easy or complex atypical endometrial hyperplasia;
hypoplasia or endometrial atrophy;
endometritis;
non-compliance of the endometrial thickness of the phase of the menstrual cycle;
malignant rebirth of endometrial.

Aspiration biopsy Endometrial is often used as a screening method for examining patients with dubious results of ultrasound. However, such a method for the collection of tissues of the inner layer of the uterus does not always allow to obtain a sufficient amount of material to completely exclude the presence of malignant tumors. That is why, if the cancer process is suspected, the patient's examination is complemented by more informative diagnostic scraping.

What to do after the aspiration biopsy endometrial

After performing Pipel biopsy, the doctor prescribes the patient to the date of the next visit. Typically, histological examination analyzes are ready after 7-14 days after the procedure is fulfilled and, on the basis of their results, the gynecologist can determine the further tactics of diagnostic and therapeutic measures.

When identifying signs of atypics or cancer processes, the doctor solves the question of the need for additional research and surgical treatment. If the results of histological analysis indicate the presence of inflammation, antibiotic therapy and anti-inflammatory agents are prescribed to the patient.

In determining the signs of hyperplasia or insufficient endometrial reaction to hormonal changes during the menstrual cycle, the doctor conducts additional diagnostic studies to identify endocrine disorders. After that, hormone therapy can be prescribed to the patient, which improves the state of the endometrium and the reducing reproductive function, the reception of other drugs and physiotherapy procedures.