Pipelle endometrial biopsy - what is it? Diagnostic procedure in gynecology. Endometrial aspiration biopsy: how and why it is performed Preparation for endometrial biopsy

Pipel endometrial biopsy is a procedure during 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, or more precisely, cytological analysis of a sample of the obtained tissue can show cancerous and precancerous changes in uterine cells, a chronic inflammatory process (of the endometrium), and identify dyshormonal changes.

The material is collected in the gynecologist’s office without the use of anesthesia. Typically this is takes about 10 minutes.

The effectiveness of this method of taking cell material from the uterus is quite high. However, it is significantly lower than during curettage (curettage) of the uterus, when the entire endometrium is taken for analysis. However, the pipell method makes it possible to diagnose endometrial cancer and hormonal disorders in the early stages. It is recommended for young and nulliparous women in simple situations when there is no suspicion of cancer, for example, before removal of uterine fibroids. During the procedure, the doctor does not expand the cervix using medical instruments, and therefore does not injure it. This is a big plus.

If we compare pipel biopsy and hysteroscopy, then each method has its own advantages. With 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 dilation of the cervix and without anesthesia, but the doctor sees everything and can take the tissue for histology. This research is deeper and more effective.

Indications and contraindications for endometrial aspiration

Endometrial cell analysis 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;
detect or exclude endometrial cancer;
assess fertility (ability to conceive a child);
check the response of the endometrium to hormonal therapy.

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

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

What painkillers should you take before the procedure?

Whether or not it is painful to undergo a pipel biopsy depends on the woman’s pain threshold, the skill of the doctor and the presence or absence of pain relief. Since the procedure is carried out on an outpatient basis, in any antenatal clinic, intravenous anesthesia is not advisable.

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

In addition, the doctor may use lidocaine spray, spray the cervix with it, this will also reduce the pain somewhat.

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

The most severe pain is felt at the moment of taking material for research. The uterus reacts to the doctor’s actions with spasm. The pain is similar to what 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 on what day it is performed

Endometrial biopsy during pregnancy can lead to miscarriage. Tell your doctor if you are or are likely to be pregnant. Your gynecologist will ask you to take a pregnancy test before the biopsy to make sure there is no pregnancy.

Sometimes it is necessary to record your menstrual cycles before the biopsy so that your doctor can schedule the procedure on the most appropriate day.

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

In case of infertility, when abnormalities of the luteal phase are considered to be 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 “receive” it. This feature is successfully detected by histological analysis.

After menopause, the test is taken any day.

24 hours before diagnosis you cannot:

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

Before the manipulation begins, 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, its risks, what results may be obtained, and what they mean for you specifically.

How it all happens

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 speculum into the vagina to straighten its walls and open access to the cervix. It will be fixed in a comfortable position using a clamp. Everything will be treated with antiseptic. After fixing the cervix, 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 some bloody vaginal discharge. Don't forget to take a sanitary pad with you. Blood may appear for several days, until the start of menstruation, if the biopsy was taken shortly before its expected start.

For several hours, pulling sensations in the uterine area and spasms are considered normal. You are allowed to take a painkiller.

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 submitted for analysis. This happens when the endometrium is thin or the material collection technique is violated. In this case, you will have to agree to curettage of the uterine cavity.

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

Signs of trouble are:

increased body temperature;
increased bleeding;
severe abdominal pain;
vaginal discharge with a putrid odor.

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

On the day of the aspiration biopsy, you should not expose yourself to heavy physical activity, play sports, or lift weights. Until the bloody and spotting discharge disappears completely, you should avoid taking a bath. At the same time, sexual activity should be interrupted.

Endometrial aspiration biopsy results - transcript

We present here some of the terms that doctors write in their conclusions.

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

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

Endometrial atrophy- thin endometrium due to age-related changes (decreased 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 days 19-23 of the cycle is 21 mm), there is no risk of cancer at this time.

Endometritis- acute or chronic inflammatory process of the uterine cavity, one of the causes of infertility.

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

Adenocarcinoma- malignant tumor, cancer.

Real reviews

Endometrial biopsy is one of the most important diagnostic methods in gynecology. This procedure is necessary for further microscopic examination of the obtained tissue samples, which makes it possible to determine the existing morphological changes in the uterine mucosa.

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

Endometrial biopsy: what is it?

An endometrial biopsy is an intravital sampling of tissue from the lining of the uterus (endometrium) for subsequent histological and histochemical analysis. This procedure refers to minor surgical interventions in gynecology and is most often performed as an independent study. But in some cases it is included in the protocol of a “major” operation and is performed intraoperatively on an emergency basis.

A biopsy most often serves purely diagnostic purposes. But in some cases, it is a therapeutic and diagnostic manipulation that allows you to obtain the information the doctor needs and at the same time improve the woman’s condition. The preparation process, the extent of the intervention, and whether the woman will be in pain or not also depend on the type of biopsy used.

Types of research

The first documented collection of a sample of the uterine lining for analysis was performed in 1937 by Butlett and Rock. In this case, special instruments were used to dilate the cervix and scrape out (mechanically separate) the entire endometrium.

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

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

the classic version of the study is therapeutic and diagnostic curettage of the uterine cavity;
vacuum aspiration biopsy of the endometrium, performed using a special syringe or device (vacuum aspirator or electric suction);
pipel endometrial biopsy is a more modern version of aspiration of the mucous membrane and contents of the uterine cavity, using a low-traumatic instrument in the form of a flexible suction tube (pipel);
CG endometrial biopsy, during which tissue is collected in the form of line scrapings (trains).

A less common way to obtain an endometrial sample is to take it during an endoscopic examination of the uterine cavity. This type of biopsy is targeted. The doctor has the opportunity to take a small amount of biomaterial from several suspicious areas at once and simultaneously assess the severity, localization and nature of the existing changes.

However, despite its high information content, hysteroscopy is not included in the list of frequently used diagnostic procedures. Not all medical institutions have the opportunity to conduct such modern high-tech research.

A very rarely used method of obtaining an endometrial sample is jet douching.

What does an endometrial biopsy show?

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

The study may not show any deviations from the age norm. In this case, the conclusion will indicate that the uterine mucosa corresponds to the phase of the cycle and has no signs of atypia. But more often than not, the study reveals various deviations. It can be:

simple diffuse endometrial hyperplasia (proliferation of the mucous membrane), also called glandular or glandular-cystic;
complex endometrial hyperplasia (with the formation of similar glands inside the hypertrophied mucous membrane), this condition can also be described as adenomatosis;
local endometrial hyperplasia (with or without atypia), which is regarded as isolated or polyposis;
atypical hyperplasia (simple or complex), in which the cells of the overgrown mucous membrane do not correspond in their morphofunctional characteristics to normal endometrial cells;
malignant tissue degeneration;
atrophy or hypoplasia of the uterine mucosa;
– inflammation of the endometrium;
discrepancy between the thickness of the functional layer of the endometrium and the current phase of the ovarian-menstrual cycle.

Detection of atypia has important prognostic significance. Some forms of atypical hyperplasia are classified as precancer.

The main diagnostic signs are cellular and nuclear polymorphism, impaired proliferation, changes in the structure of the endometrial glands and invasion of glandular tissue into the stroma. The key point for determining precancer and cancer is impaired tissue differentiation.

Indications, contraindications and timing

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

The basis for prescribing this study may be:

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

An endometrial biopsy is performed before IVF and when identifying the cause of infertility. At the same time, histological examination of the uterine mucosa is included in the comprehensive diagnostic program for a woman’s reproductive health.

The study is also carried out after spontaneous abortions in the early stages and termination of pregnancy for medical reasons (frozen pregnancy, intrauterine fetal death, detection of developmental defects incompatible with life in the child). In such cases, biopsy samples are taken by curettage of the uterine cavity.

When is a biopsy performed?

The endometrium is a hormonal-dependent tissue. And the information content of the results of histological examination largely depends on the day of the cycle at the time of the biopsy. This takes into account the clinical situation and the main objectives of the biopsy. And in postmenopausal patients, the presence and time of its onset are taken into account.

What day of the cycle is best to perform a biopsy in women of reproductive age? Currently, the following basic recommendations are followed:

when identifying the cause of infertility, in case of luteal phase deficiency and anovulatory cycles, the study is carried out the day before the expected menstruation or on the first day after its onset;
if there is a tendency to polymenorrhea, the study is prescribed between 5 and 10 days of the cycle;
in case of acyclic bloody uterine discharge, a biopsy is performed in the first 2 days after the onset of menstruation or menstrual-like bleeding;
in the presence of hormonal imbalance, preference is given to CG biopsy, which is performed several times during one cycle with an interval of 7-8 days;
to monitor the results of hormonal therapy, a biopsy is performed in phase 2 of the cycle, between 17 and 25 days;
if the presence of a malignant tumor is suspected and there is no significant bleeding, the study can be performed on any day of the cycle.

What can limit the use of this method?

Some conditions are relative or absolute contraindications for a biopsy; if they exist, the decision on the possibility of conducting the study and its type is made by the doctor or even a medical commission on an individual basis.

Possible restrictions include:

pregnancy - if there is the slightest chance of conception during the last 2 menstrual cycles, it is necessary to make sure that there is no pregnancy, because an endometrial biopsy provokes rejection of the fertilized egg;
disorders of the blood coagulation system;
constant use of drugs with disaggregation and anticoagulation effects (NSAIDs, Dipyridamole, Trental, Warfarin, Clexane and others);
severe anemia;
active phase of infectious and inflammatory diseases of the urogenital system;
intolerance to the drugs used for anesthesia.

A biopsy is not a vital examination; if it is not possible, the doctor draws up another program for examining the patient. There is also the option of choosing more gentle methods for collecting endometrial samples. But curettage in some cases performs a therapeutic function and therefore can be used even in the presence of relative contraindications.

Research methods

Biopsy by curettage of the uterine cavity

This method is the most radical and historically the earliest way to obtain a biopsy. This biopsy includes 2 main stages: dilation of the cervical canal and curettage of the uterine walls. In this case, a set of special bougies (dilators of different sizes), forceps for removing and fixing the cervix and a uterine curette - a surgical spoon with a sharp edge - are used.

Diagnostic curettage of the uterine cavity is a painful procedure and requires the mandatory use of anesthesia. Preference is given to short-term general anesthesia, and inhalation or intravenous anesthesia can be used. Therefore, this method requires compliance with the same preparation rules as any “big” operation. To prevent reflux of gastric contents and their aspiration into the respiratory tract, it is recommended to avoid drinking water and food for at least 8 hours before the procedure.

Modern probe for endometrial biopsy

During curettage, the doctor tries to pass the curette over the entire surface of the walls of the uterus, including the corners near the mouths of the fallopian tubes. As a result, almost the entire endometrium is mechanically removed, forming an extensive wound surface.

Such curettage often makes it possible, already at the diagnostic stage, to remove polyps, stop uterine bleeding and cleanse the uterine cavity of the pathological contents present in it. And the remaining open cervix does not prevent the natural outflow of blood, although it can serve as a gateway for infection.

An important advantage of diagnostic curettage is the possibility of its use in cases of suspected oncological gynecological diseases, with metrorrhagia and after an interrupted pregnancy.

Endometrial aspiration biopsy

Aspiration biopsy is a more gentle method of taking biopsy material. The separation of the functional layer of the endometrium is carried out under the influence of a vacuum created in the uterine cavity. For this, a Brown uterine syringe or a vacuum aspirator with an attached catheter can be used. Sometimes the uterine cavity is irrigated beforehand to obtain subsequent washouts.

Bougienage of the cervical canal is not required, which significantly reduces the trauma and pain of the examination. However, the aspiration method is also sometimes performed under shallow general anesthesia. This allows you to avoid severe discomfort, especially in nulliparous women.

Preparation for endometrial aspiration biopsy includes sexual rest, avoidance of douching and any vaginal tampons for 3 days before the procedure. The doctor also prescribes a preliminary examination to exclude STDs and acute inflammatory urogenital pathology. In addition, it is advisable to exclude any gas-forming products from the menu and do a cleansing enema the day before.

Aspiration biopsy is considered a technically simple procedure that does not cause the woman any obvious pain. It is often used as a screening test when questionable results of uterine ultrasound are obtained.

However, it is worth remembering that aspiration does not provide enough material to reliably exclude endometrial malignancies. Therefore, if the presence of malignant tumors is suspected, a more informative diagnostic curettage is performed.

Technique for performing pipell biopsy of the endometrium

Pipelle biopsy is an improved modern version of endometrial aspiration. In this case, the main device for collecting part of the mucous membrane is a Pipel tip - a flexible thin disposable tube with a piston. The small diameter (only about 3 mm) and sufficient elasticity of this device allow it to be inserted through the cervical canal without the use of any dilators.

According to the principle of operation, the Peipel instrument resembles a syringe. After inserting its working tip into the uterine cavity, the doctor pulls the piston toward the middle of the length of the tube, which creates sufficient negative pressure to aspirate a small amount of endometrium. In this case, extensive wound surfaces are not formed, the cervix is not injured, and the patient does not experience significant physical discomfort.

Preparation for pipel biopsy does not differ from that before classical vacuum aspiration of the endometrium. The procedure is performed on an outpatient basis and usually does not require pain relief.

Features of the CG biopsy

CUG biopsy is considered a low-traumatic option for taking an endometrial sample. It does not provoke massive bleeding and rejection of the mucous membrane and is usually performed up to 3 times during one menstrual cycle. The main objective of such a study is to determine the reaction of the endometrium to natural or artificially created changes in hormonal levels. It is not used for diagnosing cancer and precancerous conditions.

To perform a CG biopsy, a special small curette is used. It is carefully inserted into the uterine cavity without first expanding the cervical canal. Applying slight force, the doctor scrapes off a narrow strip of mucous membrane with the working surface of the curette. This is reminiscent of drawing strokes, which is why this diagnostic method is called “stroke biopsy of the endometrium.”

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

What to expect and what to do after the study?

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

Diagnostic curettage leads to heavy menstrual-like and quite painful discharge. But their duration is usually much shorter than during normal menstruation, because the bulk of the endometrium has already been removed during the procedure. Discharge after an endometrial biopsy should not be clotted, pus-filled, or have an unpleasant odor. The appearance of any of these signs or fever is grounds for urgent medical attention.

Menstruation after endometrial biopsy using other methods described above may begin on time or with a slight delay. Their volume and duration often differ from the usual ones. Most often, there is a delay in menstruation after a pipel biopsy of the endometrium for up to 10 days. In this case, you need to take a pregnancy test and consult your doctor.

Pregnancy after the study is possible in the next cycle. During this period, a complete renewal of the functional layer of the uterine mucosa will occur. In addition, the biopsy does not affect the functioning of the ovaries. And with gentle methods, the remaining area of the endometrium may be sufficient for implantation of the fertilized egg already in the current ovulatory cycle.

How long does it take for results to be prepared?

Decoding the results after an endometrial biopsy can take up to 2 weeks. Histological examination of biopsy specimens is carried out by a pathologist or histologist. If necessary, immunohistochemical analysis is also performed.

The time it takes to obtain results depends on the specific laboratory, the histologist’s workload and the urgency of the study. If an emergency test is necessary, the doctor makes a note about this on the referral. Histological examination of samples taken during surgery is sometimes carried out within 20 minutes; the result obtained can affect the extent of the surgical intervention performed.

What is done after the biopsy?

Further diagnostic and therapeutic tactics depend on the results of the biopsy. When atypia and precancer are identified, the question of the need and advisability of surgical treatment is decided. When signs of inflammation are detected, its nature is determined and anti-inflammatory and antibacterial drugs are prescribed.

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

Possible complications and consequences

A number of women, after a biopsy, complain of a temporary change in the duration of the menstrual cycle, painful menstrual periods and discomfort during sexual intercourse.

The most dangerous complication of a biopsy is endometritis. It is characterized by severe increasing intoxication, abdominal pain and the appearance of foul-smelling uterine discharge with signs of suppuration. Fortunately, this complication is rare. Its development is usually associated with hypothermia, non-compliance with doctor’s recommendations regarding genital hygiene and sexual rest.

But sometimes the cause of endometritis is an exacerbation of an existing one. Therefore, women with chronic urogenital diseases after an endometrial biopsy need to take antibiotics on the recommendation of a doctor. The same tactics are followed if the patient has undergone an abortion.

When the biopsy will be performed, which method will be chosen and how to prepare for the procedure, you need to check with your doctor. Failure to comply with recommendations may negatively affect the reliability of the study and increase the risk of complications.

You should not refuse to perform a biopsy, because no other diagnostic methods can replace histological analysis. Only this examination makes it possible to diagnose endometrial cancer in the early stages, which significantly improves long-term treatment results.

The formation of the uterine mucosa is influenced by the ratio of hormones produced by the ovaries. Violation of the structure of the endometrium, deviation of its thickness from the norm causes serious problems in the state of a woman’s reproductive health. In order to establish the cause of menstrual irregularities, infertility, and the occurrence of tumors in the uterus, it is necessary to carefully examine the condition of its cavity and identify possible pathologies in the development of epithelial cells. An effective method for examining the endometrium is a biopsy.

Content:

What is the procedure

The procedure allows you to extract endometrial particles for subsequent histological examination. In this way, it is determined what structure the cells of the mucous membrane of the uterine cavity have, and whether there are any atypical changes in it. Based on the results of the study, conclusions are drawn about the nature of pathological processes in the endometrium, the cause of infertility or menstrual irregularities.

There are several ways to extract endometrial particles. These include complete curettage of the uterine cavity, CUG biopsy (partial curettage), aspiration of the mucous membrane using a special syringe (aspiration biopsy), targeted extraction of material during hysteroscopy. The disadvantage of these methods is the need to dilate the cervix and insert instruments into the cavity, which makes the procedure for collecting endometrial particles painful and traumatic.

Advantages of pipel biopsy

When using pipell biopsy of the endometrium, much simpler and safer manipulations are performed. The so-called “Pipel instrument” is used, which is a soft elastic narrow tube with a special tip. There is a piston inside the tube. The tube is inserted into the uterine cavity. In this case, it is not necessary to expand the cervix using a special device. By pulling back the piston, the tube is approximately half filled with the sampled contents, which are then examined under a microscope.

A single insertion of the instrument allows you to select the endometrium from large areas of the uterine cavity. The duration of the procedure is 0.5-1 minute. It is practically painless. It is carried out on an outpatient basis, after which the woman can go about her usual activities. Due to the absence of the risk of damage to tissues and blood vessels, this sampling method can be used in cases of diabetes mellitus and even (with caution) in cases of reduced blood clotting.

A disposable instrument is used to collect endometrial particles, eliminating the possibility of infection during the procedure.

Video: How an endometrial biopsy is performed. Benefits of the procedure

In what cases is pipell biopsy prescribed?

Diagnostics using pipell biopsy of the endometrium is prescribed in the following cases:

a woman experiences prolonged and painful menstrual bleeding;
heavy uterine bleeding occurs between periods for an unknown reason;
dangerous bleeding appeared after hormonal therapy or long-term use of contraceptives;
discharge with blood appears during menopause;
An ultrasound showed the presence of a tumor or endometrial polyps in the uterus, and the patient was found to have an excess amount of estrogen in the blood;
the woman experiences infertility, the pregnancy was repeatedly terminated in the early stages;
a blood test for tumor markers when detecting tumors in the uterus shows the presence of cancer cells;
a woman is preparing for IVF.

Contraindications

Before performing a pipell biopsy of the endometrium, the doctor must be sure that the patient is not pregnant. The procedure for selecting material is not carried out in the presence of inflammatory processes and various types of infection (fungi, pathogens of sexually transmitted diseases), as well as vaginal dysbiosis. The procedure is canceled if a purulent inflammatory process occurs in the uterus (endometritis) or inflammatory diseases of other pelvic organs are observed, from which the infection can spread to the genitals.

A contraindication to the use of this diagnostic method is the presence of blood diseases in a woman such as hemophilia and anemia (which can cause life-threatening bleeding), as well as cardiovascular pathologies that can cause blood clots. Pipelle biopsy is not performed in the presence of congenital developmental disorders of the genital organs.

On what days of the cycle is pipell biopsy performed?

The procedure can be scheduled on different days of the cycle depending on what pathologies require diagnosis:

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

To study the causes of amenorrhea and if there is a suspicion of the formation of malignant tumors in the uterine cavity, a pipel biopsy is performed any day.

Preparation for the procedure

Before the procedure, it is necessary to donate blood for analysis of hemoglobin content and determination of coagulability, levels of estrogen, progesterone, and pituitary hormones.

Analysis of a smear from the vagina and cervix makes it possible to detect the presence of fungus and other types of infection. A general urine test allows you to determine the level of leukocytes and detect inflammatory diseases of the urinary organs.

A blood test is performed for syphilis, HIV, and hepatitis viruses. If cancer is suspected, a blood test is done for tumor markers.

1 month before the procedure, the woman must stop taking hormonal medications, and 3 days - from using anticoagulants. You should avoid douching, tampons, the use of vaginal medications, and also abstain from sexual intercourse.

You must not eat food for 12 hours before the pipel biopsy, and immediately before going to the doctor you must do a cleansing enema.

After a pipel biopsy

The impact on the endometrium during pipell biopsy is associated with damage to small blood vessels, so a woman may experience slight spotting for several days. Normally, there should be no pain.

After such a procedure, menstruation, as a rule, occurs with a delay of up to 10 days. Since the damage during manipulation is very minor, the condition of the endometrium is quickly restored.

Warning: The delay may be associated with the onset of pregnancy, since the egg fertilized after the next ovulation attaches even to that part of the endometrium that remains after the pipel biopsy. A woman should take this into account. If pregnancy is not desired, you should consult your doctor about using an appropriate barrier contraceptive method.

Doctors recommend abstaining from sexual intercourse for a month after an endometrial examination. In addition, physical fatigue and strong emotions should be avoided. Visiting a sauna, staying in a hot room, or swimming in a hot bath lead to bleeding.

If questionable symptoms appear, you should never self-medicate, use folk remedies or medications other than those prescribed by your doctor.

When to see a doctor immediately

In rare cases, after a pipel biopsy, a woman’s character of her periods changes (for example, their volume and duration increase, they become painful). A serious complication may be the occurrence of an inflammatory process. As a rule, the reason is non-compliance with doctors’ recommendations for hygienic care of the genitals during the recovery period, entering into sexual relations in the coming days after a pipell biopsy of the endometrium, hypothermia of the lower body.

You should consult a doctor if you have any symptoms of illness, especially if purulent discharge or bleeding from the genitals occurs, body temperature rises, pain appears in the lower abdomen, or menstruation disappears.

Research results

Depending on the purposes of diagnosis and the expected nature of the disease, examination of the material taken for analysis and interpretation of the results can be carried out urgently within 0.5 hours, but an answer can be received after 2 weeks.

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

Suspicion of the presence of any pathology makes a person worry. This is especially true for oncological processes. Cancer is a terrible diagnosis both for the person himself and for all his loved ones. However, there are currently many ways to combat it. The effectiveness of treatment of oncological pathologies is high in the initial stages of the disease. Therefore, in order to quickly detect cancer, it is necessary to be examined at the first signs of the disease. One of the diagnostic methods is aspiration biopsy. It is performed quickly and almost painlessly. In some cases, this study acts as a therapeutic procedure.

What is the purpose of aspiration biopsy?

In order to confirm or refute the presence of a malignant process, a study of the composition of the cells of the pathological formation is required. It is carried out using 2 diagnostic procedures. These include: The first involves making a section from the damaged organ, staining it and microscopy. This method is the standard for diagnosing cancer tumors. consists of performing a smear from the surface of the biopsy specimen. Next, microscopy of the glass slide is performed. To obtain material for research, an open biopsy is performed. This is a surgical operation that involves partial or complete removal of an organ. Another method of collecting cells is aspiration puncture biopsy. It can be used to perform histological and cytological analysis. For this purpose, biological material is obtained by puncturing the organ and breaking off small pieces of the affected area.

The advantages of the aspiration method include:

No cuts on the skin.
Painless procedure.
Possibility of performing on an outpatient basis.
Speed of execution.
Reducing the risk of complications that may arise as a result of the procedure (inflammation, bleeding).

Aspiration biopsy can be performed using special instruments or an ordinary thin needle used for injections. This depends on the depth and location of the tumor.

Indications for biopsy

An aspiration biopsy is performed if tumors of various organs are suspected. Among them are the thyroid and mammary glands, uterus, lymph nodes, prostate, bones, soft tissues. This diagnostic method is performed in cases where there is access to the tumor. Indications for the study include the following conditions:

Suspicion of a malignant tumor.
The inability to determine the nature of the inflammatory process by other methods.

In most cases, it is impossible to determine which cells the neoplasm consists of without cytological and histological examination. Even if the doctor is sure of the presence of a malignant tumor, the diagnosis must be confirmed. This is necessary to establish the degree of cell differentiation and carry out therapeutic measures. In addition to cancerous tumors, there are benign tumors that must be removed. Before proceeding with surgery, it is necessary to confirm that there is no oncological process. For this purpose, an aspiration biopsy is also performed.

Sometimes treatment of inflammatory processes is ineffective, despite the adequacy of the therapy. In such cases, histological examination of the tissue is required to exclude specific pathologies. In this way, tuberculosis, syphilitic or other inflammation can be detected.

Preparing for the study

Depending on the location of the pathological area, preparation for the study may vary. In all cases, diagnostic procedures are required before aspiration biopsy. These include: blood and urine tests, determination of biochemical parameters, coagulogram, tests for hepatitis and HIV infection. If tumors of external localizations are suspected, no specific preparation is required. This applies to tumors of the thyroid and mammary glands, skin, and lymph nodes. In these cases, a fine-needle aspiration biopsy is performed. This method is completely painless and resembles an ordinary injection. If the tumor is deep, a trepanobiopsy is required. It is carried out using a special instrument and a thick needle. In this case, local anesthesia is required.

Preparation for an endometrial aspiration biopsy is somewhat different. In addition to the tests listed, before performing it, it is necessary to obtain the results of a smear from the vagina and cervix. If the patient is a woman of childbearing age, the biopsy is performed on the 25th or 26th day of the menstrual cycle. During the postmenopausal period, the study can be carried out at any time.

Performing a thyroid biopsy

An aspiration biopsy of the thyroid gland is performed using a fine needle. It is required in the presence of nodules in the organ tissue. Before conducting the study, the doctor performs. For this, the patient is asked to make a swallowing movement. At this moment, the doctor determines the exact location of the node. This area is treated with an alcohol solution for disinfection. After which the doctor inserts a thin needle into the neck area. With his other hand, he fixes the knot to obtain cells from the pathological focus. The doctor pulls the plunger of the empty syringe towards himself to extract biological material. The pathological tissue penetrates the lumen of the needle, after which it is placed on a glass slide. The resulting material is sent to the puncture site. A cotton swab soaked in an alcohol solution is applied to the puncture site and secured with an adhesive plaster.

A fine-needle aspiration biopsy of the thyroid gland helps determine whether there are malignant cells in the nodule. In their absence, conservative treatment of goiter is possible. If a doctor diagnoses thyroid cancer, removal of the organ and chemotherapy are required.

Technique for endometrial aspiration biopsy

Indications for uterine biopsy are: suspicion of cancer, hyperplastic processes (endometriosis, polyps), monitoring of hormone therapy. The study is performed in a treatment room or small operating room under ultrasound control. First of all, palpation of the pelvic organs is carried out. Then the cervix is fixed using gynecological speculum. A special conductor - a catheter - is inserted into the cervical canal. Through it, the contents of the endometrium are aspirated into a syringe. The resulting material is sent to the laboratory to determine the cellular composition of the fluid.

In some cases, aspiration biopsy of the uterus is performed using a special vacuum device. It is necessary to ensure that the material is collected under pressure. With its help, you can obtain several samples of biological material by performing 1 puncture.

Puncture and breast

A lymph node biopsy is performed if the doctor suspects specific inflammation or regional spread of the tumor. The study is carried out using a thin needle. The technique for performing it is similar to aspiration biopsy of the thyroid gland. The same technique is used to obtain material from breast tumors. In addition, aspiration biopsy of the breast is performed in the presence of large cysts. In this case, this procedure is not only diagnostic, but also therapeutic.

If the obtained material is insufficient or it is not possible to confirm the diagnosis with its help, a trepanobiopsy of the mammary gland is performed. It is performed for research purposes. In this way, it is possible to track the progress of the needle. In some cases, a vacuum aspiration biopsy is performed.

Contraindications for the study

There are practically no contraindications to performing a fine-needle biopsy. Difficulties may arise if the patient is a person with mental illness or a child. In these cases, intravenous anesthesia is required, which is not always possible. Vacuum aspiration or fine-needle biopsy of the endometrium is not advisable for inflammatory pathologies of the cervix and vagina. Also, the procedure is not performed during pregnancy.

Interpretation of research results

Ready in 7-10 days. Cytological analysis is faster. After microscopy of a smear or histological specimen, the doctor makes a conclusion about the cellular composition of the neoplasm. In the absence of atypia, the tumor is benign. If the cells obtained during the study differ from normal elements, the diagnosis of cancer is confirmed. In such cases, the degree of tumor differentiation is determined. The prognosis and treatment methods depend on this.

Aspiration biopsy: reviews from doctors

Doctors claim that the aspiration biopsy method is a reliable diagnostic test that is safe for the patient’s health. If the obtained material has little information content, tissue sampling can be repeated. To perform this study, hospitalization of the patient is not required.

Women, due to the structure of their bodies, often have to undergo various tests. A representative of the fairer sex should visit a gynecologist regularly. Doctors talk about annual visits to the doctor in the absence of any complaints. If symptoms of pathology occur, then you need to contact a specialist as soon as possible.

Gynecologists often prescribe tests for patients such as hysteroscopy, colposcopy, ultrasound diagnostics, and so on. Pipe endometrial biopsy has gained great popularity in recent years. The consequences and reviews of the diagnostic manipulation will be presented to your attention in the article. You will learn the specifics of the procedure. You can also find out why pipel endometrial biopsy is done.

What it is

Pipelle endometrial biopsy is a diagnostic operation that allows you to examine the inner lining of the uterus without the need to dilate the cervical canal. The patient feels virtually no discomfort at the time of material collection. This allows you to avoid the use of anesthetics and narcotic drugs.

Pipelle endometrial aspiration biopsy is named after the man who discovered it. It is carried out using the thinnest tube, which has a diameter of 2.3 or 4 millimeters. This tool is hollow inside, which allows you to collect material.

When is diagnostics necessary?

In recent years, patients are increasingly being prescribed this type of diagnosis. The main indications of such a study include:

infertility of unknown nature;
irregular menstrual cycle;
bleeding due to the use of hormonal drugs;
suspicion of acute or chronic endometritis;
lack of menstruation at the scheduled time;
menopause period;
polyps and fibroids in the cavity of the reproductive organ;
preparation for surgical interventions and so on.

Sometimes a pipell biopsy of the endometrium is prescribed before IVF. This type of study eliminates possible difficulties during implantation of the fertilized egg and increases the likelihood of a positive result.

Contraindications for surgery

Like any intervention in the patient’s body, pipel endometrial biopsy has its limitations and contraindications. These include:

the presence of pregnancy, including development outside the uterine cavity;
inflammatory diseases of the pelvic organs;
vaginal infection;
low pain threshold (pain relief required);
defects in the development of the uterus (septum, adhesions, etc.).

In each individual case there may be additional contraindications. Before the manipulation, the patient is always examined by specialists and makes their opinion.

Preparing for the study

The collection of material is always carried out within the walls of the hospital. Before the procedure, the patient is asked to take an anesthetic and sedative. However, in most cases this is not necessary. Anesthesia is required only when the pain threshold is low and a pipel with a diameter of more than four millimeters is used.

Are there any special conditions for the procedure called endometrial tube biopsy? On what day of the cycle should the material be collected? It all depends on the purpose of the research being conducted. If a woman is of reproductive age and has a relatively stable cycle, then the procedure is performed between 20 and 25 days from the beginning of menstruation. Representatives of the fairer sex during menopause can be prescribed a study at absolutely any time.

When preparing for the in vitro fertilization procedure, manipulation is prescribed one cycle before the use of hormonal drugs. It is worth noting that you need to stop all medications that can affect the condition of the endometrium. These include hormones, antibiotics, chemotherapy drugs, and so on. In exceptional cases, the study is carried out directly during treatment.

How is a pipell biopsy of the endometrium performed?

The material is collected by an experienced doctor in a gynecological chair. Before the procedure, the woman must perform hygiene procedures and undress. Next, the patient sits on the chair, and the doctor begins the manipulation.

A speculum with a speculum is inserted into the vagina of a representative of the fairer sex. With its help, the cervix is fixed in a stationary position. After this, the specialist needs to find out the size of the reproductive organ. For this, a special measuring device is used. It is carefully inserted into the cervical canal until it stops. After this, the doctor selects the appropriate size pipe and begins the procedure.

The doctor takes a suction tube and carefully inserts it into the cervical canal. It is worth noting that the device should not rest against the fundus of the uterus. Otherwise, it may be damaged. When the tube is inserted to the desired depth, the doctor pulls the piston from the outer end of the device. At this moment, negative pressure is created in the uterus. Some endometrial particles end up in the tube and remain there even after removal. The next step is for the doctor to carefully remove the pipette from the patient’s cervical canal. After this, the resulting material is applied to sterile glass and sent for examination.

Opinions of doctors and patients about manipulation

Pipelle endometrial biopsy has positive reviews. Patients say that the procedure is absolutely painless. It lasts no more than one minute. It takes much longer to prepare for it. Within a few minutes after collecting the material, the patient can go home. Only in some special cases do doctors leave a woman in the hospital for several hours.

Doctors say that pipell biopsy of the endometrium gives very accurate results. If a regular biopsy examines a specific area that was taken using curettage, then a pipel takes the endometrium from all the walls of the reproductive organ. Experts also report the safety of manipulation. Gynecologists do not have to expand the patient’s cervical canal. After all, this often leads to the development of complications.

Pipe endometrial biopsy is also a safe procedure due to the use of sterile materials. The straws are made of high quality plastic and can only be used once. During curettage, reusable metal devices are used. This often leads to infection and infection. That is why pipel biopsy is the more preferable way to study the condition of the internal cavity of the reproductive organ.

Patients talk about the relatively expensive cost of the procedure. The average price category for pipel biopsy ranges from two to five thousand rubles. However, in government institutions this research is performed absolutely free of charge, provided certain documents are available.

Duration of diagnostics and obtaining results

As you already know, the collection of material takes no longer than one minute. After this, the tissues are sent to the laboratory for testing. Diagnostics lasts no more than one week. The result is usually given within ten days.

Only a qualified specialist can decipher the received data. You shouldn't try to do this yourself. Your guesses may be wrong. If necessary, after a pipell biopsy of the endometrium, any medications are prescribed to correct the condition.