How to make an aspirate. Aspirate from the uterine cavity and its diagnostic value

Many gynecologist patients hear about such manipulation as aspirate from the uterine cavity. Let's talk about what this procedure is, why it is performed on women at different ages, and what are its advantages and disadvantages.

The term “aspiration” literally means “to suck out.” In medicine, aspiration biopsy is widely used - that is, obtaining tissue fragments using “suction”, usually based on a pressure difference. The procedure is carried out with a syringe, special probes, vacuum electric aspirators, and so on.

Such aspirate can be taken from the lungs, bronchi, stomach, sinuses, and large fluid formations. In gynecology, aspiration biopsy from the uterine cavity is very common.

There are three main types of this procedure:

Aspiration biopsy of the endometrium using a vacuum aspirator;
Aspiration biopsy using a syringe or manual (manual) vacuum aspiration;
Pipelle endometrial biopsy or aspirate using a special uterine probe.

Recently, these manipulations have become widespread for various indications:

Approximate and initial diagnosis for suspected various diseases of the uterine body. This manipulation can be performed to diagnose conditions such as uterine cancer, endometrial hyperplasia, chronic endometritis, various variants of abnormal conditions of the uterine cavity - hematometer, serosometer.
Routine examination before various gynecological manipulations and operations. An endometrial biopsy is performed before IVF, insemination, and stimulation of ovulation in women with infertility.

In gynecological patients, this manipulation is performed as a primary stage before planned operations, for example, before removal of uterine fibroids, pelvic floor plastic surgery. Previously, separate diagnostic curettage of the uterine cavity was used for these purposes, but in recent years in most cases there is no need for such a traumatic examination.

Diagnosis of the causes of infertility in women. In this case, endometrial tissue can be obtained for histological examination. This is important for assessing the usefulness of the endometrium, its correspondence to the phase of the menstrual cycle, and the presence or absence of an inflammatory response.
Monitoring and evaluating the effectiveness of treatment for a particular condition. An aspirate from the uterine cavity can give an answer as to whether prescribed medications help, for example, for endometrial hyperplasia, or whether chronic endometritis has been treated with antibiotics.

Now let's look at each type of aspiration biopsy separately.

Vacuum biopsy

This is an older method, which, in addition to diagnosing the condition of the endometrium, has been and continues to be used to terminate short-term pregnancies and also to clean the uterine cavity from blood clots, hematometers, serozometers, remnants of the fertilized egg after abortion, and postpartum lochia when they are delayed.

Source: vashamatka.ru

The essence of the method is to use the principle of a vacuum cleaner. A vacuum aspirator is an electrical device consisting of a compressor, a thin aspiration probe or catheter inserted into the uterine cavity, and a container for the resulting aspirate.

This type of aspirator is also used to terminate early pregnancies.

The aspiration procedure is as follows:

The patient lies on the gynecological chair in a standard position.
The cervix is brought out in the speculum, fixed with forceps, using a button probe, the doctor passes the canal of the cervix and inserts a catheter into the uterine cavity.
The catheter is fixed, the doctor presses the pedal of the device, the “vacuum cleaner” creates negative pressure and the tissues of the uterine cavity are sucked into the container.
The doctor removes the instruments and treats the vagina and cervix with antiseptics. The procedure is over.

The resulting tissues are fixed depending on their quantity. If there is a good, abundant aspirate, the biopsy specimen can be placed in formaldehyde and sent for histological examination. When the aspirate is scanty, histology is usually uninformative. It is better to place such a biopsy on a cytological slide and send it for cytological examination of the cellular composition.

The manipulation, as a rule, is carried out without general anesthesia under local anesthesia; the cervix is injected at certain points with a solution of novocaine or lidocaine. In young women who have given birth naturally, the procedure is sometimes carried out quietly without anesthesia at all, causing the patient a moment of minor discomfort.
Manual aspiration

The meaning of the procedure is generally similar, only instead of electrical power, manual force is used to “suck out”. A manual aspirator is a kind of large syringe with a tight piston and a container for collecting the resulting tissue.

Pipel biopsy

This is the most modern, technologically advanced and minimally invasive method of obtaining endometrial tissue. For this type of aspirate, special aspiration probes are used.

The operation technique is similar, but does not require dilatation of the cervix, nor the use of “brute” force - manual or electric. Pipe probes are very thin, flexible, easily enter the cervical canal, and are very convenient to use.

Advantages and disadvantages

Let's start with the positive points:

Low invasiveness and almost complete absence of trauma to the mucous membrane of the uterine cavity, in contrast to separate curettage of the uterine cavity and hysteroscopy. This is very important and relevant for young nulliparous women, patients planning pregnancy, because the mucous membrane of the uterine cavity is one of the fundamental factors for the successful onset and course of pregnancy.
There is no need for general anesthesia, and, therefore, no risks of anesthesia and its possible complications.
Simplicity and speed. Unlike hysteroscopy, these methods are widespread, available in almost every institution, and are not expensive.
No need for hospitalization or hospital stay.

In the USA, this kind of manipulation is called “office” or “office” because it is carried out not in a hospital, but in a purely outpatient setting - on a regular gynecological chair in a regular gynecologist’s examination room, and does not require special training, anesthesia and sick leave.

That is, the woman undergoes this procedure and can return to work, to the “office”.
Few complications. Considering its minimally invasive nature, the procedure has virtually no serious complications, unlike RDV or hysteroscopy.

The disadvantages of manipulation are:

There is no “eye control”, that is, the procedure is, in principle, carried out blindly, in contrast to hysteroscopy, in which a biopsy can be taken under visual control, from the most suspicious area.
Orientation of diagnosis. As a rule, in serious cases, for example, when cancer cells are detected in an aspirate from the uterine cavity, a clarifying diagnosis is indicated - hysteroscopy.
Lack of significant therapeutic effect - that is, with aspiration biopsy it is impossible to stop the bleeding or remove the polyp. At most, vacuum aspiration can empty the cavity of liquid, blood, and exudate. When
With pipel biopsy, a therapeutic effect is generally impossible due to the extremely thin diameter of the probe.

Preparation

Although the procedure is called “office”, a minimum examination is still required before it:

Ultrasound of the pelvic organs, so that the doctor understands the picture and indications for the procedure, as well as in case of any structural features of the genital organs in this patient - for example, a bicornuate uterus or a septum in the uterus.
General blood and urine tests to exclude acute inflammatory processes in the body.
Gynecological smear for flora to exclude an inflammatory process in the vagina.
A smear from the cervix for atypical cells - oncocytology.

Complications

Complications with this type of procedure are extremely rare, but it is important to know the possible ones:

Perforation of the uterine walls with instruments or a probe is an almost casuistic situation, since in this version of manipulation there are no sharp, hard instruments, as in hysteroscopy or RDV.
Secondary infection is acute or chronic endometritis, which can occur due to poor smears in the patient and violation of aseptic rules.

In conclusion, I would like to say that aspirate from the uterine cavity is an excellent alternative to surgical diagnostic methods, a real salvation for patients with contraindications to anesthesia and invasive procedures.

Article last updated 12/07/2019

Endometrial biopsy is an effective and informative diagnostic procedure widely used in the gynecological field. This technique allows for laboratory examination of the tissues of the uterine mucosa in order to identify its condition and possible atypical cells. Biopsy of the endometrial layer is one of the most accurate ways to diagnose oncological processes even at the initial stages of development.

What is an endometrial biopsy? This procedure involves curettage of the uterine cavity and removal of tissue for subsequent histological examination. The peculiarity of this technique is that under the influence of certain hormones and with the development of pathological processes, the endometrium changes, and only laboratory tissue analysis can determine its transformation and assess the danger.

The uterine endometrial biopsy procedure is minimally invasive. If earlier, rather traumatic procedures (curettage) and fraught with numerous adverse consequences were used for diagnosis, modern specialists use the most gentle and safe methods of biopsy.

For these purposes, the following methods are used:

Aspiration- a minimally invasive procedure characterized by painlessness and minimal recovery period. The procedure is performed on an outpatient basis. During the diagnostic process, a special tip connected to an electric suction device is inserted into the patient’s uterine cavity.

Pipel- the safest, most advanced aspiration technique. During the procedure, a special catheter is inserted into the patient's uterus to obtain both cells and tissue for research. Diagnosis using this method is usually done before the start of menstruation. is considered one of the preferred methods for taking a biopsy (sample of material).
Hysteroscopy- the most informative method that allows you to identify oncology, polyposis, cystic neoplasms, uterine fibroids, adenomyosis. Hysteroscopy with diagnostic biopsy also allows a specialist to assess the stage of development of the pathological process and the degree of its malignancy, and develop the most effective treatment program. The examination is carried out under intravenous anesthesia using a special device - a hysteroscope.

The optimal method for performing a biopsy of the endometrial layer is determined by the doctor on an individual basis.

Indications

Endometrial biopsy is indicated for women in the following cases:
hyperplastic processes of the endometrium;
polyps localized in the uterine area;
endometritis occurring in a chronic form;
endometriosis;
suspicion of the presence of a tumor neoplasm of a benign or malignant nature (fibroids, cysts, cancerous tumors);
menstrual irregularities;
painful and excessively heavy menstruation;
problems with conception;
uterine bleeding during menopause;
adenomyosis.

Gynecological diagnosis by biopsy is prescribed during the period of preparation for artificial insemination IVF, after early termination of pregnancy, miscarriages, spontaneous abortions.

Contraindications

Endometrial biopsy has a number of absolute contraindications and time restrictions.

This diagnostic procedure is not recommended if:
inflammatory processes of the genitourinary system, occurring in acute form;
decreased blood clotting rates, thrombocytopenia;
severe anemia;
pregnancy;
acute form of purulent cervicitis;
sexually transmitted infectious diseases.

The study is prescribed with great caution to patients suffering from blood diseases who are taking anticoagulant drugs due to the high risk of bleeding.

Preparing for diagnosis

Before performing an endometrial biopsy, in order to identify possible contraindications and limitations, patients are prescribed laboratory and instrumental diagnostic examination methods:

taking a smear for cytology and flora;
blood analysis;
colposcopy;
Ultrasound examination of the pelvic organs.

To obtain the most accurate and reliable diagnostic results, it is important to correctly determine the day of the procedure.

In most cases this happens according to the following scheme:

Identification of the cycle phase - 18-24 days of the menstrual cycle.
Pathological uterine bleeding - 1 day.
Heavy menstruation - on days 5-10 of the menstrual cycle.
Suspicion of infertility - the first day of the cycle or the day before the start of menstruation.
Monitoring the effectiveness of the course of hormonal therapy - from 17 to 25 days of the menstrual cycle.

If the presence of a malignant tumor is suspected, diagnosis is carried out urgently, regardless of the day of the cycle.

For several days before the procedure, the patient must follow certain rules:

Stop using anticoagulants and drugs that reduce blood clotting.
Refrain from intimate contact.
Eliminate foods that cause increased gas formation from your diet.
Refrain from douching.

Features of the event

How is the procedure performed? A biopsy of the endometrial uterine layer is performed in a clinic, under local anesthesia or even without anesthesia at all. Diagnosis is carried out in a gynecological chair. The specialist inserts an instrument into the patient’s uterine cavity to take samples of endometrial tissue, after which the resulting biological material is sent to the laboratory for further histological examination.

The duration of the procedure is on average about 2-3 minutes. A biopsy does not require recovery or rehabilitation. After the session is completed, the patient can leave the clinic and return to her usual rhythm of life.

The results of the study will be ready 1-2 weeks after the collection of biological material. Decoding the results is a complex process that is dealt with directly by the gynecologist. Based on the information received, the doctor makes a diagnosis for the patient and develops an optimal treatment course for a specific clinical case.

Recovery after biopsy

A biopsy of the uterine mucosa does not affect a woman’s ability to work. As evidenced by reviews from most patients, the procedure is tolerated very well, without any unwanted reactions. But during the first few days, a woman may experience aching, painful sensations in the lower abdomen. Taking analgesic medications will help relieve pain.

Vaginal discharge of a bloody nature is also possible, which is considered one of the manifestations of the norm. If such a symptom appears, it is recommended to refrain from intimate contact until the bleeding stops.

In the first few days after taking a biopsy, the patient must follow medical recommendations:

refrain from taking hot baths, visiting baths and saunas;
stop using sanitary tampons;
do not lift weights;
avoid excessive physical activity.

Compliance with these simple rules significantly reduces the risks of complications and unwanted reactions.

Consequences and complications

In rare cases, when diagnosing the endometrium by biopsy, complications may develop. You should seek help immediately if you experience the following symptoms:

feverish state, increased body temperature above 38;
uterine bleeding;
pronounced pain syndrome;

fainting conditions;
convulsive syndrome;
attacks of dizziness.

Interpretation of results

What does an endometrial biopsy show? In the absence of pathological processes, it will be established that the endometrium is normal, without atypical manifestations.

In the presence of pathological changes, diagnostics will determine:
adenomatosis;
endometrial hyperplasia;
hypoplastic processes;
atrophy of the mucous membrane of the uterine layer;
endometritis;
discrepancy between the thickness of the mucous layer and the current phase of the menstrual cycle;
malignant degeneration of endometrial tissue.

Based on the results obtained, additional examinations are prescribed or treatment measures are developed.

Endometrial biopsy is an important diagnostic procedure that allows us to identify a number of gynecological diseases and pathological changes in the mucous membrane of the uterine layer. This diagnostic method is highly informative, and the use of modern techniques makes the procedure as painless and safe as possible for women’s health.

All materials on the site were prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative in nature and are not applicable without consulting a doctor.

An endometrial biopsy is an operation in which the surgeon removes small sections of the lining of the uterus for pathohistological examination. The material is sent to the laboratory, and after microscopy the attending physician receives accurate information about the condition of the endometrium and its changes.

Histological examination of tissue fragments is an integral stage in the diagnosis of a wide variety of pathologies. In some cases, only microscopic analysis of tissue allows one to accurately determine the nature of the changes and their cause, which means that treatment prescribed taking into account the specific histological picture will be the most effective.

In gynecology, biopsy examination has been used very widely for many decades, during which tissue sampling techniques have been improved, which may differ depending on the diagnostic purpose. Each method has its own indications and contraindications, which the gynecologist takes into account based on the expected diagnosis.

If necessary, conventional microscopy can be supplemented with modern immunohistochemical techniques, which make it possible to detect malignant tumors and accurately differentiate their origin, determine the degree of differentiation and prognosis for the patient.

endometrial biopsy

Endometrial biopsy is an operation, albeit a minimally invasive one, so it requires careful preparation, assessment of possible risks, and a balanced approach to determining indications. Today, the operation is performed on a wide range of women due to its relative safety, ease of performance and the highest diagnostic value.

As a rule, biopsy sampling is performed routinely, as an independent study, but in some cases there may be a need for an urgent biopsy performed during surgery for pathology of the female genital organs. The main purpose of a biopsy is diagnosis, but sometimes it is also therapeutic, leading to an improvement in the patient’s well-being after removal of the pathological lesion.

Types of endometrial biopsy

The endometrium is the inner layer of the uterine body, its mucous membrane, which undergoes cyclic changes under the influence of female sex hormones. Its structure is different not only in different phases, but also on different days of the menstrual cycle. Pathology of the endocrine system, ovaries, and the uterus itself inevitably affects the structure of the mucous membrane, by the characteristics of which the doctor judges the nature of the pathology.

You can “extract” the endometrium only by penetrating the uterine cavity. In the first half of the last century, attempts to obtain a sample were accompanied by expansion of the cervical canal and curettage of the entire mucous membrane. Modern biopsy techniques mean that it is minimally invasive and has low morbidity, as well as a low risk of complications, which makes it possible to expand the indications for the study. The clinic uses several types of endometrial biopsy surgery:

Classic curettage of the mucous membrane;
Aspirate biopsy with vacuum or aspirator;
Pipelle endometrial biopsy is one of the least traumatic methods;
CG biopsy;
Targeted biopsy during hysteroscopy allows you to obtain tissue from the most altered areas of the endometrium, but has limited use due to the high cost of hysteroscopy itself and the lack of equipment in many hospitals.

The operation of collecting endometrial fragments is only the initial stage of the diagnostic search, since without microscopy it is impossible to determine what structural changes occur in the uterine mucosa. The exact answer will be given by analyzing histological sections of the endometrium under a microscope.

Indications and contraindications for biopsy

Pathomorphological examination of the uterine mucosa is carried out for women of all ages, regardless of whether they have given birth to children or not. The reason for the procedure may be:

Dysfunctional bleeding;
Intense uterine bleeding or scanty menstruation;
Amenorrhea (absence of menstruation) for an unknown reason (pregnancy must be excluded!);
Possible tumor growth;
Internal endometriosis;
Suspicion of a chronic inflammatory process in the uterine mucosa;
Infertility to clarify the cause;
Planning an IVF procedure;
Miscarriages, pathology of short term pregnancy (after medical abortion).

Contraindications to endometrial biopsy are:

Pregnancy is an absolute contraindication to the study, since intervention in the uterus will provoke a miscarriage;
Pathology of hemostasis due to the risk of bleeding;
Treatment with anticoagulants and antiplatelet agents, anti-inflammatory drugs (require discontinuation in advance);
Severe anemia;
General infectious diseases (ARVI, intestinal infections, etc.);
Acute or exacerbation of chronic genital tract infections;
Allergy to anesthetics.

Since a biopsy is not performed for health reasons, in case of serious contraindications it can be abandoned in favor of other, safer diagnostic methods. If there are relative obstacles, the doctor will try to choose the most optimal method of tissue collection that eliminates complications.

Preparing for the study

Preparation for an endometrial biopsy includes general clinical tests (blood, urine), coagulation studies, determination of blood group and Rh factor, tests for HIV, hepatitis, and syphilis. During a gynecological examination, the doctor takes smears from the cervix for cytology and microflora from the vagina. If it is impossible to exclude pregnancy, a human chorionic gonadotropin test is performed.

After undergoing examinations and setting a date for the biopsy, the patient must abstain from sexual activity, douching, and vaginal tampons 2 days before the procedure, and stop taking blood thinners 7-10 days. If curettage is planned under general anesthesia, then the day before from 6 pm, food and liquid intake is stopped.

On the morning of the study, the patient takes a shower, removes hair from the external genital tract; if there are varicose veins in the legs, the doctor may prescribe elastic bandaging to prevent thromboembolic complications.

Timing and technique of performing a biopsy

Since the endometrium clearly reflects hormonal effects, the information content of the analysis depends on what day of the cycle it was received. For different pathologies, the timing of the biopsy may differ. Thus, when diagnosing the causes of infertility, anovulation, and disorders of the second phase of the cycle, young women are recommended to undergo a biopsy the day before their expected period or on the first day of their onset.

In case of heavy menstruation, it is more advisable to carry out the operation from 5 to 10 days of the cycle. If the bleeding is not associated with menstruation, then a biopsy will be prescribed in the first 2 days from the moment of its occurrence. During one cycle, the procedure can be performed several times - in case of hormonal imbalance, for example.

In the second half of the cycle, from days 17 to 25, a biopsy is indicated to assess the effectiveness of conservative hormone therapy. If a malignant process is suspected, the study is carried out regardless of the day of the cycle and without delay.

The woman will be able to find out the result of the pathological examination 7-10 days after the operation, but if it is necessary to perform additional staining techniques, this period may increase. For detailed explanations, you should contact a gynecologist, who will either prescribe treatment for the pathology or refer you to an oncologist if a malignant neoplasm is detected.

The technique for collecting endometrium for microscopic examination differs with different methods of procedure. It may include the stage of expanding the cervical canal, after which sharp instruments are inserted into the organ cavity, cutting off areas or the entire mucosa. This route is the most traumatic, although it provides the largest amount of information, so it is preferred if cancer is suspected or diffuse hyperplasia diagnosed by ultrasound. In the second case, the procedure will become therapeutic.

A purely diagnostic biopsy is often performed using gentle methods that can be performed without dilating the cervical canal - the most painful stage of the entire operation, which improves the tolerability of the study by women and reduces the risk of complications.

Scraping

curettage

The most radical method of collecting endometrial tissue is curettage - a classic technique used for half a century. To penetrate into the organ cavity, it is necessary to expand the neck, for which special dilators are taken from the smallest to the maximum diameter, the neck is fixed with forceps, and then the surgeon removes the mucous membrane with a sharp curette. The method is traumatic and requires great care due to the risk of damage to the basal layer of the endometrium and the uterine wall.

Classic uterine curettage is quite painful and therefore requires anesthesia; general anesthesia - mask or intravenous - is considered optimal. Due to the need for anesthesia, the woman is advised to prepare similar to that for any other surgical intervention (examination, discontinuation of certain groups of drugs, refusal of food and water the evening before the operation).

Curettage of the uterine cavity is usually carried out in case of hyperplastic processes in the mucous membrane, non-developing pregnancy, prolonged and heavy bleeding, or suspected cancer. Removing the mucous membrane from all the walls of the organ and the area of the tubal angles in some cases allows not only to make an accurate diagnosis, but also at the same time to remove the pathological process itself, that is, it is a therapeutic procedure.

Aspiration biopsy

Endometrial aspiration biopsy involves removing the mucosa using a vacuum. The method is not as traumatic as curettage, does not require expansion of the cervical canal, so the pain and risk of complications is much lower. In nulliparous patients, aspiration can cause subjective discomfort, so the surgeon may offer short-term general anesthesia to especially sensitive women.

When preparing for a study using vacuum aspiration, a woman should exclude sexual activity, douching and the use of tampons 3 days before the biopsy date, and an enema is indicated the day before to cleanse the intestines. Due to the risk of infection upon penetration into the uterine cavity, it is important at the preparation stage to exclude inflammatory and infectious processes in the genital tract.

Aspiration biopsy can be performed for any pathology in the uterus, and is also indicated for questionable ultrasound findings. Its disadvantage can be considered to be the smaller volume of aspirate compared to curettage, which can make diagnosing a malignant neoplasm difficult, so if cancer is suspected, it is better to do curettage.

Video: endometrial aspiration biopsy

Pipelle biopsy

pipel biopsy

Pipelle biopsy resembles aspiration, but has the advantage that tissue is collected using a thin tube, the diameter of which is about 3 mm. The method is low-traumatic, does not require cervical dilatation, and has virtually no complications.

Pipelle biopsy can be performed on an outpatient basis, in a antenatal clinic; you need to prepare for it in the same way as for aspiration. During the procedure, the doctor places a Pipel tip into the uterus and then pulls on a plunger, releasing a small piece of endometrium by creating negative pressure in the syringe.

Pipelle biopsy does not cause trauma to the mucous membrane, does not cause the formation of an open wound surface with the risk of infection, and is practically painless, therefore it is preferred for young patients who do not have children, with endometrial pathology, infertility, for tissue collection for immunohistochemical determination of hormone receptors.

CUG biopsy

A CUG biopsy is performed without dilating the cervical canal, using a special small curette, with which the surgeon scrapes off the narrow cavities of the mucous membrane, starting from the fundus to the internal os of the uterus. This type of biopsy is indicated mainly to determine the effectiveness of hormone therapy, the degree of endometrial maturation at the natural level of hormones in different phases of the cycle, so the study may include several procedures during one menstrual cycle.

CUG biopsy is considered a safe and low-traumatic procedure, since only small areas of the mucous membrane are removed in the form of “stripes”. The information content of the study is increased by collecting several strips of mucous membrane from different parts of the organ.

Evaluation of biopsy results

To adequately assess the condition of the endometrium, the pathologist must know, if possible, the exact day of the patient’s menstrual cycle, therefore, the date of the last menstruation is always indicated in the referral for examination. It is also important to indicate the woman’s age, the nature of the treatment being taken (especially if it is hormonal drugs), the expected diagnosis based on the results of ultrasound and other examination methods.

Deciphering the results of an endometrial biopsy can show the norm, and then the pathologist in conclusion will indicate the specific phase of the cycle and its stage corresponding to the day of the menstrual cycle. These parameters are determined based on the structure of the glands, characteristics of the vessels and endometrial stroma.

The pathology most often detected by biopsy is:

Hyperplastic processes - simple or complex non-atypical, as well as hyperplasia with atypia;
Endometrial polyps with or without epithelial atypia;
Malignant tumors;
Atrophic processes (in older women - a variant of the age norm);
Inflammation (acute or chronic).

Hyperplastic changes are more often diagnosed in patients whose age is approaching menopause, since during this period fluctuations in sex steroids occur, and many cycles are anovulatory in nature. Endometrial cancer occurs in both young and elderly women, and mucosal atrophy is a variant of the normal structure during the menopausal period.

One of the key points in assessing the morphological features of the endometrium is to identify or exclude cell atypia, which may indicate a high risk of malignant transformation. Atypia can be found in areas of overgrown endometrium with hyperplasia, in polyps.

The presence of a dysplastic process and a high risk of cancer is indicated by increased cell division with an increase in their number, polymorphism of the nuclei and epithelial cells of the endometrial glands themselves, and the appearance of pathological mitoses. In cancer, cells acquire malignant features (polymorphism, hyperchromic nuclei, many abnormal mitoses), characterized by foci of necrosis (death), hemorrhages, altered tissue grows into the underlying structures and vessels, which serves as the basis for metastasis.

The main question that a morphologist examining a biopsy often has to answer is whether there is cancer or whether it can be completely excluded. If there is a tumor, then the degree of its differentiation is indicated (well-differentiated adenocarcinoma, for example).

A biopsy for infertility is carried out not only to compare the morphological picture with the day of the cycle, established by the date of the last menstruation, but also for an immunohistochemical search for receptors for sex hormones, which may give a chance to determine the genesis of infertility and choose a way to combat it.

Consequences of endometrial biopsy and possible complications

Regardless of which way the mucous membrane was taken, the procedure inevitably injures the tissue, so there will be bleeding in any case. Their intensity and duration are determined by the method of manipulation.

After curettage, the bleeding is most profuse, often painful, but it is still lighter than during normal menstruation, since the mucous membrane is almost completely removed. The discharge should not contain large clots or pus-like fragments, it should not emit an unpleasant odor, otherwise the woman should contact the doctor again to exclude postoperative inflammation. E If the temperature rises, you need to go to the gynecologist immediately.

The first menstruation after the biopsy comes on time or a little later, it can be more abundant or more scanty. Most often, a delay occurs after a pipel biopsy, but to rule out pregnancy you should still do a test and go to the doctor.

If a woman is planning a pregnancy, then she can count on it in the next cycle. The functional layer will have time to recover, the work of the ovaries is not disrupted, so the fertilized egg can be safely implanted in the uterus. However, experts advise abstaining from sexual intercourse until the discharge completely stops, and in the next cycle use barrier methods.

Further actions of the patient and the doctor will depend on the data of the morphological analysis. If cancer or atypical changes are diagnosed, a consultation with an oncologist is scheduled with the possibility of repeated surgical intervention, but this time radical. For inflammation, anti-inflammatory and antibiotic therapy is indicated; dishormonal processes may require the prescription of sex hormones.

Negative consequences after a biopsy are rare. Most often, patients complain of menstrual irregularities, painful menstruation, and discomfort during sexual intercourse. The most dangerous complication of the intervention is acute endometritis, which occurs with fever, abdominal pain, symptoms of intoxication, and foul-smelling pus-like discharge. This condition requires immediate treatment with repeated curettage of the uterine cavity.

In the presence of chronic inflammation in the genital tract, miscarriages or abortions for medical reasons, broad-spectrum antibiotics are prescribed before surgery to prevent endometritis.

To prevent complications, a woman should maintain sexual rest until the discharge stops, carefully perform genital hygiene, and refrain from visiting the pool, sauna and bathhouse, as well as home hot baths.

Endometrial biopsy is usually performed free of charge, in antenatal clinics or inpatient clinics, but paid diagnostics are also possible.

On average, the price of the procedure is 3-5.5 thousand rubles, depending on the qualifications of the personnel, the conditions of stay, the method used and additional treatment.

If a histological examination of the uterine mucosa is prescribed, then it is impossible to refuse it without compelling reasons. The risk of complications if you follow your doctor's recommendations is minimal, but the amount of information that can be obtained from a biopsy is not comparable to any other non-invasive methods. Only an accurate diagnosis will help you prescribe truly effective treatment, get pregnant, normalize your health, or avoid the consequences of a malignant tumor.

Taking an aspirate from the uterine cavity or aspiration biopsy is a technique for obtaining contents from the uterine cavity in a non-surgical way to study the cellular composition - cytological examination. The process of taking an aspirate is called aspiration, and the resulting material is, accordingly, aspirate.

Taking an aspirate from the uterine cavity is a screening test, that is, a simple, cheap and quick method for identifying organ pathology, which can be performed for preventive purposes for the early detection of a malignant tumor, mainly endometrial cancer.

But taking an aspirate solves the issue not only of diagnosing cancer; in case of infertility or menstrual irregularities, studying the cellular structure of the endometrium - the mucous membrane lining the internal cavity of the uterus - can tell a lot.

If there is a suspicion of an inflammatory process - endometritis in a woman wearing an intrauterine device, or she suffers from endometriosis, then this quick test will confirm or reject the suspicions.

Bleeding in an elderly woman can be caused by both cancer and endometrial hyperplasia, and aspiration biopsy will differentiate the process, which is completely impossible with ultrasound, which reveals pathology but does not distinguish its nature.

In all cases of suspected intrauterine pathology, this is the simplest and most harmless diagnostic method.

When can I take an aspirate?

Aspiration of the contents of the cavity is a simple procedure, but it should not be in vain; the most informative analysis will be a little less than a week after the 20th day from the start of menstrual bleeding, when blood will not be mixed with the endometrial cells. If you do not observe the deadline for taking the microscope into the eyepiece, you risk seeing continuous fields of red blood cells, overshadowing all other cells.

In a postmenopausal woman, aspiration can be performed at any time, but again, outside of uterine bleeding.

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How should a woman prepare for an aspirate?

No special preparations are required from the patient, a banal hygienic procedure and that’s all, because although the uterine cavity communicates with the vagina through the cervical canal, and sperm pass into it, it is a very clean place. Cervical mucus prevents pathological flora from penetrating into the uterus; when douching, liquid does not get there and vaginal medicinal suppositories do not penetrate.

Before the procedure, inflammatory and infectious processes of the external genital organs must be identified and treated.

Is it painful to give aspirate from the uterine cavity?

The manipulation does not require pain relief, much less hospitalization for anesthesia; everything is performed in a gynecological office.

How is the manipulation carried out?

It begins with a standard gynecological examination of the cervix in the speculum, the vagina and cervix are treated with an antiseptic solution. The cervix is fixed with special forceps, and then two manipulation options are possible.

The first method: cellular material is drawn through the cervical canal from the uterus with a catheter into an empty syringe.
The second method: several milliliters of physiological solution are injected into the cavity with a catheter, which washes the entire uterine cavity, and the solution is pulled back with a syringe, resulting in a washout from the endometrium.

The aspirated material is applied to glass slides, which, after staining, are sent for analysis to a cytologist. The waiting time for a response is about two days.

What complications are possible?

A study of aspirate from the uterine cavity is carried out to diagnose pathological processes occurring in the endometrium. The prerequisites for carrying out such a procedure are the presence of multiple disorders occurring in the uterus and ovaries, to assess the effectiveness of treatment with hormonal drugs, to identify the causes of infertility, and in the formation of malignant tumors in the endometrium.

The need for

The use of this technique makes it possible to detect the atypical component of aspirate cells from the uterine cavity at the initial stages of the disease, which facilitates timely treatment and guarantees a successful recovery. The need to use the method of aspiration from the uterine cavity appears in cases of bleeding during menopause, in the case of long-term use of the IUD, in cases of suspected hyperplasia of the mucous membrane, and much more.

If problems are discovered in the condition of the genital organs, the woman must be examined by a specialist and undergo the necessary tests. This is due to the fact that a successful outcome in the treatment of progressive pathology in cases of oncological formations is possible only in the early stages, which can only be diagnosed using the procedure for examining aspirate from the uterine cavity. Analyzing the aspirate in this way provides a detailed picture of the condition of the endometrium and makes it possible to select effective treatment methods based on the individual characteristics of the patient.

The current level of medicine allows a graduate student to conduct an analysis of the uterine cavity during a visit to the antenatal clinic and, based on the study, determine the nature of changes in the endometrium for the presence of malignant formations in the shortest possible time. The results of the examinations, during which aspirate is collected from the uterine cavity, are usually ready within 2 days. If the presence of atypical cells is detected in the analysis results, additional biopsy and histological tests are prescribed to determine the nature of the pathological changes.

Contraindications for aspirate collection

The aspiration procedure is a gentle way of conducting an examination, however, there are some contraindications for its implementation. Aspirate is not recommended in case of exacerbation of chronic diseases of the reproductive organs, as well as their condition in an acute complicated form. Inflammation in the uterine cavity and the presence of pathological foci in the vagina are also an obstacle to analyzing aspirate from the uterine cavity. The use of such a procedure in cases of colpitis or cervicitis is strictly prohibited. Pregnant women are never given an aspirate.

Features of the method

The procedure for collecting aspirate from the uterine cavity is carried out on the twenty-fifth day from the start of menstruation. If there is menopause, patients can undergo this examination at any convenient time. Removing material from the uterine cavity for further research occurs in two ways, using a syringe and a catheter inserted into the uterine cavity. The second method uses a flushing method using a sterile sodium chloride solution injected through a syringe and then drawn back in. The resulting liquid, after a series of procedures using rotation, provides material for further study.

Modern medicine offers improved medical instruments for use to obtain material for research. For example, aspirate from the uterine cavity using the vacuum method differs in many ways from previously used options. Through the slightly open cervix, the depth of the fundus of the uterine cavity is measured, then the required amount of material is taken for further research using a vacuum syringe and cannula. The resulting sample is sent for final analysis.

Possible complications after examining an aspirate

Carrying out the aspirate procedure does not require special preliminary preparation; it is enough to take ordinary hygienic actions. The use of the aspirate method rarely causes complications in the form of severe consequences. Sometimes injury to the mucous membrane occurs during the insertion of a catheter or careless use of a syringe when introducing and suctioning a solution from the uterine cavity. This may result in minor pain in the genital area. If blood vessels are damaged during the test, there is a risk of internal bleeding. The result of such a disorder can be a drop in heart pressure, dizziness and nausea. After some time, discharge mixed with blood may appear from the vaginal cavity.

If inflammatory complications occur as a result of the aspiration procedure, the temperature may rise, loss of strength, fever, and abdominal pain may occur. The manifestation of the listed symptoms is possible immediately after the end of the aspirate procedure, or they may manifest themselves within several days. However, the occurrence of such complications is rare and is the exception rather than the rule.

Aspirate from the uterine cavity is currently considered the most reliable method for obtaining high-quality material for research. With the help of this analysis, it became possible to apply more gentle examination methods to a woman without the use of traditional curettage. This procedure protects the female organs from unnecessary injury and very rarely causes subsequent complications.