Endometrial biopsy (paypel, aspiration, Zug): what it is, what day of the cycle, doing that show

Any pathological changes in the endometrial structure had a negative effect on the reproductive function of women (violation of cycle, infertility and miscarriage of the child, the development of tumors).

One of the most modern diagnostic methods is paypel-endometrial biopsy. During the operation extracted particle endometrium, then conducted histological examination. Operation reveals atypical changes, determine the cause of menstrual irregularities or infertility.

Depending on the technology implementation, there are several ways to extract tissue: partial scraping operation, hysteroscopy.

Description endometrial biopsy

The purpose of a biopsy of the endometrium is a study to identify the causes of infertility, miscarriage, menstrual irregularities. Also, the procedure is used in preparation for IVF. It allows you to get full information about the state of the mucous membrane.

Aspirate taken from the uterine cavity and hormonal abnormalities, history of miscarriages, uterine bleeding, is not associated with menstruation, hyperplasia, malignant neoplasms.

During the procedure, operationally removed mucous particles. Depending on tactics execution fence fabrics produced via ducts vacuum device or syringe. In conventional curettage is used for diagnostic purposes surgical curette. Material for the study can also be obtained during hysteroscopy with a probe. Equipped with a video camera device has a small surgical instrument which takes samples with a dot of the uterus (endometrium).

Modern equipment allows without damaging healthy tissue to take a sample of the mucous membrane in the desired zone - the uterus, cervical canal. The possibility of complications and discomfort during surgery is minimized. Biopsy refers to a small surgical intervention. Typically, it is conducted scheduled for diagnostic purposes, but rarely implemented in the framework of the basic operation or in an emergency order.

Servicing is

Diagnosis via aspiration biopsy or other type of sampling of material is carried out at various uterine defects absence of menstruation and bleeding during menopause.

If the research carried out planned operations precede such diagnostic measures:

• taking a smear cytology and flora;
• behavior colposcopy;
• US of organs located in the pelvis women;
• urinalysis and blood.

Extra biopsy carried out in cases of suspected or ascertaining the presence of cancer in the uterus or cervix, it ignores day cycle.

Also in preparation are recommended:

• receiving a rejection of drugs affecting coagulability of blood, and anticoagulants;
• temporary abstinence from sexual activity (at least three days before the operation);
• abandonment of irrigation;
• exclusion from the menu of dishes that cause flatulence.

Improper preparation for operation may cause various complications, such as vascular injury (as a result - the bleeding), rejection of the endometrium, impaired cycle.

When the aspirate taken from the uterine cavity

Endometrial biopsy is performed on the testimony which determines watching a woman doctor. Taking aspirate from the uterus in the following cases:

• suspicion of tumor growth;
• scanty menstruation or uterine bleeding, including dysfunctional;
• in the presence of inflammatory processes of the endometrium;
• determining the cause of infertility, miscarriages or missed abortion;
• amenorrhea without pregnancy for unknown reasons;
• preparation for the IVF procedure;
• pregnancy pathology.

Scraping of the endometrium to determine its structure and to identify abnormal cells. As determined by its thickness, precise localization.

Procedure shall apply if after the standard gynecological examination and ultrasound of the doctor detects pathological changes in the endometrium. Always diagnosis is carried out before the removal of fibroids or myomas, polyps, cancer.

Contraindications

The list of contraindications is the same for all variants of this diagnostic procedure. Paypel biopsy is not carried out in the following cases:

1. Pregnancy. Even if you have unprotected sex before the surgery, when the definition of conception is impossible standard home test, done research on HCG levels for ascertaining facts fertilization.
2. Bleeding disorders. In such cases, aspiration biopsy is not performed. Sometimes diagnostic event is preceded by treatment of the underlying pathology.
3. Presence of infection (chronic or acute process). About Pathology say pain, itching, bleeding, not associated with menstruation, purulent discharge.
4. It also contraindications include hemophilia, a high degree of anemia, some chronic diseases in the acute stage.

The list of contraindications strictly taken into account before the diagnosis of conduct in order to avoid side effects after surgery.

Suspected oncological causes a direct indication for carrying out diagnostics, and emergency. In this case, a biopsy is performed with a minimum of contraindications.

What is the procedure

Endometrial biopsy is performed by different methods, but the most used is the aspiration option. It is less traumatic, is completely absent discomfort during the procedure, the risk of complications and side effects minimized, and the information content of the study is quite high.

Fence analysis carried out after appropriate preparation for a procedure which starts 3 days before the manipulation. Immediately before the test intestines cleaned with an enema.

Mucosal biopsy of the cervical canal or uterus lasts no more than 3 minutes (average of 30-60 seconds, depending on doctor's skill). Occasionally a woman may require anesthesia. The absence of nerve fibers allows manipulation with a minimum use of painkillers.

Biopsy with erosion assumes fence material with cervical canal or uterus by vacuum / syringe / tubing / curette. In addition, the doctor may remove polyps.

Scraping the uterine lining and further histological examination of material held women of any age, including during menopause, before or after delivery and pregnancy.

Timing and technique of biopsy

Endometrial Biopsy performed at certain periods of the cycle, depending on the goals pursued diagnostics:

1. The refinement of infertility factors on the background of anovulatory cycles and luteal phases of the minimum analysis is done one day before the beginning of the month or the first day of bleeding.
2. In the case of acyclic bleeding not related to menstruation, scraping the mucosa is assigned to the first or second day of menstruation.
3. When diagnosing polimenorei manipulation is carried out in the period between the fifth and tenth days of the cycle.
4. To investigate the cause of failure of hormonal sample is taken during the second phase of the cycle between 17-bit and 25-mi days.
5. If you suspect the presence of benign and malignant tumors of the scraping is taken regardless of the day of the cycle (extra).

Any study provides an introduction into the vagina of a special device for taking samples of endometrium. The techniques differ in the duration of, the possible side effects of informativeness.

Scraping

Scraping biopsy - a procedure as a diagnostic and therapeutic. Curettage was used not only to identify previously endometrial pathology, but also for emergency aid for bleeding.

cervical scraping is now used less frequently than other methods, as is done blindly, sometimes under ultrasound imaging or body of the device by means of a hysteroscope. Manipulation is performed under general anesthesia, usually intravenous.

Such a procedure not only allows you to identify the cause of the changes in the lining of the structure, but also has a therapeutic effect:

• emergency stop bleeding from the uterus;
• removing the damaged mucous portion;
• removal of polyps and other glandular tumors (except malignant).

Best time for scraping considered 3-4th day before menstruation, and in violation of the cycle - the first day of occurrence of acyclic blood secretions.

The total time of the operation takes up to 20 minutes, preferably as analgesia intravenous anesthesia. During operation vulva disinfected iodine-containing drugs, urine output using a catheter.

After the introduction of short anesthesia special tool called cervical canal curette surgical material scraped and placed in a special vial. After that hysteroscopy is performed a review of the mucous membranes of the uterus, then curette larger again take material from the inner surface of the body. The obtained sample was placed in a separate vial and sent for histology.

aspiration biopsy

Aspiration technique for obtaining tissue samples is used more often than scraping. With this technique does not require an extension of the cervical canal because the procedure is quite painful. A flexible tube used during the procedure, eliminates the risk of traumatizing the uterus.

The suction tube material allows to obtain from any department using sterile devices, which reduces the risk of infection. Also, if you are using aspirate biopsy is taken almost painlessly, quickly restored the uterus, a woman can return to usual life immediately after scraping.

The negative factors of aspiration biopsy is the impossibility of simultaneous examination of the structure of all sections of the endometrium. There is a risk that local small pockets of damage remain unexplored.

Results of histological examination of material selected in this manner have a high information content.

particulate sampling from the endometrium is performed on different days, depending on the task:

• to remove a polyp immediately after menstruation;
• in the 1st day of the cycle in atypical secretions of the blood;
• during hormonal treatment - at 17-24-day cycle (and also for monitoring the prescribed treatment);
• in case of prolonged and painful menstruation - to 7-10th day;
• to clarify the factors of infertility - 2-3 days;
• irrespective of the day after / before the month in determining malignancy.

Aspiration biopsy is conducted by several methods: Particle fence tissue immediately into the syringe, placing tissue samples in saline or application of a vacuum installation.

Paypel biopsy

This method for diagnostic rather than aspiration biopsy and scraping. In the diagnosis of catheter replaces a small plastic cylinder. At one end, placed in the uterine cavity, there is a small hole in the side, on the other - the piston. When removing material vacuum formed, the hole is attached to the uterus, mucous cells literally sucked into the apparatus.

The procedure is also carried out in certain periods of the menstrual cycle, depending on the type of study. The technique has several advantages:

• painless, does not apply anesthetics;
• no side effects;
• held without dilatation;
• the most informative;
• flexible tube allows you to control the depth of the introduction, which reduces the risk of injury of the uterine wall;
• not require hospitalization;
• less contraindications, the possibility of use in women with severe chronic or acute diseases.

This technique also allows you to identify the causes of hormonal disorders, infertility, to evaluate the growth of tumors.

Zug biopsy

This technique is one of the least dangerous and less traumatic compared with endometrial aspiration biopsy or curettage. It can be carried out a maximum of three times in the cycle.

This technique is not applicable for diagnosing precancer or cervical malignancies.

To investigate the cause of uterine cervical canal diseases artificially expands, small curette gently introduced into the body cavity. With the help of the tissue collected from the surface of the inner layer.

Shaped scraping depth of the endometrium carried out up to the internal cervical os. At a time two samples collected material.

The procedure is performed on 1-2 th day of menstruation or after. Taken mother material is also sent to histology, which allows to accurately identify the cause of infertility, hormonal changes, uterine bleeding, tumor localization.

Procedure for infertility

Endometrial biopsy is considered one of the leading methods to refine the factors causing infertility, miscarriage, miscarriage, termination of the viability of the fetus, and other reproductive harm female function. Furthermore, it is possible to establish the cause of diseases of the uterus biopsy, to increase the chances of attachment of the embryo when administered IVF.

The procedure helps not only to identify the factors of infertility. Even pregnancy that occurred against the background of in vitro fertilization, occurs more often. Marked by a high percentage of effective IVF. Positive effects were recorded when the biopsy was carried out in the month prior to fertilization.

surgery is performed in the same way as a conventional diagnostic procedure to clarify infertility factors. Examination of the material makes it possible to identify the presence or absence of atypical cells, including precancerous status, hormonal disorders, inflammation, hyperplasia, and other factors that lead to a lack of conception.

Complications and consequences

Aspiration biopsy with professional conduct virtually no side effects. The most dangerous in terms of risk is a normal scraping, because after it may develop bleeding due to uterine wall injury, and other complications. On the whole, are possible undesirable consequences:

• heavy bleeding - can occur against the backdrop of traumatic uterine wall or cervix;
• dizziness and other signs of weakness;
• pulling or acute pain;
• after the development of the inflammatory process of infection in case of insufficient sterility of the instrument (for scraping);
• fever.

Biopsies woman receives no earlier than 6-7 days after the manipulation. Histological examination of the endometrium fragment reveals various pathological processes: oncology, diffuse and atypical hyperplasia, atrophy, endometriosis, hormonal failure. According to the results is assigned to appropriate therapy.

Always manipulations are carried out before surgery for the removal of uterine fibroids, cancers.

Biopsy - the most effective way to determine the cause of endometrial pathology. This minimally invasive method most accurately reflects the processes taking place inside the uterus, allowing the early stages of growth identified cancer or polyps, serves to clarify the hormonal status, identify the causes of infertility and other disorders reproductive function.