Deciphering the test results of cervical biopsies

gynecologic diseases include invasive diagnostic methods, as well as invasive technologies and the last representative of a variety of cervical biopsy, allows us to study in detail the structure of surface epithelium. The procedure is the removal of pieces of card cervical tissue for histological analysis under a microscope. The result of the biopsy allows to exclude or confirm the malignant tumor.

The following parameters are specified in the deciphering of the analysis:

• epithelial differentiation, implying structural differences between the layers of the cells;
• fact and degree of keratinization;
• state of the nucleus and cytoplasm, shapes and sizes of cell elements, the presence of atypia is also indicated in decoding;
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• mitoses - division activity;
• stratification of the epithelium;
• the presence of inflammation and leukocyte infiltration due to infection;
• the state of the basement membrane, spread beyond its borders atypical cells;
• state vessels;
• the location and characteristics of the transformation zone - the place of transition into the cylindrical squamous epithelium, the presence of metaplasia (substitution cylindrical fabric flat view) is also indicated in decoding.

Cervical Biopsy It designed primarily to rule out cancer.

There is no strictly specific complaints with this dangerous disease. Furthermore, preinvasive stage which is characterized by the absence of characteristic features, lasts from 1 to 5 years. Therefore, wariness oncology physicians fully justified. After performing such analyzes as cytology and colposcopy, women often prescribed biopsy to exclude malignancy. In the analysis of the patients complaints it found that bleeding from the vagina B1 correspond to the first - second step 2A. And the pain and discomfort characterize 2B 4A-stage cervical cancer. Biopsies allow to promptly take action and determine the treatment strategy.

Indications for biopsy of the cervix

After the inspection of the cervix in mirrors physician may suspect pathology, but it should be noted that the initial step change epithelial structures do not have external features. Therefore, every woman should undergo annual screening tests in the form of Cytology and analysis on sexual infections. Based on the cytogram results of the analysis, as well as any changes in the visible surface of the cervix, colposcopy is performed. After deciphering colposcopy gynecologist detects the presence of the indications for biopsy.

This analysis is carried out in the first phase of the cycle, preferably between 7 and 13 day cycle. The most favorable period of execution of analysis are the days immediately following menses. This will allow the tissue to recover as quickly as possible. If there is suspicion oncology, cervical biopsy is performed on any day of the cycle.

A biopsy is performed in the following situations:

• availability as a result of cytology dysplasia symptoms: impaired epithelial layering, a different size and shape of cell elements in the analysis, large nucleus, clear nucleoli, keratosis (actinic);
• as a result of the presence of colposcopy atsetobelyh portions, iodine-negative areas and mosaic punktatsii, keratosis, atypical vessels;
• External changes in the cervix: leukoplakia, warts, polyps, erythroplakia.

A biopsy is performed, usually during colposcopy for the accuracy of the capture of suspicious sites.

If the result of cervical biopsy 3 shows the stage dysplasia or cancer, the patient is sent for consultation to cancers.

The analysis is not carried out upon detection of a smear acute inflammatory reaction in the first and last trimester of pregnancy, acute respiratory infections, disorders of blood coagulation, severe extragenital diseases character.

Progress analysis

Depending on the decoding cytology and colposcopy, cervical biopsy may be performed using the species:

• or sighting point;
• conization or cone-shaped excision of cervical tissue (excisional biopsy).

To prepare for the analysis of the patient delivers the necessary tests: cytology smear on bacterioscopy, blood and urine tests, coagulation. To carry out targeted biopsy for the purpose of fulfilling the decryption results take a few pieces of tissue from different locations under the control of a colposcope. Perform the procedure using eletkropetli or radiofrequency apparatus. Local anesthesia if necessary.

cervical biopsy, regardless of the type of performance is carried out with the capture of healthy tissue 5-7 mm for a total reflection results in decoding and efficiency diagnostics.

Cone biopsy is both therapeutic and diagnostic method at a time. Using electrode-triangular sails or radiowave scalpel excised cervix cone. to perform such analysis also applies laser scalpel, however, a significant disadvantage is the cut edges of the charring, which complicates decoding biopsy. The most suitable method is considered radiowave technique the execution due to the absence of charring as well as simultaneously sealing vessels and sterilization of wounds. Excisional biopsy is performed in the presence of dysplasia symptoms in decoding cytology.

Deciphering the biopsy results

Upon detection of pathological changes in the results of detailed analysis indicated all changes. Disease may have an infectious-inflammatory in nature and have a new formation: a benign, precancerous and cancer.

1. Inflammation of the cervix and uterine cervical department as a whole (cervicitis and endocervite) are described in the results enhanced mitosis, a large number of leukocytes (infiltration), signs of cell degeneration and portions necrobiosis. Atypia is absent. Nucleus and cytoplasm have no significant changes.
2. Metaplasia characteristic of the true form of healing erosions and described in deciphering the great amount of metaplastic cells, cylindrical and planar fabrics have varieties features.
3. Polyps can be as simple and benign or precancerous. In the first case as a result of a large number of fixed glands, cylindrical or flat epithelial cells that form a polyp, in the center of the rod it is pierced by connective tissue. In the second case noted atypia and excessive mitosis.
4. Warts is one of the results of the pathogenic effect of HPV, so the presence of fixed koylotsitov, enlarged nucleus, the cells are deformed, there keratosis, many small cells.
5. Leukoplakia with atypia are also considered for this disease when activated by HPV. In decoding there is a violation of maturing squamous cells, keratosis, the kernel can absent inclusion in different cells, basal cell elements present in thicker epithelium there koylotsity.

The biopsy and the cancer stage

cervical biopsy is one of the techniques necessary for the staging of cervical cancer. In addition to biopsy results, determined after performing step colposcopy, cytology, radiography, intravenous urography, diagnostic endocervical curettage and body cavities. If necessary, carried out and a number of other tests (stsintiografiya, cystoscopy, multislice CT and MRI with contrast).

Diagnosis of Cervical Cancer A1 and A2 of the first stage is carried out only by the result of a biopsy, and more specifically, according to the definition histological examination of tissue removed.

Most often, when poor cytology and colposcopy performed conization with the capture of healthy tissue at a rate of 5 mm in diameter. If the tumor spreads in a horizontal plane for analysis of tissue excised with the capture of 7 mm. In deciphering the biopsy indicates the presence of tumor invasion into vessels, but it does not affect the staging, however, it has to be reflected in the result. Germination in the vessels determines treatment.

The first step involves not only the diagnosis based on biopsy results, but with the other methods. If the doctor visualizes the mirrors suspicious formation, confirming the unfavorable results of cytology and colposcopy, the pre-exposed in the first stage. The specialist may assume in the second stage of cervical cancer in the presence of assays distribution data tumor towards pelvic wall of the uterus body. In this case, the doctor palpates the seal in the area of ​​the vaginal wall and uterus.

The third stage, in addition to characteristic changes in the histological study of biopsy, has spread to the pelvis, hydronephrosis, ureteral contraction. At the same time, in some cases, in deciphering cervical biopsy is indicated 1 or 2 stage of cancer, and in additional studies found tumor invasion in the pelvic region and urinary organs. This is due to the individual characteristics of cancers growth.

As is known, the most common types of cervical cancer based on biopsy results, refer to the species and squamous adenocarcinoma. Squamous cancer develops from the surface epithelium of the vaginal portion of the cervix and adenocarcinoma - glandular epithelium of the endocervix. Through this analysis, biopsy, skilled possible to determine a type of cancer.

According to the results of a biopsy, carcinoma is divided into:

• highly differentiated;
• moderately differentiated;
• poorly differentiated.

In decoding assay it must indicate the degree of differentiation of cells forming the tumor, then have stratified their delineation on the characteristics of the nucleus and cytoplasm, inherent in the normal laminate epithelium. This feature determines the prognosis of the disease. The most aggressive poorly differentiated characteristics have formation when there is no distinction between stratified cell structural difference between them is generally not.

Squamous cell carcinoma in biopsy results

In the course of the study biopsy under a microscope, the doctor determines the degree of differentiation of squamous cell carcinoma, and describes the result in decoding.

1. Vyskokodifferentsirovanny views squamous formation is defined as follows: Large cell keratinizing epithelium (keratosis) - "cancer pearls", more than 75% of the cellular elements well differentiated, the number of mitoses low, the analysis determines the presence of tumor papillary structure elements are formed by connecting the border cloth.
2. moderate degree a decoding means having biopsy about 50% of the differentiated cells of the type - neorogovevayuschy large, only some elements have signs of keratinization, moderate speed division whose boundaries are blurred - have some degree of infiltration into the surrounding tissues, is defined in the analysis of atypical inflammation character.
3. low differentiation describes a result of the large number of small cells that have a basophilic cytoplasm, nuclei and cell sizes are identical, at least 25% of the cellular elements in layers demarcated (Differentiated), the number of mitoses in decoding biopsy indicated as high, there are pathological tumor boundary have mild, there is infiltration of malignant cells beyond borders.

adenocarcinoma

In describing the results in uterine cervical adenocarcinoma biopsy also indicates three degrees of differentiation of tumors.

1. The high degree of a decoding analysis means well-formed with the presence of prostate papilla cell elements have an elongated shape, oval nucleus, the number of layers - at least three. In addition, the decoding indicates that the number of rare mitosis.
2. average differentiation tumor biopsy analysis describes the presence of complex glands frequent mitoses, the nuclei have a rounded shape, and an irregular cell shape, there are various inclusions.
3. Low level deciphering includes a large number of isolated cancer cells, small amounts of iron, cell elements of large and uneven, some are in the form of the ring, the nucleus is damaged, a lot of pathological mitosis. In addition, the interpretation of the biopsy indicated the presence of necrotic changes.

The value in the differential diagnosis of

Of primary importance of this analysis, as cervical biopsy is the ability to distinguish the nature of the formation at the surface of the body. Often, ectopia, dysplasia or cancer may look in the mirror exactly the same. Results of a biopsy, cytology and colposcopy allow the doctor to make a definitive diagnosis.

The most difficult task is the decryption result of the analysis under microinvasive cancer or precancerous condition (dysplasia 3 levels). Only a biopsy can put a point when searching for the correct diagnosis. Furthermore, immunohistochemistry widely used which is capable to reflect production oncoproteins.

In the analysis of cervical biopsy experts estimate the depth of invasion of atypical cells, the horizontal spread of the tumor, the number of outbreaks. The result is a complete picture of the processes in the cervical epithelium.

deciphering biopsy It must include an indication of the state of the remote section of tissue at the edge of conization. So make conclusions about the prevalence of pathological process on the surface and in the thickness of the neck. If the edge of the note abnormal cells, is performed a second operation.

Mainly the differential diagnosis is between ectopia - benign process, and dysplasia - precancerous.

Ectopic on histology

The displacement of the columnar epithelium on the surface of the cervix is ​​often the reason for the emergence of suspicion of cancer, since hearth redness appearance is similar to dysplasia or initial stage cancer. In decoding biopsy will be indicated when the presence of ectopia normal glands, oval or irregular epithelial cells form with the correct outline of the nucleus without pathological inclusions metaplastic cellular elements with large kernel. Possible inflammatory changes in the form of infiltration by leukocytes, epithelial cell elements are directly above the basement membrane and remain lamination. As a result, notes the existence of open and closed ducts glands. The decoding can be specified and the transformation zone in the form of immature squamous epithelium.

Dysplasia on biopsy

dysplasia plot analysis represents keratosis lesions - keratinization, but its degree may be different: acanthosis, hyperkeratosis. In decoding also indicated the presence of leukocyte accumulation around the blood vessels (infiltration). There have extended atypical vessels, atypical epithelial cells with a modified core to propagate at different basement membrane thickness, lamination is disturbed. If abnormal cellular elements penetrate beyond the membrane, talking about cancer, which is indicated as a result.

Mild (CIN1) atypical elements describe in the upper layer coating the tissue. At moderate (CIN2) - in the surface and intermediate, with severe (CIN3) - down to the basement membrane.

Tactics of treatment depends on the revealed pathology.