If a doctor detects pathological processes in the body of the uterus, he prescribes an aspirate collection for his patients. The contents are examined to determine the condition of the endometrium, its structure and compliance with one or another phase of the menstrual cycle. Let's look at how aspirate is selected, why it is needed and how to prepare for it.
Aspirate analysis is the most effective way to extract uterine contents for later analysis.
Unlike scraping, pipel analysis is more reliable and gentle. It does not harm or injure the uterine mucosa.
That is why more and more doctors trust this minimally invasive and painless diagnostic method, which reveals many pathologies.
This diagnostic method can be used in the following cases:
Every patient knows what a biopsy is. Of course, for many women this word is associated with unpleasant sensations. After all, during a biopsy, a fragment of tissue from the organ being examined is taken, which is accompanied by pain due to the obligatory expansion of the uterine cavity. As a result, endometrial aspirate is taken in such cases using an anesthetic.
Pipel analysis is radically different from a biopsy. First of all, the fact that before the procedure there is no need to perform anesthesia or other procedures. In order to take the necessary biological material, a vacuum syringe with only three millimeters in diameter is used.
Before performing a biopsy, there is no need to dilate the uterus or administer special medications to the woman. Moreover, the penetration of the piston may not even be noticeable to the patient.
The results of the pipel analysis are accurate and with a high degree of probability allow you to determine the correct diagnosis and exclude options when diagnosing a particular disease.
Research cannot be done spontaneously, on any day: this does not give the correct results. Endometrial analysis is done only during the period from 20 to 25 days of the menstrual cycle. This is due, first of all, to the physiology of the woman’s genital organs.
The doctor must perform the following manipulations:
The collection procedure is completed within a few minutes. No special preparation is required for it; the woman can wash herself and take a shower before and after the procedure. The day before collecting the aspirate, sexual intercourse is excluded, and the introduction of suppositories is not allowed.
Immediately before the procedure, the woman must wash herself and maintain the toilet of the external genitalia.
If you do not wash yourself, then additional risks may arise during the procedure (infections). Special anesthesia is very rarely required.
When analyzing an aspirate, there is a possibility that there will be complications after the procedure. In extremely rare cases, trauma to the body of the uterus is possible. This leads to severe pain. The pain radiates to the abdomen and collarbone and can be unbearable.
During such manipulation, blood vessels may be damaged. After this, internal bleeding may develop with all the ensuing consequences. As a result of the sudden loss of blood, the patient’s health deteriorates sharply.
Consequences of internal bleeding:
The most common negative consequence of uterine aspirate analysis is possible infection, which was already mentioned above.
With the development of an inflammatory process in the uterine cavity, the patient complains of:
The illness may appear immediately after taking the liquid. That is why before such a procedure a woman needs to wash herself thoroughly. Then taking aspirate from the uterine cavity will occur with less risk of infection.
Analysis of uterine aspirate reveals the causes of infertility and allows appropriate treatment to be prescribed. This is why many women need to undergo such a procedure before planning a pregnancy. Moreover, a test before another pregnancy will avoid complications.
The pipel test is indicated in cases where:
After carrying out Pipeline diagnostics, successful pregnancy treatment and recovery are guaranteed. This means that a woman has a much greater chance of giving birth to a healthy child.
Like any other diagnostic measure, the pipel test has contraindications. So, taking an aspirate is prohibited in such cases.
In general, analysis of uterine aspirate is a fairly effective procedure that allows one to determine the causes of many gynecological pathologies and prescribe their treatment in a timely manner.
[12-043 ] Cytological examination of aspirate from the uterine cavity
715 rub.
Order
Study of the characteristics of cells, their nuclei (size, shape, degree of staining) and endometrial glands, used for the diagnosis of benign diseases, precancerous conditions and endometrial cancer.
Synonyms Russian
English synonyms
Research method
Cytological method.
What biomaterial can be used for research?
Aspirate from the uterine cavity.
How to properly prepare for research?
No preparation required.
General information about the study
There are several ways to diagnose endometrial diseases. Today, the main research method is diagnostic curettage (curettage of the uterine cavity) - an invasive procedure during which fragments of uterine tissue can be obtained using a special surgical instrument. These fragments are sent to histological study, allowing us to establish the nature of the cells and their ratio in the sample. Curettage involves artificial expansion of the cervical canal (dilation of the cervix) at the first stage of the procedure and is performed under general anesthesia in a hospital setting.
Cytological examination- This is an addition to histological examination. The main differences between the two methods are as follows:
Indications for cytological examination of aspirate from the uterine cavity overlap with indications for diagnostic curettage:
Cytological examination allows to identify signs of impaired endometrial proliferation or inflammatory process, as well as pathogenic microorganisms. The pathologist studies the characteristics of cell nuclei and the characteristics of the glands and comes to one of the following conclusions:
When using the aspiration biopsy technique, material adequate for a full analysis can be obtained in more than 90% of cases. This is comparable to the result using the curettage method. According to one study, the sensitivity of cytological analysis for any pathological process in the endometrium is approximately 88%, the specificity is 92%, the positive predictive value is 79%, and the negative predictive value is 95%. It was also shown that the results of cytological examination are in very good agreement with the results of histological examination. On this basis, some authors suggest using cytological examination as the first stage of diagnosis, and curettage and histological examination as the second stage of diagnosis in women with a pathological result of cytological examination. This approach, however, is not universal.
What is the research used for?
When is the study scheduled?
What do the results mean?
What do the results mean?
Based on the submitted material, a doctor’s report is issued.
Examples of cytological examination conclusions:
What can influence the result?
Important Notes
Who orders the study?
Obstetrician-gynecologist.
Literature
Vacuum aspiration of the uterine cavity is the easiest and most reliable way to extract the contents of the uterus for examination. Unlike diagnostic curettage, this method is much more gentle on the delicate mucous membrane of the uterine cavity, does not injure it, and leads to complications such as inflammatory processes much less often. Taking aspirate from the uterine cavity is indicated in the following cases:
Cytological examination of the aspirate helps to track whether the endometrium corresponds to the phase of the cycle, whether malignant formations are developing in it, and to identify uterine cancer at the earliest, preclinical stage.
A woman who is about to undergo aspiration of the contents of the uterine cavity is usually interested in how painful such a manipulation is, on what day of the cycle it can be performed and how to properly prepare for it.
Until recently, Brown syringes were used to take aspirate from the uterine cavity - plastic containers with a length of 300 mm and an outer diameter of 3 mm, and the woman could experience unpleasant, even acutely painful sensations. Now more advanced instruments are used for these purposes: vacuum syringes made in America and cannulas made in Italy. In order to minimize discomfort, you should take a painkiller 30-60 minutes before the procedure. The study is usually prescribed on days 20-25 of the menstrual cycle.
During the procedure for taking aspirate from the uterine cavity, the doctor performs the following manipulations:
Vacuum aspiration of the contents of the uterine cavity is performed within the walls of a regular district antenatal clinic and takes only a few minutes. This procedure does not require any specific preparation, so the woman only needs to carry out ordinary hygiene procedures, as before an ordinary visit to the gynecologist.
Taking aspirate from the uterine cavity should not be done in case of acute or exacerbation of chronic diseases of the genitourinary system, or the presence of inflammatory processes in the cervix and vagina.
In a small percentage of cases, in the process of taking aspirate from the uterine cavity, the mucous membrane of the uterine walls may be injured, which is manifested by abdominal pain that radiates upward to the collarbone. If blood vessels are injured during the procedure, internal bleeding may occur. As a result of blood loss, blood pressure drops, a feeling of nausea and dizziness, and bloody discharge from the genitals appear.
Another possible complication after aspiration of the uterine cavity may be the development of an inflammatory process in the uterus. In this case, the woman experiences weakness, pain in the lower abdomen, and a rise in body temperature. Symptoms of inflammation may appear either a few hours after taking the aspirate or several days later.
Biopsy is one of the most important diagnostic methods used in gynecology. For various diseases of the uterus, suspicion of atypical development of the endometrium, this method makes it possible to obtain the most accurate information. Based on this, a decision is made on how complex the treatment is needed. There are several methods for carrying out such a procedure. Among them, the aspiration method of collecting material is the least traumatic. When choosing a date for a biopsy, the nature of the pathology and the characteristics of the state of the endometrium on different days of the cycle are taken into account.
Content:
An endometrial biopsy is the removal of a sample of the mucous membrane from the uterine cavity using mechanical devices. The resulting material is examined in the laboratory to determine the structure of endometrial cells and detect deviations in its condition. The method allows you to diagnose mucosal hyperplasia and the formation of polyps. Study of the extracted material is necessary to detect precancerous changes in the structure of cells, as well as their malignant degeneration.
Endometrial particles are collected in various ways:
The latter method uses a flexible catheter through which the material is collected into a syringe or thin tube with a piston at the end (pipel). Sometimes aspiration is performed using an electric vacuum device.
Using the endometrial aspiration biopsy method allows you to do without dilating the cervical canal of the cervix - a painful procedure necessary for inserting instruments into the uterine cavity during curettage. The use of a flexible tube significantly reduces the risk of wall damage and the development of an inflammatory process.
The material can be removed from any part of the uterus using disposable, sterilely packaged devices (there is no chance of infection from insufficiently sterilized instruments).
Compared to traditional curettage and CG biopsy, aspiration is a virtually painless procedure that can be performed on an outpatient basis. The likelihood of complications is very low, so after such a procedure the functionality of the uterus is quickly restored. The patient can return to her normal lifestyle almost immediately.
Due to its advantages, this method is especially often used when examining women planning a pregnancy (for example, before IVF). Despite its simplicity, the method is quite informative and does not require special preparation.
Among other aspiration techniques, the most modern is pipel biopsy.
Disadvantages include the inability to simultaneously study the structure of the entire endometrium. Since samples are taken from only selected areas, there is a risk that individual areas of damage will go undetected.
Indications for endometrial aspiration biopsy are:
This is the most preferred method when examining the condition of the endometrium after hormonal therapy.
Aspiration biopsy is not performed during pregnancy.
Its use is contraindicated in the presence of acute inflammatory processes in the genital and urinary organs, as well as in infectious diseases.
The procedure is not prescribed if the patient has low blood clotting due to diseases of the hematopoietic organs. If low blood viscosity is caused by the use of anticoagulants, then aspiration biopsy is performed only if such drugs can be stopped for some time.
A contraindication to aspiration biopsy is the woman's allergy to medications used for local anesthesia.
Before prescribing the aspiration procedure, the patient must undergo an examination (gynecological examination, ultrasound, colposcopy). In addition, it is necessary to examine the microbiological composition of smears from the vagina and cervix to detect infectious agents.
Blood tests are also performed for leukocytes and the hCG hormone (its level is increased during pregnancy and some diseases). The absence of antibodies in the blood to the pathogens of syphilis, HIV, and viral hepatitis B and C is also checked.
The doctor asks the patient what medications she is taking and warns her about the need to avoid them for several days before the procedure. Before a biopsy, a woman should not douche, use vaginal ointments, or suppositories. It is necessary to abstain from sexual intercourse 2 days before the biopsy. Foods that cause bloating should be excluded from your diet. On the eve of the procedure, the stomach is cleansed with an enema.
In young women, the day of the procedure is selected depending on the purpose of the examination.
There are several options for performing an endometrial aspiration biopsy procedure.
A catheter with a diameter of 2-4 mm is inserted into the uterine cavity until it touches the wall. Using a thin syringe attached to the outer end of the tube, mucous particles are removed. The resulting sample is then applied to a microscope glass for histological examination.
Through the catheter using the same syringe, 3 ml of saline solution is injected into the uterus. The presence of sodium nitrate in it prevents the formation of blood clots. The liquid is immediately drawn back into the syringe. It is transferred to a test tube and placed in a centrifuge for several minutes. Endometrial cells settle at the bottom, after which they can be examined.
The procedure is more informative, but requires prior use of painkillers that relax the cervix (baralgin, analgin) or injection of lidocaine directly into its muscle.
A probe is first inserted into the uterine cavity to examine the depth of the organ and select an aspiration tube of the appropriate length. Then the probe is removed and a flexible tube connected to a vacuum pump is inserted. By moving it into the uterine cavity, material is collected from several areas, and then it is transferred to a container with a formaldehyde solution.
You can control the selection process using ultrasound. When performing such aspiration, healing of the surface of the uterus occurs more slowly, taking 3-4 weeks.
Instead of a catheter, a thin plastic cylinder is used. At one end, inserted into the uterine cavity, there is a side hole, at the other - a piston. With its help, a vacuum is created inside the cylinder, the hole sticks to the wall, and endometrial particles are sucked into it.
Complications after aspiration (endometritis or bleeding) occur extremely rarely if the preparation rules are followed. A woman must follow the doctor’s recommendations: do not lift anything heavy, refrain from other physical activities, bathing, or visiting the sauna. Over the next few weeks, it is necessary to avoid sexual intercourse, hypothermia, and especially carefully observe the rules of personal hygiene.
Warning: Since using this method does not cause a significant change in the structure of the endometrium, in the absence of serious pathologies, pregnancy can occur already in the current or next cycle. However, you should plan to conceive only after receiving the results of the biopsy.
In some cases (if the procedure is performed after recovery from chronic inflammatory processes in the organs of the genitourinary system), antibiotics are prescribed for preventive purposes. If symptoms such as fever, purulent or bloody discharge with an odor, or abdominal pain appear, a woman should immediately consult a doctor.
Deciphering the results takes up to 2 weeks.
Menstruation usually comes on time after such a biopsy, sometimes with a slight delay (up to 10 days). Their duration and volume may change slightly, and subsequently the nature of menstruation will depend on the type of treatment performed.
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 its advantages and disadvantages are.
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:
Recently, these manipulations have become widespread for various indications:
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.
Now let's look at each type of aspiration biopsy separately.
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 resulting tissues are fixed depending on their quantity. If there is a good, abundant aspirate, the biopsy 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.
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.
Let's start with the positive points:
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:
Although the procedure is called “office”, a minimum examination is still required before it:
Complications with this type of procedure are extremely rare, but it is important to know the possible ones:
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.
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