Endometrial biopsy is a diagnostic method characterized by taking a small amount of tissue for microscopic examination.
This procedure belongs to minor gynecological operations, since the uterine mucosa is scraped using a special tool.
Endometrial biopsy is based on the appearance of pronounced structural changes in the endometrium in response to hormonal stimulation. Most experts argue that the correct diagnosis of endometrial dysfunction is possible only with close contact between the gynecologist and the pathologist. In the history of medicine, endometrial biopsy was first performed in 1937. In order to conduct a correct diagnosis by scrapings from the endometrium, it is necessary to create certain conditions.
To conduct a correct diagnosis, the doctor must adhere to certain rules:
- in infertile women with suspected anovulatory cycle scrapings are taken before menstruation or directly during menstruation;
- repeated streak scrapings are performed for amenorrhea for four weeks with an interval of one week;
- with menorrhagia, scraping is taken on the fifth to tenth day after the onset of menstruation;
- metrorrhagia scrapings are usually taken immediately after bleeding;
- to diagnose neoplasms, endometrial scrapings can be taken on any day of the cycle.
The purity of the experiment depends on the correct selection of the biomaterial. If fragmented pieces of tissue are submitted for examination, it is extremely difficult to restore the structure of the endometrium. Proper curettage involves obtaining large, non-crushed strips of the endometrium. In the process of curettage, after each passage of the curette along the walls, the endometrium is removed from the cervical canal.
Endometrial biopsy can be performed in several ways:
- complete diagnostic curettage of the uterus. Most often, curettage is performed separately (first from the cervical canal, then from the uterine cavity). In case of bleeding, especially in the perimenopausal period, curettage of the tubal corners of the uterus is carried out with the help of a small curette, since it is in these zones that, as a rule, polypous growths of the endometrium are localized. It is in these areas that malignancy begins. If carcinoma is suspected (soft, crumbling tissue is scraped out at the first injection of the curette), scraping stops immediately;
- endometrial aspiration biopsy is performed during mass examinations of women in order toendometrial cancer;
- stroke scrapings of the endometrium are made to determine the reactions of the mucous membrane to the endocrine function of the ovaries, to determine the causes of infertility, to monitor the results of hormone therapy. The presented technique is not applicable for uterine bleeding.
Pipel biopsy of the endometrium is performed using the Paypel instrument (a flexible tube with a diameter of three millimeters with a side hole at the end). A piston is placed inside the tube, as in a conventional syringe. Indications for this type of biopsy: bleeding in women over forty; bleeding due to the use of hormonal contraceptives; diagnosis of the endometrium in infertility; heavy bleeding in premenopause; menopausal bleeding.
