Endometrial biopsy

Endometrial biopsy is a diagnostic procedure in which the doctor removes a small piece of tissue or fluid from the uterine cavity. Then the sample is sent to a laboratory for testing.

The procedure can be performed under the control of a hysteroscope, with the forceps. Or minimally invasive, with a special miniature probe - a pipel (a thin tube with a piston inside), in the ambulatory, painless for the patient. To the doctors of Universum clinic, a pipel biopsy provides valuable medical information about pathological processes in the uterus and makes it possible to draw up an individual plan for the effective treatment of the patient.

Indications for endometrial biopsy

The reason for such examination can be various gynecological diseases if other methods do not allow to establish an accurate diagnosis.

A list of possible indications for pipel biopsy:

• irregular menstrual cycle;

• abnormal uterine bleeding of unknown origin;

• amenorrhea in women who have not reached menopause;

• chronic endometritis;

• bleeding after menopause;

• suspicion of the neoplasm process;

• problems with conception, recently trying the IVF;

• evidence of hyperplasia of the uterine mucosa, detected by ultrasound, MRI, or x-ray methods.

Due to its availability, safety, and informativeness, the pipel biopsy is used as a method of monitoring the response of the endometrium to hormonal therapy, for example, during the treatment of polycystic ovary syndrome.

What can we detect with a pipel biopsy?

LuxMedic Clinic uses all available methods to have the diagnostics of gynecological pathology. In order not to cause excessive discomfort to patients, if there are the indications, in the clinic is performed a non-traumatic aspiration or pipel biopsy of the uterus.

By using this type of minimally invasive technique, the following are detected and confirmed:

• acute or chronic endometritis – infectious inflammation of the inner layer of the mucous membrane of the uterus, its causative agents are determined;

• cellular disorders – benign or malignant processes in the uterus;

• causes of abnormal uterine bleeding;

• early stages of ectopic pregnancy;

• histological and cytological characteristics of neoplasms, cells of endometrial hyperplasia.

Due to its informativeness and safety, minimally invasive aspiration biopsy complements the results of ultrasound and tests, often making it possible to make a reasonable and accurate diagnostic conclusion about gynecological pathology. In certain cases, the technique even helps to avoid diagnostic uterine curettage.

Methodology of endometrial biopsy

In the traditional option, taking tissue for analysis is carried out in a gynecological chair. The doctor disinfects the area of ​​the genitals and the cervix, inserts a hysteroscope into the uterine cavity and through its channel puts thin forceps, with which he pinches off a small fragment of tissue. Modern pipel biopsy of the endometrium takes place differently, it is gentler for the patient.

Stages of the procedure:

• a woman sits down in a gynecological chair;

• speculum are inserted into the vagina and the cervix is ​​exposed;

• a soft retainer is placed on the vaginal part of the cervix;

• a thin polypropylene probe (pipe) is introduced through the cervical canal into the uterus cavity;

• with a light movement, the doctor pulls the inner piston of the tube towards himself;

• the probe and speculum are removed, the procedure is finished.

A sample of biological material and fluid remaining in the pipel is sent to the laboratory for histological, cytological, bacteriological examination. The procedure, unlike the classical hysteroscopic one, often does not cause any unpleasant sensations. To achieve such results, the professionalism of the doctor is important.

How to prepare for the procedure and what are the contraindications

The universalism of pipel biopsy is that it practically does not need to be prepared in advance. The only thing to make the results more accurate, the doctor can recommend examination in certain periods:

• determine which phase of the cycle corresponds to the state of the endometrium - 18-24 days after menstruation;

• in order to find the cause of abnormal uterine bleeding - within 24 hours of its appearance;

• infertility - a day before the expected menstruation or the first day of menstruation;

• polymenorrhea - in the period from the 5th to the 10th day of the cycle;

• control of hormone treatment - on 17–25 days;

• suspicion of a tumor - at any time.

In the case of diagnostics of the causes of amenorrhea and infertility, there may be a need to carry out several procedures with a period of one week between them.

The list of contraindications to pipel endometrial biopsy is short:

• pregnancy status;

• acute fever.

In all other situations, a modern pipel biopsy of the endometrium, at the Universum clinic, is performed in a few minutes, without discomfort, without risks of complications and with maximum informativeness.

Sources

1. “Endometrial Biopsy: American College of Nurse-Midwives.” Journal of midwifery & women's health vol. 62,4 (2017): 502-506. doi:10.1111/jmwh.12652.
2. Hemsell, David L. “Pipelle biopsy.” American journal of obstetrics and gynecology vol. 190,3 (2004): 869; author reply 869. doi:10.1016/j.ajog.2003.08.047.
3. Clark, T J et al. “Accuracy of outpatient endometrial biopsy in the diagnosis of endometrial hyperplasia.” Acta obstetricia et gynecologica Scandinavica vol. 80,9 (2001): 784-93. doi:10.1034/j.1600-0412.2001.080009784.x.
4. Williams, Pamela M, and Heidi L Gaddey. “Endometrial Biopsy: Tips and Pitfalls.” American family physician vol. 101,9 (2020): 551-556.