Endometrial biopsy is a diagnostic method characterized by taking a small volume of tissue for microscopic examination.
This procedure refers to small gynecological operations, since using a special tool, the uterine mucosa is scraped.
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, an endometrial biopsy was first performed in 1937. In order to conduct the correct diagnosis of scrapings from the endometrium, it is necessary to create certain conditions.
To conduct a correct diagnosis, the doctor must adhere to some rules:
- in infertility, women with suspected anovulatory cycle take a scraping before menstruation or directly during menstruation;
- repeated stroke scrapings are performed with 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;
- with metrorrhagia, scraping is usually taken immediately after bleeding;
- for the diagnosis of 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 tissue pieces arrive for examination, it is extremely difficult to restore the structure of the endometrium. Proper curettage involves obtaining large, unbroken strips of the endometrium. In the process of curettage, after each curette is performed along the walls, the endometrium is removed from the cervical canal.
Endometrial biopsy can be done in several ways:
- complete diagnostic curettage of the uterus. Most often, curettage is done separately (first from the cervical canal, and then from the uterine cavity). In case of bleeding, especially during the perimenopausal period, curettage of the uterine tubular corners is carried out with the help of a small curette, since it is in these zones that polypoid growths of the endometrium are usually localized. It is in such areas that malignancy begins. If there is a suspicion of a carcinoma (during the first injections of the curette, soft, crumbling tissue is scraped out), the curettage stops immediately;
- endometrial aspiration biopsy is performed during mass examinations of women in order to diagnose endometrial cancer;
- dashed endometrial scrapings are performed to determine the reactions of the mucous membrane to the endocrine function of the ovaries, find out the causes of infertility, and monitor the results of hormotherapy. The presented technique is not used for uterine bleeding.
Endometrial pipelin biopsy 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 regular syringe. Indications for this type of biopsy: bleeding in women older than forty; bleeding on the background of the use of hormonal contraceptives; diagnosis of the endometrium in infertility; heavy bleeding in premenopause; bleeding in menopause.