Aspirate from the uterine cavity and its diagnostic value. Aspirate from the uterine cavity - what is it Aspirate from the endometrium hurts to take

[12-043 ] Cytological examination of aspirate from the uterine cavity

715 RUB

To order

Investigation of the characteristics of cells, their nuclei (size, shape, degree of staining) and endometrial glands used to diagnose benign diseases, precancerous conditions and endometrial cancer.

Synonyms Russian

• Endometrial aspiration biopsy

English synonyms

• Endometrialcytology
• Endometrial cytopathology
• Endometrial aspiration for cytology
• Pipelle biopsy

Research method

Cytological method.

What biomaterial can be used for research?

Aspirate from the uterine cavity.

How to properly prepare for the study?

No preparation required.

General information about the study

There are several ways to diagnose endometrial diseases. To date, 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 to establish the nature of cells and their ratio in the sample. Curettage involves the artificial expansion of the cervical canal (dilatation 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 the histological examination. The main differences between the two methods are as follows:

• Material for cytological examination is obtained during the so-called aspiration biopsy. This method consists in introducing a special cannula (blunt-pointed needle) into the uterine cavity and creating negative pressure at one of its ends for aspiration of a fragment of the endometrium. Although the material obtained by aspiration contains intact (not involved in pathology) cells, their natural ratio in pathology is disturbed. Therefore, the aspirate is sent not for histological, but for cytological examination.
• The aspiration biopsy procedure does not require dilatation of the cervix and is therefore less traumatic. It can be performed under local anesthesia in a polyclinic setting.

Indications for cytological examination of the aspirate from the uterine cavity overlap with indications for diagnostic curettage:

• Dysfunctional uterine bleeding;
• Infertility;
• Postmenopausal bleeding.

Cytological examination reveals signs of impaired endometrial proliferation or an inflammatory process, as well as pathogenic microorganisms. The pathologist studies the characteristics of the nuclei of cells and the characteristics of the glands and comes to one of the following conclusions:

• Normal endometrium in the proliferative phase;
• Normal endometrium in the secretion phase;
• Normal endometrium in the menstrual phase;
• Endometrial atrophy;
• Endometrial hyperplasia without atypia and other benign proliferative disorders. There are no cytological criteria for differentiation of "simple" and "complex" hyperplasia, like the histological classification of WHO;
• Endometritis;
• Endometrial hyperplasia with atypia, other precancerous conditions and endometrial cancer.

When using the technique of aspiration biopsy, material adequate for a complete analysis can be obtained in more than 90% of cases. This is comparable to the result when using the curettage method. According to one study, the sensitivity of the 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 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 propose to use cytological examination as the first stage of diagnosis, and curettage and histological examination - as the second stage of diagnosis in women with pathological results of cytological examination. This approach, however, is not universal.

What is research used for?

• For the diagnosis of benign diseases, precancerous conditions and endometrial cancer.

When is the study scheduled?

• If the patient has dysfunctional uterine bleeding / infertility / postmenopausal bleeding.

What do the results mean?

• Endometrial atrophy;
• Endometritis;
• Epithelial metaplasia of the endometrium (squamous, syncytial, morular and others);
• Endometrial adenocarcinoma.

What do the results mean?

A doctor's opinion is issued on the basis of the submitted material.

Examples of cytological findings:

• Normal endometrium (in the proliferation / secretion / menstrual phase)
• Endometrial atrophy;
• Endometrial hyperplasia without atypia;
• Endometritis;
• Epithelial metaplasia of the endometrium (squamous, syncytial, morular and others);
• Endometrial hyperplasia with atypia;
• Endometrial adenocarcinoma.

What can influence the result?

• Phase of the menstrual cycle;
• Physician's experience with aspiration biopsy;
• The amount of material received.

Important notes

• Cytological examination is an addition to histological examination.

• Histological examination of biopsies of organs and tissues (excluding liver, kidneys, prostate, lymph nodes)
• Ultrasound examination of the uterus and appendages (transabdominal / intravaginal)
• Appointment of a doctor - obstetrician-gynecologist, candidate of medical sciences, primary

Who assigns the study?

Obstetrician-gynecologist.

Literature

• Maksem JA, Meiers I, Robboy SJ. A primer of endometrial cytology with histological correlation. Diagn Cytopathol. 2007 Dec; 35 (12): 817-44. Review.
• S. Ashraf, F. Jabeen. A Comperative Study Of Endometrial Aspiration Cytology With Dilitation And Curretage In Patients With Dysfunctional Uterine Bleeding, Perimenopausal And Postmenopausal Bleeding. JK-Practitioner, Vol.19, No (1-2) Jan-June 2014.
• Sweet MG, Schmidt-Dalton TA, Weiss PM, Madsen KP. Evaluation and management of abnormal uterine bleeding in premenopausal women. Am Fam Physician. 2012 Jan 1; 85 (1): 35-43. Review.

If women find any pathologies, defects or abnormalities of uterine development, as well as uterine bleeding of unknown origin, in case of failures in the menstrual cycle, infertility, it is necessary to immediately conduct a study of the uterine cavity. If we analyze the number of malignant lesions of the genital organs of a woman, then the main percentage will be uterine cancer. Not everyone succeeds in identifying it at the initial stage, since this requires a regular visit to a gynecologist, and this, unfortunately, is not followed by everyone. At the slightest suspicion or doubt, the gynecologist prescribes taking an aspirate from the uterine cavity. As a result of this study, the attending physician receives comprehensive information about the uterine endometrium, and on the basis of this material, a final diagnosis is established and an individual patient treatment is prescribed.

Nowadays, aspirate from the uterine cavity can be taken even in clinics (antenatal clinics), which will allow the gynecologist to have an idea of \u200b\u200bthe pathological processes taking place in the uterine cavity in a short time. Cytological examination of this process is the most important diagnostic method that allows timely detection of cancer at its early preclinical stage, as well as to provide differential diagnosis between malignant neoplasm and other conditions of the endometrium.

Until now, the aspirate from the uterine cavity could be taken with a Brown syringe (pipe). The pipel looks like a plastic catheter three hundred millimeters long and three millimeters outside diameter. Its final part, directly inserted into the uterine cavity, is tightly sealed, and on the side there is a hole that has a diameter of two millimeters. There is a metal conductor inside.

Naturally, the sterility of the instruments must be observed, and they must also be dry, since contact with formalin, disinfectant solution or water can significantly damage endometrial cells. The pipe is inserted to the bottom of the uterine cavity. Then the piston is slowly pulled back while the cannula is moved over the surface of the uterine cavity, or rather the mucous membrane of the uterus, while the tube corners are necessarily captured. When the metal piston is pulled back, the impression of being sucked to the walls of the uterus is created, and the cellular material is extracted into the pipe through the opening of the catheter. You need to make two or three such pulling movements. Before removing the instrument, the plunger is stopped pulling so that cells from the vagina and cervical canal do not get into the syringe cavity.

Aspirate from the uterine cavity is applied in a thin layer on two dry, fat-free sterile glasses. Its thickness is no more than one and a half millimeters. The material must be applied in an amount of at least two thirds of the glass surface. If the obtained cellular material is too tightly fixed in the inner walls of the pipe, then the instrument is washed in this case in a vial containing a furacillin solution. Then the bottle is closed with a stopper and delivered to the cytological laboratory.

The sampling materials must be delivered to the laboratory strictly within three days.

Taking aspirate in modern conditions is carried out using new improved Italian-made cannulas, as well as vacuum syringes made in the USA. This procedure is carried out in the following order. First, a disinfectant treatment of the genitals is performed. Then, using a mirror, the cervix is \u200b\u200bexposed, captured and the depth of the uterine cavity is determined using a special probe. After that, the aspirate from the uterine cavity is taken using a cannula and a vacuum syringe. After repeated processing, the aspirate is sent to the laboratory for research.

Another method for examining the endometrium is curettage of the uterine cavity, but it is more traumatic for the lining of the uterine layer. The whole procedure takes about three minutes, while the patient may experience slight pain, but if desired, anesthesia is performed.

\u003e Cytological examination of aspirates from the uterine cavity

This information cannot be used for self-medication!
Consultation with a specialist is imperative!

What is a cytological examination of aspirates from the uterine cavity?

Cytological examination of aspirates from the uterine cavity involves the collection of material with a special suction catheter from the uterus and subsequent examination under a microscope of smears prepared from the material obtained on glass slides. The study makes it possible to identify in the aspirate not only atypical (malignant) cells, but also minimal cellular changes that begin 2–2.5 years before their malignant transformation occurs.

In what cases is a cytological examination of aspirate from the uterine cavity prescribed?

In gynecology, oncology, the analysis is carried out for the early detection of malignant diseases of the uterus. The study is indicated for women of reproductive age, menopause and premenopausal periods with complaints of irregularities in the menstrual cycle, changes in the nature of menstruation, the appearance of sudden bleeding not related to the cycle, with endometriosis, uterine myoma, absence of pregnancy after a year of regular sexual life without protection.

Do you need special preparation for research?

In menstruating women, the study should be carried out from 6 to 23 days of the cycle, that is, approximately between two periods. Be sure to pass a pregnancy test and ultrasound before manipulation. During pregnancy, taking aspirates from the uterine cavity is contraindicated!

Any manipulation of the uterus presupposes a preliminary cure for infectious diseases of the vagina, debridement of the cervix. With vaginitis, colpitis of any nature, antimicrobial therapy is indicated, followed by taking a smear on the flora.

You should not douche 24 hours before your procedure. It is also necessary to exclude the introduction of any drugs into the vagina, spermicides, ultrasound gel, etc.

On the referral form for analysis, the doctor indicates the following data: the estimated diagnosis, the dates of the beginning and end of the past menstruation, the treatment that the patient is receiving or received (hormonal drugs, contraceptives, chemotherapy, radiation or surgical treatment).

How is material taken?

The woman is on the gynecological chair. The cervix is \u200b\u200bexposed using mirrors, removed and fixed with bullet forceps. A special catheter is inserted through the vagina and cervical canal into the uterine cavity, through which the material is aspirated (sucked in). Anesthesia is not required, since the examination is painless and accompanied by only some discomfort.

Advantages and disadvantages of the method

The method is safe and painless, the walls of the uterus are not injured. However, the information content of the study of the aspirate is significantly lower than the conduct of hysteroscopy with targeted biopsy and histological and cytological examination of the material obtained. Therefore, aspirates from the uterus are examined for early diagnosis of diseases of the endometrium and uterus, when the cells are just beginning to acquire signs of malignancy, but there is no invasive growth of ophol and tissue damage.

What are the normal values \u200b\u200band how should the results be interpreted?

Normally, when examining aspirates from the uterine cavity, there should be no signs of malignant cell degeneration. If these signs are found, the doctor describes the degree of their severity. The patient is subject to further examination. According to the indications, she undergoes hysteroscopy with a biopsy of a suspicious formation and further histological examination of the material. If necessary, separate diagnostic curettage, laparoscopy and other examinations are prescribed to confirm the diagnosis, clarify the severity and prevalence of the process.

If the doctor discovers pathological processes in the body of the uterus, then he prescribes the selection of aspirates for his patients. The study of the contents is carried out in order to determine the state of the endometrium, its structure and compliance with one or another phase of the menstrual cycle. Let's consider how the aspirate is selected, what it is for and how they prepare for it.

Indications and features of the

Aspirate analysis is the most efficient way to extract uterine contents for later analysis.

Unlike scraping, pipel analysis is more reliable and gentle. It does not harm or injure the lining of the uterus.

That is why more and more doctors trust this minimally invasive and painless diagnostic method, which reveals many pathologies.

You can use this diagnostic method in such cases:

How is this analysis different?

Every patient knows what a biopsy is. Of course, for many women, this word is associated with unpleasant sensations. Indeed, with a biopsy, a tissue fragment of the examined organ is taken, which is accompanied by pain due to the mandatory expansion of the uterine cavity. As a result, an endometrial aspirate is taken in such cases using a pain reliever.

Pipel analysis is radically different from biopsy. First of all, the fact that before carrying out it is not necessary to carry out anesthesia, to do other procedures. In order to take the necessary biological material, a vacuum syringe is used, which has only three millimeters in diameter.

Before the biopsy, it is not necessary to dilate the uterus, to inject the woman with special drugs. Moreover, the penetration of the piston may not even be noticeable to the patient.

The results of pipel analysis are accurate and with a high degree of probability allow you to determine the correct diagnosis, exclude options for diagnosing a particular disease.

How is research done?

Research cannot be done spontaneously, on any day: it does not give correct results. Endometrial analysis is done only during the period from 20 to 25 days of the menstrual cycle. This is primarily due to the physiology of the female genital organs.

The doctor must carry out the following manipulations:

The collection procedure is carried out within a few minutes. No special preparation is required for it, a woman can wash herself, take a shower before and after the procedure. The day before the intake of the aspirate, sexual contact is excluded, the introduction of suppositories is not allowed.

Immediately before the procedure, a woman should wash herself and observe the toilet of the external genital organs. If you do not wash away, then additional risks may arise during the procedure (infection). Very rarely, special pain relief is required.

Possible complications and limitations

When analyzing the 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 syndrome. The pain radiates to the abdomen, collarbone and can be unbearable.

During this manipulation, blood vessels can be damaged. After this, the development of internal bleeding with all the ensuing consequences is possible. As a result of a sharp loss of blood, the patient's health sharply worsens.

The consequences of internal bleeding:

• nausea;
• vomiting;

The most common negative consequence of the analysis of uterine aspirate is possible infection, which was already mentioned above.

With the development of an inflammatory process in the uterine cavity, the patient complains about:

• feeling weak;
• pains of varying intensity in the lower abdomen;
• increased body temperature (sometimes up to significant readings).

The appearance of the disease is possible immediately after taking the liquid. That is why, before such a procedure, a woman needs to wash herself thoroughly. Then taking the aspirate from the uterine cavity will occur with a lower risk of infection.

Pregnancy and diagnosis

Analysis of the aspirate from the uterus reveals the causes of infertility and allows for appropriate treatment. That is why many women need to undergo such a procedure before planning a pregnancy. Moreover, a test before re-pregnancy will avoid complications.

The pipel test is indicated in cases where:

• the previous pregnancy was frozen;
• there is a threat of spontaneous abortion;
• there is a threat of polyhydramnios;
• there is a risk of fetoplacental insufficiency;
• there is a risk of fetal hypoxia
• there is a risk of fetal immaturity, as well as damage to its nervous system.

After carrying out pipel diagnostics, successful pregnancy treatment and recovery are guaranteed. This means that a woman has a much higher chance of giving birth to a healthy child.

Contraindications for pipel diagnostics

Like any other diagnostic measure, the pipel test has contraindications. So, taking aspirate is prohibited in such cases.

In general, the analysis of aspirate from the uterus is a fairly effective procedure that allows you to determine the causes of many gynecological pathologies and prescribe their treatment in time.