Gentle endometrial biopsy
The pipel is inserted through an unexpanded canal into the uterine cavity, the piston creates a vacuum, and when the tube moves, fragments of the endometrium are aspirated into it from different parts of the cavity; a short-term nagging pain is felt. The method is quite informative for identifying hyperplasia, atypia, endometritis (with CD138 immunohistochemistry), assessing the compliance of the endometrium with the cycle phase in infertility and monitoring hormonal treatment. The doctor chooses the day of the cycle: 7–10th for endometritis, 21–24th for assessing the secretory phase, any for bleeding. If there is not enough material or ultrasound shows a polyp, hysteroscopy is performed.
Indications
- abnormal colposcopic picture, HSIL/ASC-H in cytology, HPV 16/18 with changes - cervical biopsy;
- endometrial hyperplasia by ultrasound, bleeding, bleeding in menopause, control of treatment of hyperplasia - endometrial biopsy;
- infertility, unsuccessful IVF - assessment of chronic endometritis and receptivity;
- atypical glandular cells, suspicion of canal pathology - curettage of the cervical canal;
- breast formation by ultrasound/mammography (BI-RADS 4–5) - breast biopsy.
Why is histology needed?
Only examination of the tissue under a microscope gives a final diagnosis: the degree of cervical dysplasia (CIN 1–3) or carcinoma, the type of endometrial hyperplasia (with or without atypia), chronic endometritis, benign or malignant breast formation. Tactics depend on the result - observation, conservative treatment, conization, hormonal therapy, surgery. Modern methods (pipel, vacuum and core needle biopsy, colposcopic targeted biopsy) make it possible to obtain material on an outpatient basis in minutes with minimal trauma.
