Histological results after cervical biopsy. What does a cervical biopsy show, preparation, cost and reviews

A cervical biopsy is the removal of a tissue sample from the surface of the cervix for examination to detect cancerous cells. This procedure is performed not only in cases where the gynecologist suspects cancer, but also when a woman has to undergo a procedure to remove a polyp or ectopia (erosion).

A biopsy is the most reliable method for determining the presence of a cancerous tumor. In its accuracy, it surpasses even cytology (collection of cells using scraping from an affected or suspicious area of ​​​​the mucous membranes).

Without a biopsy, it is absolutely impossible to judge whether a tumor is malignant, which is why the procedure often precedes medical procedures that the gynecologist plans to carry out in the future.

Indications for the procedure

• Cervical erosion - if during a routine gynecological examination the doctor diagnoses ectopia, this does not mean that he will immediately take a biopsy. The woman will be recommended to remove the affected tissue, and before removal, a small part of it will be collected.
• Dysplasia is a consequence of advanced erosion and is considered a precancerous condition. Tissue examination is carried out to determine the extent of the disease.
• The presence of genital warts and polyps on the pharynx of the cervix - if the doctor decides to remove them, a biopsy is always performed before the procedure.
• Any visible changes in the epithelium - this may include an abnormal structure of the vascular network, deep tissue damage, as well as areas of the mucosa that show a negative reaction when stained with Lugol’s solution.
• Leukoplakia - upon examination, growth and thickening of tissue on the pharynx of the cervix is ​​visible. A biopsy is necessary to determine whether these changes are a sign of a malignant tumor.

Do not be alarmed if the gynecologist prescribes a cervical biopsy for erosion (before its removal) - this is considered a standard procedure, which is carried out so that the doctor is confident that there are no cancer cells and that the treatment will not provoke their further growth.

Tissue collection for histological examination can be carried out in different ways:

• Targeted biopsy is performed most often. The gynecologist uses a special biopsy needle.
• Conchotomous - tissue sampling is carried out using an instrument resembling wire cutters. It is usually used in cases where it is necessary to pinch off not a flat section of the epithelium, but a condyloma or polyp.
• Loop - an electric knife is used to carry it out. It has the least pain of all the presented types of procedures.
• Conization of the cervix - used in cases where the presence of dysplasia or other malignant changes in the epithelium of the external pharynx is proven.

In addition to these methods, biopsy can also be performed using a laser and radio wave. But the principle of these techniques is similar to loop biopsy.

Preparation and stages of biopsy

Conization of the cervix

Tissue collection for examination is carried out quite quickly, from one or several areas of the cervical pharynx. Before a cervical biopsy, it is necessary to take a hygienic shower and also avoid lifting heavy objects - this can cause increased blood loss during tissue sampling.

1. Initially, the doctor examines the patient using a gynecological speculum. This is necessary for a preliminary assessment of the scale of minimally invasive intervention.
2. The cervix is ​​stained with Lugol's solution, iodine or acetic acid solution. The gynecologist looks at the tissue reaction: suspicious areas will remain white and not stained. From there a piece of tissue will be taken for examination.
3. A biopsy needle is inserted into the vagina, and then the doctor pinches off a piece of mucous membrane from the external pharynx. Many women are interested in whether it hurts to take a cervical biopsy? The fence is, of course, sensitive, but not critically so. In most cases, the patient only feels a pinch (or several pinch) that lasts 1 to 2 seconds. Within a few minutes after the biopsy, stinging pain may occur.
4. The cervix and vagina are treated with an antiseptic solution. After 2 - 3 minutes, the woman can leave the gynecological chair and go home.

If you become familiar with how a biopsy is performed in advance, this will help to avoid unnecessary fears before this procedure, because of which women sometimes hesitate to begin treatment for polyps or ectopia.

Condition of the cervix after the procedure

Because the surgery is minimal, severe bleeding almost never occurs. In the first hours after the procedure, the pharynx swells slightly and turns red. Over the next day, the wound heals.

Bloody discharge after a cervical biopsy is not observed in most cases. Only sometimes, 2–3 hours after the intervention, women find a few brown drops of blood on their panty liner.

Sex after a biopsy is possible no earlier than 2 weeks. This is due to the danger of pathogenic organisms entering an unhealed wound.

The removed piece of tissue is sent for microscopic examination. Usually the result is ready no earlier than after 2 - 2.5 weeks. Based on the data obtained, the doctor determines a treatment regimen for the disease that was discovered in the patient. The results of a uterine biopsy may include the following:

• The absence of pathological processes means that the mucous membranes of the external pharynx are healthy, do not require additional treatment and do not interfere with the treatment of the underlying disease.
• Benign changes - endometriosis, endocervicitis, eroded ectropion, benign polyps or cysts. This analysis result allows the patient to be treated without risking her life.
• Precancer – most often this includes cervical dysplasia, which occurs due to advanced erosion. This analysis result signals the gynecologist that the woman needs urgent conization of the external pharynx so that the tumor does not affect the entire cervical canal.
• Malignant changes - microscopic examination reveals cancer cells in the layers of the epithelium. This result means that the doctor needs to conduct a more serious examination, establish the stage of the cancer and determine a treatment regimen.

You should not interpret a cervical biopsy yourself. It is better to show the analysis to a doctor and be confident in its accurate interpretation. Menstruation after this procedure usually comes without delay, since tissue sampling does not disrupt the woman’s hormonal levels.

Content

Cervical biopsy is considered one of the most commonly used diagnostic tests in gynecology. This method involves excision of a fragment of tissue from the vaginal part of the cervical uterus and the visible area of ​​the cervical canal for histological analysis. The area of ​​the cervix that has undergone pathological changes is examined in detail under a microscope. A biopsy shows the tissue structure and cellular composition, the degree of change in the nucleus, cytoplasm, the process of cell division and its nature, how many mitoses occur in layers, and whether atypical processes are present.

A biopsy of the cervix is ​​performed to rule out cancer. Since during a gynecological examination in the speculum many pathologies look the same, a histological examination under a microscope helps to make an accurate verdict. After the doctor takes cytology tests (PAP test, oncocytology), receives the result and determines how many cells and what volume of tissue have undergone changes, a decision is made to prescribe a biopsy.

How long does it take to prepare cervical biopsy results?, is determined by the type of analysis, the workload of the clinic and staff, but on average, you can get a histological conclusion after 1.5 - 2 weeks from the date of delivery. In non-state structures, the time limit is reduced to one week.

Purpose of biopsy

Women who visit a gynecologist annually undergo several screening tests that show the presence of background and precancerous processes. Such studies include:

• scraping from the cervical canal for cytology;
• PAP test;
• flora smear;
• analysis for STIs using PCR;
• extended colposcopy;
• Digene test.

The gynecologist decides how many methods to use in each specific case. The examination of the patient begins with an examination in the mirrors. This simple method shows how much the surface tissue of the vaginal part has changed. Normally, the cervical region has a pale pink color, a smooth and shiny surface. The doctor assesses how much discharge the cervical canal contains and its nature: the discharge should be translucent and odorless. The amount is determined by the phase of the cycle.

If a specialist visualizes changes - hyperemic or white-gray areas, papillomas, polyps, bleeding erosions - tests are prescribed.

1. A flora smear shows how many leukocytes and epithelium are present in a woman’s genital tract. This analysis demonstrates the presence of pathogenic flora - Trichomonas, gonococci, gardnerella, normal microflora - Doderlein bacilli. When stained according to Romanovsky-Giemsa, the method shows the presence of chlamydia. Based on this analysis, the gynecologist largely judges the inflammatory process.
2. Cytology test or Pap test shows how many cells have undergone atypical changes, namely: the presence of koilocytes, atypical cells of squamous and columnar epithelium, precancerous and cancerous processes. These disorders are caused by the persistence and activation of high-oncogenic risk HPV, so the next step will be HPV analysis by PCR and biopsy. The cytogram shows the presence of dysplasia, ectopia, cancer, inflammation. Liquid cytology is considered one of the most reliable tests.
3. Testing for the presence of various types of HPV is carried out using the PCR method or using a modern analysis, the Digene test, which shows the viral load - how many viral particles are in the cervical canal, as well as the spectrum of strains.
4. STI testing is considered a mandatory screening method for diagnosing sexually transmitted infections in women. The analysis shows how many and what types of bacteria and viruses circulate in the cervical canal. The most frequently recorded mixed infections are: chlamydia, urea and mycoplasmosis, genital herpes, human papillomavirus infection.
5. Colposcopy shows the presence and area of ​​altered areas of the integumentary epithelium of the cervix. A gynecological microscope has the ability to magnify the epithelium of the vaginal part of the cervix by twenty to forty times. What the doctor did not see in the mirrors is shown by colposcopy. The cervix is ​​treated with an acetic solution, and the specialist evaluates how many vessels are atypically changed, which area of ​​the cervical region is covered with a different type of epithelium. Acetowhite epithelium - a too pale area - indicates dysplasia, leukoplakia, indicating activation of HPV. Healthy vessels react to acetate with spasm, while damaged vessels are characterized by a lack of reaction (atypical vessels). Precancerous changes are judged by the presence of a rough mosaic - dilated capillaries of the cervix. Treatment of the surface of an organ with iodine shows how many areas are not stained - these are the ones that indicate ectopia or dysplasia.

Confirmation of dysplasia and ectopia using tests is a direct reason to perform a cervical biopsy. In case of inflammatory changes (endocervicitis), histological examination is not always indicated.

Types of procedure

After receiving the test results related to the screening, the gynecologist decides which type of cervical biopsy to use. There are several types:

• targeted or puncture biopsy;
• knife;
• conchotomous (gynecological nippers);
• conization (laser, radio wave);
• electroloop biopsy;
• curettage;
• circular.

Various types of cervical biopsy are used depending on the changes detected in the tests. The most common method is targeted or puncture biopsy - minimally invasive and easy-to-use techniques. This analysis is used if ectopia or grade 1 dysplasia is suspected. More invasive methods - knife, loop excision, conization, circular sections - are used for a combination of leukoplakia, grade 2, 3 dysplasia, and non-invasive cancer. Polyps of the cervical canal require curettage. Invasive techniques are both tests and methods for removing polyps, condylomas, and dysplasia.

When performing conization for the purpose of biopsy, the radio wave method should be chosen. Laser and electrosurgical techniques lead to charring of the edges of the cone during excision, which can lead to an incorrect histological diagnosis.

In order for a cervical biopsy to show a reliable result, the specialist must capture the healthy and pathological area at the same time. This indicates the need for careful selection of the clinic for the analysis. Only an experienced gynecologist and diagnostician can adequately determine how much tissue is changed and what pathological process the cervix is ​​susceptible to.

Many women are interested in how many days after menstruation should pass before a cervical biopsy is performed? It has been established that the most favorable days for taking an analysis are days 7–14 of the cycle.

Normal biopsy result

A cervical biopsy shows the main characteristics of tissues, cellular composition, structure of the nucleus and cytoplasm, division processes, how many nuclei and pathological inclusions are in the cytoplasm. All terms that will be indicated in the conclusion are related to the shape of cellular elements and the nucleus, the type of tissue, and its structure.

A healthy cervix in its vaginal part has stratified squamous epithelium, which is similar in structure to skin, but does not have the ability to keratinize. Normally it consists of 3 layers.

• Main or basal– the layer is directly adjacent to the connective tissue basement membrane, under which the muscles are already located. The cells of this layer are large and round (prism-shaped).
• Medium or spiky– together with the basal layer they form the germinal layer.
• Superficial - the elements are flat, their lifespan is five days, then they peel off and are renewed.

The cervical canal of the cervix has a different type of tissue - single-layer glandular (cylindrical or prismatic) epithelium. The cellular elements are elongated, rectangular, with glands located between them.

A special structure of the cervix, which is most often subject to pathology, is the transition zone - the place where two types of epithelium connect. In histology it is called metaplastic epithelium.

The basement membrane is present in the cervical canal in the same way as in the vaginal part of the cervix.

A healthy woman receives a “negative result” from a biopsy, which can have two interpretations.

• “Without pathology” - the analysis shows how many cells make up the multilayered squamous epithelium, what is the shape of the cellular elements in the cylindrical layer, the structure of the glands. The tissues are not changed and are located in places corresponding to normal anatomy.
• “Minor changes” - this result describes only changes in cell shape.

If during a cervical biopsy the conclusion shows metaplasia - this means that the area for analysis was taken from the transition zone. This result is the norm, in the absence of other indications of pathology.

Pathology

The biopsy result may contain the name of the identified disease and characteristics of the structures.

Benign background pathologies include:

• ectopia;
• eroded ectropion (eversion of the endocervix);
• endometriosis;
• endocervicitis.

Precancerous conditions include:

• mild dysplasia (CIN 1, ASCUS or ASC-H), moderate (CIN 2, LSIL), severe (CIN 3, HSIL);
• leukoplakia with atypia;
• adenomatosis;
• erythroplakia;
• polyposis;
• condylomas.

A cervical biopsy shows cancer, both pre-invasive and invasive.

To designate certain changes in tissues, histologists use specific terminology.

1. Koilocytes - indicate papillomavirus infection caused by high-oncogenic risk HPV. Most often, koilocytosis is characteristic of severe dysplasia (CIN 3, or HSIL, or Papanicolaou type 4). The histologist can indicate how many such cells are identified, for example, whether they are single or multiple. Koilocytes appear empty. The nuclei are subject to degeneration, and vacuoles form around them. This means that at any moment they can degenerate into cancer.
2. Atypical cells in multilayered squamous epithelium - the shape and size of cellular elements are changed to irregular, may contain several nuclei, the nuclei are enlarged. The biopsy analysis indicates how many of them are found in the biopsy. These results of cervical biopsy often indicate dysplasia or cancer, less often - inflammation.
3. Acanthosis - the number of cells of the intermediate spinous layer is increased, there may be an indication of how many of these cells are visualized. This result of cervical biopsy analysis is typical for HPV infections, in particular papillomas, dysplasia, and leukoplakia.
4. Keratosis - shows the degree of activation of HPV, namely leukoplakia or papillomatosis. There is keratinization of the squamous epithelium. The diagnostician indicates how many such cells there are. If there are a lot of them, they talk about hyperkeratosis;
5. Epithelial dystrophy - division and maturation are slowed down, tissues are thinned. Indicates inflammation or perimenopausal condition.
6. Endometriosis is the appearance of endometrium in the endocervix.
7. Leukocyte infiltration – a large number of leukocytes, some of them are destroyed. There may be an indication of how many white blood cells there are. This cervical biopsy result shows inflammation.
8. Gland hypertrophy - gland cells have increased size and number, the contours are uneven, the nuclei are changed. Analysis shows adenomatosis.
9. Proliferation – thinned cell membrane, cells are small and their number is large.

If the result of the biopsy shows cancer, then the conclusion will indicate a combination of the described terms, but the number of atypical cells will be large, proliferation and keratosis are pronounced, new vessels are noted, and there is no layering of the epithelium. If the process has not reached the basement membrane, we speak of pre-invasive cancer; in the case of germination of the basement membrane, we speak of invasive cancer.

All materials on the site were prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative in nature and are not applicable without consulting a doctor.

Cervical pathology is extremely common. According to various sources, certain changes in it are found in at least every second woman, regardless of age and lifestyle. These figures are extremely alarming, because cervical cancer remains one of the most common cancers in developing countries and in countries with a high level of medical care.

For early detection of changes in the cervix, a variety of methods are used - from examination to cervical biopsy, which is considered the most informative procedure, allowing one to determine with absolute accuracy the nature of the pathological process, confirm or exclude the possibility of malignant growth.

one type of cervical biopsy

A biopsy is performed for both young girls and women who have entered menopause, but the indications for it must be clearly defined to eliminate the possibility of unjustified interventions, especially in nulliparous patients.

Cervical biopsy has long become a routine diagnostic procedure that every gynecologist can perform. It is safe, easy to perform, does not require anesthesia and is short-term, and the risk of complications is minimal. It is prescribed to a wide range of patients when suspicious lesions are identified in the cervix.

Often, a biopsy is also therapeutic in nature. This applies to situations where there are small pathological lesions in the cervix that are completely removed and sent for pathohistological examination, that is, the doctor achieves two goals at once: establishing an accurate diagnosis and completely eliminating the pathological process.

It is known that the sooner a doctor detects a disease, the easier it will be to treat it. This applies, first of all, to cancer, which provides good survival rates only if detected early. A biopsy allows not only to make an accurate diagnosis of an existing tumor, but also to assume its high probability in the case of severe dysplasia, viral damage and other dangerous changes in the organ.

Early diagnosis will make it possible to promptly develop a treatment plan, establish dynamic monitoring of the patient and help her prevent cancer or get rid of it completely, so the role of a biopsy as the main source of information cannot be overestimated.

When is a biopsy needed?

Theoretically, the basis for the study could be any pathological process in the cervix, however, given the invasiveness of the procedure, it is not performed on absolutely all patients. Some diseases do not require detailed morphological confirmation and do not pose a threat to life, so a biopsy can be dispensed with.

In the case of young girls and nulliparous women, approaches to prescribing a biopsy are even more strict, although the procedure itself is believed to have no complications and rarely leads to scarring. To avoid possible problems with pregnancy in the future, you should refuse unnecessary biopsies, which in one way or another injure the surface of the organ.

A cervical biopsy is performed when:

• Identification of suspicious focal changes during colposcopy;
• Poor results of cytological analysis of the cervical epithelium;
• Suspicion or diagnosis of carcinoma during colposcopy.

The biopsy is preceded by a colposcopic examination of the cervix and a cytological smear. which may give rise to suspicion of carcinoma or a high risk of its occurrence in the near future. During colposcopy, the gynecologist can detect white areas of the epithelium under the action of acetic acid, a lack of reaction to iodine, and eroded red areas. Cytology provides information about the structure of cells, their proliferative activity, and the presence of atypia.

Taking a biopsy under the control of a colposcope increases the value of morphological analysis, because the doctor acts with precision and takes the most altered fragments of the cervix.

The most compelling reason for prescribing a biopsy is considered to be suspicion of cancer or the beginning of malignant transformation of existing non-cancerous lesions. Detailed microscopic examination allows us to distinguish between a benign process, severe dysplasia, invasive carcinoma, or cancer that has not yet begun to grow under the epithelial layer. Further treatment tactics will depend on the results of the study.

Another reason for pathomorphological examination may be the presence of structural changes in the cervix with infection proven by PCR with highly oncogenic strains of the human papillomavirus. The virus itself is capable of causing lesions visible to the eye, similar to carcinoma, but only histological examination can help distinguish between actual cancer and changes caused by the activity of the virus in the epithelium.

A cervical biopsy for erosion (true) is rarely done due to its fragility and low risk of malignancy, while endocervicosis (pseudo-erosion), often referred to by the incorrect term “erosion,” may well cause malignancy. With pseudo-erosion, a morphological study is indicated when there is reason to assume malignant transformation in the foci of erosive glands.

Absolute indication for biopsy the cervix is ​​a tumor-like focus visible to the eye, exophytic, protruding epithelial growths, especially with ulcerations, secondary inflammation, and an abundance of bleeding vessels.

Obstacles to study are few in number due to its low morbidity. They are considered:

• Pathology of hemostasis due to the risk of bleeding;
• Menstruation;
• Acute inflammatory changes, aggravated chronic infections in the genital tract (after complete elimination of the inflammatory process, a biopsy can be considered safe).

Pregnancy is considered a relative contraindication to the procedure; in the short term it can cause spontaneous abortion, in the long term it can cause premature birth. The safest period for invasive diagnosis of cervical pathology is considered to be the second trimester of gestation.

If cervical pathology detected during pregnancy does not require an immediate biopsy, then the doctor will prefer to postpone it and do it after childbirth. If there is a very likely growth of a malignant tumor in a pregnant woman, and the results of a cytological examination are poor, the gynecologist may even insist on a biopsy. Sometimes, to preserve the life and health of the patient, the pregnancy must be terminated.

Preparing for the study

Preparing for a routine cervical biopsy includes a number of standard examinations that can be completed at your clinic. General and biochemical blood tests, a coagulogram, and examination for syphilis, hepatitis, and HIV are prescribed.

Before the procedure, a woman must visit a gynecologist and undergo a colposcopy with smears taken for cytology and vaginal microflora. If necessary, an ultrasound of the internal genital organs is performed.

The study is accompanied by injury to the outer layer of the organ, so it must be prescribed in the first phase of the menstrual cycle (on days 5-7) so that the defect is epithelialized by the next menstruation.

Two days before the procedure, you should avoid sexual intercourse, douching, the use of vaginal suppositories, ointments, capsules, and you should also not use tampons, as all this can distort the results of the study. When planning general anesthesia, a woman should not eat or drink liquids from 6 pm the night before the test.

After undergoing examinations and preparatory measures, the patient must give her written consent to take tissue for research.

Methods and techniques for tissue collection

Depending on the technique for obtaining tissue for histological examination, there are:

• Radio wave biopsy;
• Conchotomous;
• Targeting (puncture);
• Loop;
• Laser;
• Wedge resection.

Radio wave biopsy

The trend in surgery in recent years is the search for the least traumatic and minimally invasive methods of diagnosis and treatment, which are not accompanied by complications, but are highly informative. One of them is the radio wave method. It has a number of advantages and is preferable for women of all ages with any pathology of the uterine cervix.

radio wave biopsy using the Surgitron device

Radio wave biopsy is based on the action of high temperature on cells, the liquid part of which evaporates. The main instrument in this case is a loop through which high-frequency radio waves pass. The loop does not touch the excised tissue, that is, the method is non-contact. Evaporation of tissue is accompanied by the formation of steam, which coagulates blood vessels, preventing bleeding.

Radio wave biopsy is practically painless, allows you to preserve the integrity of both the removed tissue fragment and the surrounding tissues, therefore it is highly informative and low-traumatic. The risk of burns, scarring and infectious-inflammatory complications is extremely low, as is infection due to the disinfecting effect of radio waves. Healing proceeds much faster than after conventional surgical procedures.

The radio wave technique is preferable for nulliparous women who are subsequently planning a pregnancy, since it does not leave scar deformation, and, therefore, there is no risk of miscarriage or miscarriage.

Radio wave biopsy can be performed on an outpatient basis and without anesthesia, without specific preparation, it is simple to perform and accessible to a wide range of patients. To carry it out, the Surgitron device is used, which is available in many antenatal clinics and gynecological hospitals.

Thanks to the listed advantages of the method, radio wave biopsy is practically free of contraindications. It cannot be performed on patients with a pacemaker, and this is perhaps the only reason to abandon this diagnostic method in favor of standard surgery.

Puncture (targeted) biopsy

Targeted biopsy remains one of the most common methods of obtaining cervical tissue for morphological analysis. It is carried out under the control of colposcopy, and the doctor excises those fragments of tissue that seem most suspicious upon examination. The material in the form of a column is taken using a puncture needle.

A puncture biopsy is performed in antenatal clinics and does not require special preparation or anesthesia. Subjective unpleasant sensations are short-lived and limited to those seconds when the needle enters the thickness of the organ.

Conchotomic technique

A conchotome biopsy is performed with a special instrument (conchotome) resembling scissors. It also does not require hospitalization, but can be painful and is most often accompanied by local anesthesia.

Loop and laser biopsy

loop biopsy

Loop biopsy involves excision of tissue using an electric current passing through a special loop. Electrical excision is painful and therefore requires local anesthesia, but there is no need for hospitalization.

Excision of tissue by electric current is quite traumatic; the defect scars and epithelializes over several weeks, and the woman may complain of bloody discharge from the genital tract.

After the action of the electric loop, there is a risk of the formation of dense scars that deform the cervix, which will interfere with pregnancy in the future, therefore this biopsy method is extremely undesirable for nulliparous patients planning to have children.

Laser biopsy is based on the use of a laser beam as a cutting tool. This manipulation is accompanied by pain, so it is done under general anesthesia. Advantages: rapid healing and low likelihood of scar deformities.

Wedge biopsy (conization)

wedge biopsy

During wedge resection, the doctor takes material in the shape of a cone, which includes both the surface epithelium and the underlying layer. This type of biopsy is considered extended, since both pathologically changed and surrounding tissues are taken into the removed organ fragment, which makes it possible to examine the transition area and use this type of biopsy as a therapeutic measure.

Conization of the cervix is ​​traumatic, because it is carried out with an ordinary scalpel without the use of electric current or radio waves. This procedure is painful and requires anesthesia ranging from local anesthesia to general or spinal anesthesia.

Circular biopsy

One of the options for surgical excision of a fragment of the cervix for histological analysis is a circular biopsy, in which a large section of the cervix is ​​removed with a scalpel or radio knife along with the initial part of the cervical canal.

A circular biopsy is traumatic and is performed in an operating room, always with pain relief. If during this operation the entire pathologically changed area of ​​tissue is removed, then the manipulation is diagnostic and therapeutic in nature.

Endocervical curettage

endocervical curettage

Endocervical curettage is considered a radically different method of cervical biopsy. Its goal is to diagnose the pathology of the cervical canal by scraping its mucous membrane, carried out under local anesthesia. The resulting tissue is placed in formaldehyde and sent to the laboratory.

The technique of taking a biopsy is not difficult for an experienced specialist. If an outpatient procedure is planned, the woman should come to the clinic at the appointed time with the results of the examinations. The patient is in a gynecological chair; a special mirror is placed in the vagina to improve visibility; colposcopic control is possible.

If the examination may cause pain, then the cervix is ​​pricked with a local anesthetic, and then the affected area is excised using a scalpel, radio knife, conchotome, or electric loop, which is immediately placed in a container with formaldehyde and sent to the pathohistology laboratory.

During a biopsy under general anesthesia, an anesthesiologist talks to the woman before the procedure, and during tissue sampling the patient sleeps and does not feel pain. During spinal anesthesia, the subject does not sleep, but does not feel discomfort from manipulations on the cervix.

Taking material for examination lasts on average about half an hour; in the case of general anesthesia, the operation lasts up to one and a half hours. After an outpatient biopsy, the patient can go home immediately, and during the study under anesthesia, she remains in the clinic for up to 10 days, depending on the condition.

Most women undergoing a cervical biopsy worry about the possible pain of the examination. The sensations will depend on the type of manipulation: during puncture and radio wave biopsy, the woman will not feel pain, in some cases there is no need even for local anesthesia. Biopsy with a scalpel, loop, and laser techniques are quite painful, but painkillers and anesthesia help to survive the pain.

Postoperative period and possible complications

In most cases, after a cervical biopsy, women feel satisfactory, possible pain is relieved by analgesics, and their ability to work is not impaired. Regardless of the method of taking tissue, after its excision bleeding appears of varying intensity and duration.

The discharge after the biopsy is not too heavy and lasts for several days. In the case of minimally invasive methods of tissue sampling, they bother you for the next 2-3 days, while a loop biopsy, electroconization or knife technique gives quite pronounced bleeding within a week, and then the discharge becomes spotting and may be present for another 2-3 weeks.

After a biopsy, doctors strongly do not recommend using tampons, douching, or resuming sexual activity until the bleeding stops completely. You should avoid visiting the pool, bathhouse, sauna, or lifting weights of more than 3 kg in the next 2 weeks after the study or longer if the discharge has not stopped.

Among the complaints presented by patients who have undergone a cervical biopsy may be pain in the lower abdomen and genital tract. They are associated with a cervical injury and, as a rule, go away quickly on their own. In some cases, gynecologists recommend taking analgesics in the first few days after the procedure.

Negative consequences after a cervical biopsy are very rare, but still not excluded. Among them, the most likely are bleeding and infection, as well as scar deformation in the long-term period after resection with a scalpel, conchotome or electric current.

A woman should be alerted to heavy bleeding, discharge for more than 2-3 weeks, fever, cloudy and foul-smelling discharge from the genital tract. These symptoms are a reason to urgently consult a doctor.

Interpretation of cervical biopsy results

Often, the most painful thing for a woman is not the biopsy itself, but the waiting time for its results, which can last up to 10 days or more. Usually the answer is ready within 5-7 days, and the woman goes to her doctor for him. It is better not to engage in amateur activities and not to try to decipher the results yourself, since unfamiliar terms and their incorrect interpretation will lead to erroneous conclusions.

The most common processes appearing in the conclusions of pathologists based on the results of a cervical biopsy are:

• Acute or chronic cervicitis - inflammation of the cervix;
• Pseudo-erosion (endocervicosis) - simple, glandular, papillary, epidermal - ectopia of columnar endocervical epithelium;
• Viral koilocytosis of stratified squamous epithelium (MSE) - indirectly indicates damage to the cervix by papillomavirus;
• Epithelial dysplasia from low to severe;
• Flat or genital warts are the result of the activity of the papillomavirus;
• Leukoplakia (keratinization) of the integumentary squamous epithelium of the cervix requires observation due to the risk of malignancy.

The interpretation of the results should be carried out by the attending physician; based on the information received, he will prescribe the correct treatment. In the case of inflammatory changes, viral damage, pseudo-erosion, conservative antiviral, antibacterial and anti-inflammatory therapy is indicated, and the woman is monitored dynamically.

A much more serious problem is dysplasia - a precancerous process, but even with such a conclusion it is premature to panic. Mild and moderate degrees of dysplasia can be additionally treated conservatively if the lesions were completely removed by biopsy, otherwise they are excised during re-intervention.

In case of severe dysplasia, the doctor will suggest excision of the pathological focus to prevent malignant transformation, active antiviral treatment when diagnosing HPV, and treatment of the infection.

Video: doctor about cervical biopsy, indications, how the procedure is performed

Update: October 2018

A cervical biopsy is the “pinching off” of a piece of mucous membrane from a suspicious area of ​​the cervix. A biopsy of any organ is the most reliable way to make a final diagnosis, because the pathological tissue is examined directly, and in this case, it is a unique way to clarify the type of disease and, most importantly, to identify cancerous lesions at an early stage. This does not require cutting into the abdomen or chest. The procedure is carried out quite quickly and most often does not require hospitalization.

From anatomy

It would seem that the very phrase “cervix” suggests that the cervix is ​​part of something. Historically, this is the case, there is the body of the uterus and the cervix. But after many years of observations, treatment of a variety of pathologies, and monitoring of pregnant women, the opinion began to emerge that the cervix is ​​still a very special organ with its own structural structure and specific diseases.

The normal length of the cervix is ​​about 3-4 cm, width is about 2.5-3 cm. Its shape is cylindrical, the external pharynx opens into the vagina, and the internal pharynx opens into the uterine cavity.

We pay attention to this aspect, because cervical diseases are now not at all uncommon, even among young and nulliparous women.

And this is all the more alarming because the cervix is ​​a visually accessible organ. And by all standards, the patient should visit the gynecologist once a year. And during this visit she must undergo a smear for flora (to determine whether there is inflammation, vaginal dysbiosis, and so on) and a cytological examination of the cervix (scraping for cancer cells from the cervix), and the doctor also examines the cervix in the speculum.

Indications or who should undergo a cervical biopsy

Cervical dysplasia

Cervical dysplasia is atypical (pathological) changes in the tissue of the vaginal part of the cervix. Unlike erosion, dysplasia penetrates deeper, has three stages and threatens the development of a pathological process up to cancer. In these cases, instrumental and laboratory diagnostics play a key role, because the woman may not be bothered by anything until the severe stage of the disease. There is no pain, no unusual discharge, no menstrual irregularities. When performing a biopsy, the accuracy of the diagnosis is almost one hundred percent, which means we can make a decision on treatment/operation/observation as quickly as possible.

Ectopic cervix

Cervical ectopia is a condition when tissue that is normally located in the cervical canal (inside the cervix) seems to “crawl” out and we find it on the external os of the cervix. This condition in itself is not dangerous, but in order to calm down and simply undergo routine observation once a year, it is necessary to exclude more serious diagnoses.

Leukoplakia of the cervix

Leukoplakia is the formation of “white plaques” on the cervical mucosa. The word “leukoplakia” itself means “white plaque”. Areas form on the cervix that have a denser structure and are unevenly colored during colposcopy. When performing a biopsy, the fundamental question is resolved - is it simple leukoplakia and is it observed, or is it atypical leukoplakia (precancerous condition), which should be actively treated. Treatment in this case may involve a very wide range of interventions, from destruction (electric current, laser) to removal of part or the entire cervix.

Cervical polyps

Cervical polyps are outgrowths of the mucous membrane that resemble warts and have a diverse and often mixed origin (hormonal imbalance, sexually transmitted infections, mechanical injuries during abortions and diagnostic curettages, age-related changes).

Polyps may not manifest themselves in any way, and then, during an examination by a gynecologist, this becomes a godsend. Or it may happen that a woman comes precisely with complaints of spotting after sexual intercourse, pain and other manifestations. In any case, polyps should be removed and examined histologically. And in this case, too, we are most afraid of cervical cancer.

Condylomas acuminata

Genital warts or anogenital warts are formations on the mucous membranes (including the neck) and skin. This disease is caused by the human papillomavirus and also threatens to develop into cancer. A biopsy determines what stage the disease is currently at and whether it is necessary to take more active actions than observation and drug treatment (antiviral drugs).

Questionable or abnormal Papanicolaou test result (Pap test)

A Pap test or the familiar “cytology” from the cervix is ​​a screening test, that is, an examination that is carried out to all women who apply without exception at least once a year. This is necessary in order to identify suspected cancer. If a scraping from the cervix reveals suspicion of cancer cells, then you should not hesitate and perform a biopsy.

Changes detected during colposcopy

Colposcopy is an examination of the cervix under a microscope, while the cervix is ​​treated with solutions of iodine and acetoacetic acid. There are standards for how the cervix should look normally and after treatment with solutions. If the colposcopic picture is not normal, then the diagnosis should be deepened and, in some cases, a biopsy should be performed.

Detection of HPV infection

HPV (human papillomavirus) is an oncogenic virus that is sexually transmitted and can cause the development of cervical cancer. HPV has a number of strains (types of virus) that are dangerous to varying degrees and cause different types of lesions (from papillomas and anogenital warts to cancer). If the examination reveals the presence of high oncogenic risk HPV in the scraping (16, 18, 31, 33, 39), then it is advisable to further examine it to the maximum. Cervical cancer detected at an early stage, especially in situ cancer, is highly treatable and rarely recurs.

Cancer in situ is literally “cancer in place,” that is, a small accumulation of cancer cells that have not yet spread and have a chance to be completely cured.

Contraindications to cervical biopsy

Acute inflammation of the cervix or vagina

Inflammation in the vagina is a temporary contraindication to a biopsy. A biopsy involves some trauma to the mucous membranes, and if infection is present, the process can spread and deepen, which will add additional problems and may be fraught with complications.

I and III trimesters of pregnancy

In the first trimester, manipulation of the cervix can provoke a threat of miscarriage. This is due to the mechanical effect on the cervical tissue, pain and the risk of inflammation.

In the second trimester, the situation is most stable in many respects, the baby is already growing, it is tightly attached (unlike the first trimester), but is not yet so large in size.

In the third trimester of pregnancy, the baby is already large, the cervix shortens in natural conditions, and if we add our intervention, we can provoke premature birth. In this case, diagnostic procedures should be postponed until “after childbirth”. After giving birth, a woman should come to the local gynecologist (or the gynecologist who was seen during pregnancy) a couple of days after being discharged from the maternity hospital, and then after 1.5-2 months. It is during the second visit that you should decide whether an in-depth examination is necessary. By this time, the tissues of the birth canal have almost recovered, and the diagnosis will be reliable.

Bleeding disorder

Blood clotting disorders can be expressed in varying degrees. In case of severe coagulation disorders, frequent bleeding, spontaneous formation of bruises of various sizes, you should first select all possible minimally invasive (non-traumatic) research methods, and resort to biopsy as a last resort.

If the clotting disorder is not critical, then the procedure should be performed under the guise of blood clotting drugs. The names and regimen of medications will be prescribed to you by a therapist or hematologist (a specialist in blood diseases).

This also includes patients who take blood thinning drugs. We must remember that patients are sick not only with what they came to us with. It is possible that the woman has had a history of stroke, myocardial infarction, and venous thrombosis and is taking aspirin, warfarin, Xarelto, or other blood thinners. If we prescribe a biopsy procedure, we must clarify what medications the patient is taking. When such facts are clarified, the patient must visit a physician/cardiologist/vascular surgeon to clarify whether the drug should be discontinued and how long before the biopsy this should be done. And also when to resume taking it in order to avoid bleeding from the genital tract and not provoke the formation of blood clots.

Menstruation period

During menstruation, firstly, little is visible, and you can take a biopsy not from the most suspicious area. And secondly, this is irrational because there is a risk of inflammation, increased bleeding, etc. You should wait until your period ends before performing a biopsy.

Examination before biopsy

1. General blood test (primarily interested in the presence of inflammation and the number of clotting elements - platelets)
2. Hemostasiogram (blood clotting test)
3. Vaginal smear for flora + gonococci, trichomonas
4. Cytological smear (Pap test)
5. Colposcopy (examination of the cervix under a microscope)
6. Blood test for STIs (chlamydia, mycoplasma) using PCR method
7. Blood test for HIV and hepatitis B and C using ELISA
8. RMP (microprecipitation reaction to syphilis)

How is a biopsy performed? Does it hurt?

A biopsy is usually prescribed 5-6 days after menstruation, that is, approximately 9-13 days of the cycle (should be counted from the 1st day of menstruation). If a woman is in menopause and does not have periods, then on any day, taking into account the above contraindications.

A cervical biopsy can be performed in several ways. The type of intervention depends on the patient’s age, whether she has given birth or not, preliminary diagnosis and complaints. After almost all types of biopsy, the patient feels some pain during the procedure (it is very short in time) and 5-6 days after.

Types of biopsy

Targeted biopsy

A colposcope is used to perform a targeted biopsy. A colposcope is a special microscope for examining the cervix and vagina. This allows you to minimize the risk of inaccurate diagnosis and obtain reliable results. Therefore, this type of research is considered the easiest to perform and at the same time accurate and is mentioned first.

The patient lies down on a chair, the gynecologist inserts speculum into the vagina and adjusts the colposcope to obtain the clearest picture.

When the gynecologist identifies the most suspicious areas, he applies an iodine solution to them. This allows you to make them even clearer and define the boundaries.

In the first case, a piece of mucous membrane, approximately 3x5 mm, is taken from each suspicious area with a special instrument - a conchotome (similar to scissors with a pointed end).

In the second, a special needle is used, and then a puncture is taken from each desired area (a column of tissue is sucked into the needle). If there are many sections, then each piece is placed in a separate container and labeled accordingly.

The biopsy sites are then processed and the patient is sent home. If there are complaints of heavy bleeding or increased body temperature, then referral to a gynecological hospital is possible.

Normally, after a biopsy, the patient experiences moderate to scant bleeding for 5-6 days, as well as discomfort and moderate pain in the perineum.

Radio wave

In this case, the Surgitron device is used to take a biopsy. The essence of the procedure is that a biopsy sample (a piece of tissue) is captured using a loop through which a radio wave charge is passed. The positive aspects of this method are that:

• the tissue does not heat up and the histology results are not distorted,
• this method can be used in nulliparous women, since scars are not formed and the cervix is ​​not deformed,
• there is no risk of bleeding, since after exposure the vessels are sealed,
• there is no risk of infection.

Knife

This type of biopsy is already performed in a hospital (day or 24-hour) and is a more extensive intervention than previous methods.

It is necessary to prepare, take smears for flora and, if necessary, treat the inflammation. If necessary, you will have to be tested for sexually transmitted infections. Untreated inflammation, against the background of which a knife intervention was performed, can lead to the spread of infection throughout the entire pelvis and an open operation will have to be performed. These are completely undesirable complications and it is better to prevent them.

The woman is warned that for 2 days she should not be sexually active, insert suppositories/pills and tampons into the vagina, and should not douche.

On the day of surgery, you must not drink or eat in the morning, and you must not smoke.

The procedure is performed under anesthesia; the type of anesthesia is selected individually. Most often, short-term intravenous anesthesia is used. The same anesthesia is used in the case of medical abortions, therapeutic and diagnostic curettage and hysteroscopy (examination of the uterine cavity using video equipment). Local anesthesia can also be used.

Further, the technique is similar to a targeted biopsy: the cervix is ​​removed in speculum, a colposcope is adjusted and the mucous membrane is treated with iodine solution. The suspicious area is excised completely, the resulting tissue is placed in a stabilizing solution (formalin 10%).

Circular

In this case, a “circle” of mucous membrane is surgically removed from the external os of the cervix. This type of intervention combines diagnostic and therapeutic measures.

Cervical curettage

In this case, the material is taken not only from the external os of the cervix. The cervical canal is also scraped. Histological material is also packaged in separate containers. This is necessary in order to find out the localization of the pathological process and determine the method of treatment.

What can you find out after a biopsy?

Based on the results of the biopsy, we make a final diagnosis, which determines further treatment tactics.

The biopsy result excludes or confirms cancer. If cancer is excluded, the histological report must confirm another diagnosis: polyp, condyloma, leukoplakia, erosion and others.

Depending on the conclusion, treatment tactics can vary significantly. From local treatment of erosion to surgery.

What are the consequences after a cervical biopsy procedure?

Pain in the lower abdomen

Usually the pain is cramping or pulling in nature, the intensity is weak to moderate. If you experience severe pain, accompanied by fever, bleeding, discharge with an unpleasant odor, or decreased blood pressure (weakness, dizziness, nausea), you must contact the gynecologist on duty.

Normally, there may be mild or moderate pain over the pubis for up to 5 days.

Bloody issues

Discharge (blood), from moderate to scanty, mucous-sacral, can be normal for up to 5-7 days. Heavy bleeding is a reason to call an ambulance.

Periods after cervical biopsy

After the biopsy procedure, menstrual irregularities may occur. In most cases, your period will come as usual, but it may become more painful in the first 1-2 cycles.

The earlier arrival of menstruation is explained by hormonal imbalance and infectious complications after the procedure. Bloody discharge within 1 week after diagnosis should not be considered menstruation; the mucous membrane is healing. Normal menstruation should be accompanied by your usual sensations. Some people's breasts swell before menstruation, others notice swelling or excessive emotionality and irritability. If bleeding starts, but you are not sure that this is normal menstruation, then it is better to consult a doctor again.

A delay in menstruation after a biopsy is also not uncommon and is most often associated with the psycho-emotional stress that a woman experiences when undergoing the procedure for the first time. If menstruation does not occur within normal periods, make sure that there is no pregnancy (test strips for human chorionic gonadotropin in the urine or the well-known pregnancy test). A delay of no more than 1 cycle should not greatly frighten the patient. If your period comes as usual in the next cycle, then no additional examination or treatment is needed. If you haven’t come, then you need to go to the gynecologist.

Inflammation

As a rule, this is a consequence of an untreated latent infection or a violation of the regime (below we will tell you what not to do after the biopsy procedure). If you experience unusual discharge, itching and burning in the perineum, or increased urination, you should urgently consult a gynecologist at your place of residence.

What not to do after a biopsy

Live sexually

Go to the bathhouse, sauna

And other thermal procedures are also prohibited. You should also avoid body wraps, massages and hot baths for about two weeks. Just a short warm shower.

Use sanitary tampons

Tampons prevent bloody discharge from flowing out of the vagina. If the mucous membrane is undisturbed, this is not a problem; if you change tampons regularly (maximum 8 hours), no disturbance of the flora occurs. But if there is damage to the mucous membrane, it is necessary to ensure complete outflow.

Use vaginal tablets/capsules/suppositories

Without the appointment of a gynecologist, no suppositories “for prevention” should be administered, as this can slow down the healing process and create conditions for the development of complications.

Swim in a river, lake

It is clear that there is no clean water in open reservoirs. And after the biopsy, the woman has an almost open wound in her vagina. Ingestion of bacteria can lead to serious inflammation.

Be physically active

Abdominal tension leads to a temporary disruption of blood supply in the pelvis.

Where can a cervical biopsy be performed? Price of the procedure

Cervical biopsy is performed in day hospitals of antenatal clinics, cervical pathology rooms, 24-hour gynecological hospitals and equipped private clinics.

Upon referral from the LCD and the appointment of a local obstetrician-gynecologist in public clinics, a biopsy is performed free of charge.

In private clinics, the cost of a biopsy ranges from 2,000 to 12,000 rubles.

Conclusion: thus, cervical biopsy is an accessible, informative and safe (if all rules are followed) method for diagnosing cancer and other diseases of the cervix. If you are offered a biopsy, you should not be afraid. Take care of yourself and be healthy!

One of the common diagnostic procedures for cervical diseases is a biopsy.

What is a cervical biopsy? This is a surgical procedure during which a small piece of tissue is removed from the vaginal part of the organ. It is then examined under a microscope.

Purpose of the procedure

It is usually prescribed after any pathology has been found in the cervical area during an external examination or a smear. This usually occurs when signs of precancerous changes or cancer are detected, as well as when a human papilloma virus is detected that can cause a malignant tumor of an organ. A biopsy is also prescribed to diagnose genital warts and polyps.

What does this study reveal?

It provides complete information about the structure of cervical cells and allows you to determine the morphological (structural) signs of diseases. The histological conclusion after microscopic diagnosis gives the doctor the opportunity to make a diagnosis, determine the prognosis of the disease and formulate the correct treatment plan for the patient.

A cervical biopsy is used to confirm the suspected diagnosis. This is a very important part of diagnosing cervical diseases, without which it is impossible to effectively help a woman. The main purpose of the procedure is to diagnose precancerous conditions and malignant tumors of the cervix.

In what cases is a biopsy performed?

The first stage of diagnosis is to examine the surface of the cervix using a gynecological optical apparatus - a colposcope. During colposcopy, the doctor not only examines the surface, but also conducts some diagnostic tests that help detect pathological foci.

Indications for the study are formulated after receiving the results. The following abnormal signs are detected:

• areas of white epithelium that appear after treatment with acetic acid (solution) and are an accurate sign of dysplasia;
• areas that do not stain after treatment with iodine solution during the Schiller test; usually they are represented by keratinizing cells, under which altered tissues may be hidden; this picture is observed, in particular, with cervical leukoplakia;
• punctuation, or red dots on the surface of the mucosa, caused by the proliferation of blood vessels;
• mosaic, which is areas of branched stromal (submucosal) papillae, separated by small vessels;
• atypical transformation zone, combining several of the above symptoms;
• an uneven or bumpy surface, which may be a sign of cancer;
• condylomas;
• inflammation;
• atrophy;
• true erosion;
• polyp;
• endometriosis.

For all of the listed conditions and diseases, histological examination of the altered tissues is necessary.

In addition, a biopsy is performed when there is a combination of colposcopic signs of papillomavirus infection in combination with the detection of this highly oncogenic virus:

Such changes may be an early sign of cervical cancer.

The study is also indicated if the patient has Pap smears of grade 3-5:

• single cells with a disturbed structure of the nucleus or cytoplasm (koilocytes);
• single cells with obvious signs of malignancy;
• cancer cells in large numbers.

In deciphering the Pap smear, which requires a biopsy, the following designations may appear:

• ASC-US – altered epithelial cells that appear for an unknown reason;
• ASC-H – altered cells indicating precancer or tumor;
• AGC – altered columnar epithelial cells characteristic of the cervical canal;
• HSIL – epithelial precancer;
• AIS is a precancer of the cervical canal.

You need to ask your doctor in detail what the detected changes mean. This will help the woman make the right decision about further treatment.

The study is contraindicated during inflammatory diseases of the genital and other organs, in particular during colpitis or acute respiratory infection. It is not performed for blood diseases accompanied by severe bleeding disorders (thrombocytopenia, hemophilia).

The main reason why a biopsy is postponed is infectious diseases of the genital organs. In addition, if general anesthesia is necessary, restrictions may arise due to drug allergies, severe heart disease, epilepsy, and diabetes.

Types of manipulation

Types of cervical biopsy:

1. Excision (puncture). A small piece of tissue is taken using a special instrument - biopsy forceps. To determine the site of analysis, the doctor may pre-treat the cervix with acetic acid or iodine.
2. Wedge-shaped, or conization, involves the removal of a cone-shaped section of the cervix using a scalpel, laser beam or other physical factors. General anesthesia is used for this procedure.
3. Cervical curettage is the removal of cells from the cervical canal using a curette.

The choice of intervention method depends on the expected disease, its severity and the general condition of the patient.

Preparation

The procedure is planned according to the menstrual cycle. On what day of the cycle is the manipulation performed? Usually 5-7 days after the first day of menstruation. This is necessary for the wound to heal before the next period, which reduces the likelihood of subsequent inflammation. In addition, endometrial cells that fall on an unhealed wound during menstruation can take hold there and subsequently cause endometriosis.

The following studies are prescribed:

• blood and urine tests;
• if indicated, determine blood levels of bilirubin, liver tests, creatinine, urea and sugar;
• coagulogram (blood clotting test);
• smear to detect microflora;
• Pap smear;
• tests for viral hepatitis, HIV, syphilis;
• tests for chlamydia, ureaplasmosis, mycoplasmosis;
• colposcopy.

If an infectious process is detected, a biopsy can be performed only after it has been eliminated.

You should first inform your doctor about the medications you are taking. It is necessary to discontinue medications that increase the risk of bleeding, for example:

In addition to the list of medications taken, the doctor must provide the following information:

• allergies to medications or food;
• recurrent abnormal bleeding in the patient or her family members;
• presence of diabetes, high blood pressure, heart disease;
• previous deep vein thrombosis or pulmonary embolism;
• previous surgical interventions (removal of the appendix, gallbladder, etc.) and features of recovery after them.

At least one day before the procedure, you must stop vaginal douching, do not use tampons, and do not use medicated vaginal creams or suppositories.

Before the procedure, you do not need to use intimate hygiene products, smoke or drink alcohol. Persons with diabetes should first consult an endocrinologist: a temporary change in the dose of insulin or glucose-lowering medications may be necessary.

Before the biopsy, a routine examination of the patient and a gynecological examination are performed. After a conversation with the doctor about the need for the procedure, the procedure for carrying it out, and possible complications, the woman signs consent to perform the procedure.

If anesthesia is planned, preparation for a cervical biopsy is accompanied by refusal to eat, drink, or take medications for 12 hours before the procedure.

It is possible that a woman will have some bleeding after the biopsy. Therefore, you should take a pack of pads with you. After anesthesia, the patient will experience some drowsiness, so she will need to be taken home by relatives. It is extremely undesirable for her to get behind the wheel herself.

According to modern requirements, the procedure should always be carried out under colposcopy control - a targeted biopsy of the cervix.

Procedure for performing the manipulation

How is a cervical biopsy performed?

Depending on the volume of tissue to be removed, it can be performed in a antenatal clinic using local anesthesia or in a hospital under general anesthesia.

The procedure begins as a routine examination by a gynecologist. For pain relief, irrigating the cervix with lidocaine spray or injecting this drug directly into the organ tissue is used. If a circular biopsy of the cervix is ​​performed, spinal, epidural or intravenous anesthesia is required, which is used only in a hospital setting.

A dilator is inserted into the vagina, the cervix is ​​grabbed with forceps and lowered closer to the entrance to the vagina and treated with acetic acid or iodine to detect suspicious areas. If the manipulation is carried out without anesthesia, at this time the patient may feel a slight burning sensation. The doctor removes the abnormal tissue using biopsy forceps, a scalpel, or other instrument.

Is it painful to have a cervical biopsy?

Under conditions of appropriate anesthesia, the woman does not feel any discomfort. There are few pain receptors in the cervix, so manipulations on it may cause discomfort, but do not cause pain. If intravenous, spinal or epidural anesthesia is used, the examination is completely painless.

How is a biopsy performed depending on the method of intervention?

A piece of tissue is taken from the pathological area discovered during colposcopy. If there are several such lesions and they appear heterogeneous, several samples are taken. The doctor uses a scalpel to cut out a wedge-shaped area at the border between the healthy and the changed part of the cervix. It should be large enough, 5mm wide and up to 5mm deep, to encompass the underlying tissue. This is necessary to assess the degree of penetration of altered cells under the epithelium.

Surgitron device for radio wave biopsy, so-called. "radio knife"

When using a special conchotome instrument that resembles forceps, the structure of the tissue may be damaged, which will complicate diagnosis. Diathermic or loop biopsy of the cervix may be accompanied by charring of the edges of the sample, which also reduces quality. Therefore, it is better to use a scalpel. But the best option for the procedure is using radio waves, that is, biopsy of the cervix with Surgitron. This is a surgical device “radio knife”, with the help of which biopsy material is quickly, bloodlessly and accurately taken.

After the procedure, separate catgut sutures are placed on the wound in the cervical area, which will subsequently dissolve. If a knife biopsy was performed, a hemostatic sponge or tampon soaked in fibrin or aminocaproic acid is inserted into the vagina. This is necessary to stop bleeding. With diathermocoagulation or radio wave biopsy, these manipulations are not necessary, since the heat “seals” the damaged vessels and the blood immediately stops.

Taking a biopsy of the cervix should always be accompanied by an examination of the cervical canal to exclude precancerous changes.

The resulting tissue sample is fixed in a formaldehyde solution and sent to the laboratory for examination under a microscope.

Conization, or circular biopsy, is accompanied by the removal of more tissue. A circular excision of the cervix is ​​performed in the form of a cone, with the base directed towards the vagina, and the apex into the cervical canal. It is necessary to capture at least a third of the channel. For this, a special scalpel, Rogovenko tip, radio knife is used, or an ultrasound biopsy of the cervix is ​​performed.

Circular biopsy of the cervix

A circular biopsy is not only a diagnostic, but also a therapeutic procedure. Tissue removal must be carried out so that the biopsy sample includes all the changed cells and part of the healthy neck.

This study is carried out in the following cases:

• damage to the cervical canal, which spreads from the cervix;
• precancer of the canal according to diagnostic curettage;
• suspicion of tumor growth into the underlying tissue during colposcopy, which was not confirmed by conventional biopsy.

Indications for performing the procedure in a hospital:

• conization;
• laser biopsy;
• the need for intravenous anesthesia.

Recovery period

An excisional biopsy of the cervix is ​​performed on an outpatient basis, after which the patient can go home. The next day she can go to work, or she is given a sick leave for 1-2 days.

After conization, the woman remains under medical supervision for 1-2 days. She is issued sick leave for up to 10 days.

In the first days, you may experience mild pain in the lower abdomen and minor bleeding. Sometimes they have a greenish tint due to the treatment of the cervix with iodine solution. These signs last no more than a week. If pain after a biopsy causes discomfort, you can use regular painkillers. You can put a warm compress on your lower back or wrap yourself in a woolen scarf.

To prevent infectious complications, the doctor may prescribe certain medications, for example, Terzhinan vaginal tablets. They need to be administered at night for 6 days.

Other medications your doctor may prescribe in the first days after the biopsy:

• antimicrobial drugs Metronidazole or Ornidazole in tablet form;
• rectal suppositories Genferon to stimulate local immunity;
• Betadine vaginal suppositories.

Suppositories may be prescribed to speed up healing and prevent scar formation, for example, Depantol.

Women are advised to wear cotton underwear and use absorbent pads. You need to wash yourself daily with fragrance-free soap and dry the perineal area well. You can drive a car only after 24 hours.

What not to do after a biopsy: lift objects heavier than 3 kg, use vaginal tampons or douches for a week during an excisional biopsy or a month after conization. Sexual intercourse is not allowed for 4 weeks after the usual procedure and 6-8 weeks after conization. According to foreign recommendations, restriction of sexual activity after a puncture biopsy lasts only for a week. For 2-4 weeks you do not need to take a bath, visit the sauna or pool.

Healing of the wound occurs after 4-6 weeks, depending on the amount of tissue removed. After this period, the woman visits a gynecologist who examines the cervix using mirrors.

Menstruation after a biopsy occurs at normal times, since the procedure does not affect the hormonal status and condition of the endometrium. There may be a slight shift in the cycle associated with the patient’s emotional reaction or with the characteristics of the recovery period.

Possible complications

Risk factors that increase the likelihood of complications:

• obesity;
• smoking;
• elderly age;
• high levels of sugar and/or glycosylated hemoglobin in people with diabetes;
• impaired renal function with increased levels of urea and creatinine in the blood;
• liver dysfunction with increased levels of bilirubin, transaminases and other liver tests;
• chronic lung diseases;
• bleeding disorders;
• autoimmune diseases and other chronic diseases;
• weakened immunity.

Unpleasant consequences of a cervical biopsy usually occur with the development of an infection and are manifested by such conditions as:

• pain in the lower abdomen;
• vaginal discharge with an unpleasant odor and itching in the perineal area;
• high body temperature;
• the appearance of heavy discharge after it has almost disappeared;
• discharge of dark blood clots;
• yellow discharge;
• deterioration of general condition.

You should go to the hospital if there is blood coming from your vagina and it is not menstrual bleeding. A delay in menstruation after a biopsy for more than a week may be a sign of pregnancy, which occurred due to non-compliance with restrictions on sexual activity. In any case, if your menstrual cycle fails, you should visit a gynecologist.

Sometimes complications can occur due to an allergy to the pain medication. In this case, a reaction in the form of urticaria, Quincke's edema, or even anaphylactic shock is possible. These effects develop almost immediately after the administration of the medicine, so doctors can provide immediate assistance to the patient.

During spinal or epidural anesthesia, a woman may experience weakness in her legs and back pain for some time. If these symptoms do not go away within 2 days, you should consult a doctor.

If the doctor carries out the procedure technically correctly, and the woman follows all his further recommendations, then complications after a cervical biopsy develop very rarely. With extensive conization or high removal of the cervical canal, cicatricial narrowing of the cervix is ​​possible, which subsequently prevents conception and the normal course of pregnancy. With a large volume of removed tissue, columnar epithelium from its canal can grow on the surface of the cervix, and ectopia (pseudo-erosion) may occur.

results

What does a cervical biopsy show?

Using a histological examination of the obtained material, the doctor determines whether there are altered cells on the surface of the organ. These disorders may not have serious consequences or may be a sign of precancer and malignant tumor.

According to the WHO classification, there are mild, moderate or severe dysplasia and carcinoma in situ - an early stage of cancer. The degree of cervical intraneoplasia (CIN) is also determined. This division is carried out according to the depth of penetration of the modified cells into the thickness of the epithelium and underlying tissue. In addition, changes in the cervix caused by the papillomatosis virus are determined.

Deciphering the analysis results allows us to classify the detected changes into one of the following groups:

Which do not turn into precancer, but can serve as the basis for the development of the disease:

• dishormonal hyperplastic (endocervicosis, polyp, papilloma without signs of atypia, simple leukoplakia and endometriosis);
• inflammatory (true erosion, cervicitis);
• post-traumatic (cervical rupture, ectropion, scars, cervicovaginal fistula).

Which are not yet malignant, but with a certain probability (about 50%) can transform into a tumor if left untreated:

• dysplasia on a healthy neck or with background processes;
• leukoplakia with atypia;
• adenomatosis.

Directly malignant formations:

• preclinical – early stage of the disease, asymptomatic (cancer in situ, with initial invasion, microcarcinoma);
• clinically expressed (squamous, glandular, clear cell, poorly differentiated).

Depending on what changes are found in the patient, the doctor makes a diagnosis and prescribes various treatments. Therefore, a biopsy is an indispensable method, which in many cases allows one to recognize cancer at an early stage and help the patient in time.

The reliability of biopsy data for detecting precancerous lesions and cancer is 98.6%. This means that if such results are obtained, in the vast majority of cases a diagnostic error is excluded.

Biopsy-guided biopsy improves diagnostic quality by 25%. Therefore, colposcopic control should be a mandatory part of the procedure.

The only drawback of the method is the limited ability to use it several times in the same woman. Therefore, to the question of how often a biopsy can be done, the answer is this: a repeat examination is prescribed only if absolutely necessary. Injury to the cervix can lead to scarring, which will complicate pregnancy and childbirth. Re-conization is most often performed for the purpose of treatment rather than diagnosis.

The biopsy sample is sent to the laboratory. There it is processed and sections are prepared, which the pathologist examines under a microscope. The test result is usually ready 2 weeks after the biopsy, but in some institutions this period is reduced to 3 days.

Many women feel confused after receiving biopsy data and do not understand what this information means. If the doctor’s explanations do not seem clear enough to the patient, she can turn to another specialist to get a “second opinion” and dispel her doubts about the diagnosis and treatment tactics.

Biopsy and pregnancy

Removing a piece of tissue from the cervix subsequently causes the formation of a small scar consisting of connective tissue. It is inelastic and does not stretch during childbirth. Therefore, when a child is born, the risk of cervical rupture increases.

Large scars can deform the cervix, causing the walls of the cervical canal to not close tightly. This can lead to the threat of miscarriage and other complications.

Therefore, cervical biopsy in nulliparous women should be performed as carefully as possible. In such women, electrical excision or diathermocoagulation (removal of tissue using an electrically heated loop) should not be used, since this procedure causes a slight burn to the surrounding mucous membrane. This increases the likelihood of scarring. The best option for women planning a future pregnancy is a radio wave biopsy.

Pregnancy after a biopsy proceeds normally if the procedure was performed using a laser, ultrasound, or radioknife. In other cases, the resulting scar can cause cervical incompetence.

A cervical biopsy during pregnancy is prescribed only in exceptional cases, for example, to diagnose cancer in which it is impossible to bear a child. It is usually not performed in the first trimester, as it increases the risk of miscarriage. In the second trimester, this procedure is safer. In the third trimester, a biopsy is also usually not used so as not to provoke premature labor.

Conization is carried out only if there is a justified suspicion of cancer. Cervical canal curettage is not used during pregnancy.

Sexual activity is permitted after complete healing of the cervix, that is, 4-8 weeks after the manipulation, depending on its type. The degree of recovery is determined by the doctor during a second examination. If the wound has healed without complications, you can be sexually active and become pregnant.

Gynecologist, gynecology

Make an appointment with Dr. Borisova

Biography of gynecologist Borisova

Gynecology – information for patients

Selected topics in gynecology

Gynecologist - about the specialty

Gynecology - clinics

Cervical biopsy

A cervical biopsy is the act of pinching/cutting a piece of tissue from the surface of the cervix with or without curettage of the cervical canal.

Cervical biopsy - indications. The indication for a biopsy is the identification of a pathological area/areas on the cervix/vagina during colposcopy.

Biopsies are usually performed on:

Areas of white epithelium that appear after the use of acetic acid;

Iodine-negative zones on the surface of the cervix.

A cervical biopsy is a low-pain procedure that usually does not require anesthesia. However, if the patient has a low pain threshold or a biopsy is planned from several areas of the cervix, then the procedure is performed using local anesthesia. To do this, use either Lidocaine spray (may cause tingling in the vagina), which is sprayed onto the surface of the cervix, and/or injection of Lidocaine solution directly into the cervix.

A cervical biopsy is always performed under colposcopy control:

Either with the help of special tweezers, then a piece of epithelium is pinched off from the surface of the cervix;

Or using the Surhydron device; then a piece of the cervical epithelium is cut out.

A cervical biopsy may be performed immediately after a colposcopy. The doctor may also schedule the biopsy to be performed on a different day. In most cases, the biopsy is performed in the first phase of the menstrual cycle, i.e. 3-5 days after the end of menstruation. Why is this so? Because the biopsy site usually heals within 2 weeks and it is necessary for this healing to occur by the beginning of the next menstruation.

The result of a cervical biopsy (histological examination) is usually ready within a day.

Cervical biopsy - possible complications:

Bleeding from the vessels of the cervix (sometimes suturing the cervix is ​​required to stop it);

Development of infection/inflammation at the biopsy site (sometimes a course of antibacterial treatment is required).

These complications occur in less than 0.5% of all cervical biopsy procedures.

Cervical biopsy - instructions after biopsy.

After a cervical biopsy, you may have:

Moderate nagging pain in the lower abdomen, sometimes cramping - on average 3-5 days;

Slight/moderate bleeding from the genital tract – on average 5-10 days

You should call the clinic/your gynecologist immediately if:

Bloody discharge from the genital tract is heavier than your normal menstruation;

You have heavy bloody discharge from the genital tract or a lot of clots;

You have severe pain in the lower abdomen;

Body temperature is above 37.5;

You notice an unusual discharge with an unpleasant odor

Cervical biopsy, what you should not do:

Lift weights over 3 kg

Have sex within the next 2 weeks

Go to the bathhouse, sauna, take a bath for the next 2 weeks (you can wash in the shower).

Take aspirin; This medication thins the blood and prevents blood clots from forming in the biopsy area, which can lead to prolonged/heavy bleeding.

You can take Indomethacin/Nurofen 200 mg per os to reduce the pulling sensations in the lower abdomen.

Consulting obstetrician-gynecologist, Ph.D. Borisova Alexandra Viktorovna

Discharge after cervical biopsy - normal or abnormal

The phenomenon of discharge after cervical biopsy and bleeding after cervical biopsy causes significant fear in women. How alarming are these symptoms, is it worth worrying about this, what results of a cervical biopsy are normal - these questions should be examined in detail.

A cervical biopsy is a gynecological procedure whose purpose is to remove one or more pieces of mucosal tissue for histological examination. In essence, such a manipulation can be regarded as a minor surgical intervention, which does not exclude complications during this period. Every woman who has been prescribed such a test should be informed about this. Discharge after a cervical biopsy and moderate bleeding after a cervical biopsy are present in every woman, so this is not something to be alarmed about.

Discharge after cervical biopsy

Bleeding after a cervical biopsy is a fairly common occurrence and is not considered a complication, but rather a natural healing process. During this period, a woman may experience unexpressed nagging pain in the lower abdomen, as during menstruation. As healing progresses, spotting after a cervical biopsy gradually becomes scarcer, the wound becomes scarred, and after five to six days the patient can return to her normal routine. After a cervical biopsy is performed, discharge may persist for quite a long time. To avoid complications, it is enough to follow the rules of personal hygiene and medical recommendations:

• use sanitary pads;
• do not use a syringe;
• do not visit the swimming pool, bathhouse, sauna;
• exclude heavy physical activity;
• refuse intimate relationships (the period will be indicated by the doctor);
• do not take medications that contain aspirin (aspirin thins the blood and bleeding may increase).

Every doctor is obliged to warn his patient: when a cervical biopsy has been performed, the discharge may be bloody, scanty and not last for a long time. Although discharge after a cervical biopsy may be of a different nature depending on the type of biopsy: for example, discharge after a cervical biopsy by conization is more abundant and prolonged. But discharge after a cervical biopsy using the radio wave method can be extremely scanty and short-lived. Bleeding after a cervical biopsy is always less pronounced with more gentle techniques.

After a cervical biopsy has been performed, the discharge should not cause concern to the patient. Usually, a cervical biopsy does not have any consequences, and it is better to do it in the first half of the cycle. It is known that it is during this period that tissue regeneration is highest. After a cervical biopsy is performed, discharge is an indicator of health. The likelihood of complications increases if the patient does not follow medical recommendations. Consequences obtained after manipulation of a cervical biopsy may occur if the biopsy was performed during menstruation. If a cervical biopsy is planned, menstrual bleeding may require postponing the procedure.

Dangerous symptoms after the procedure

• bleeding of bright scarlet or dark color with clots;
• increased body temperature above 37C;
• unpleasant smell of discharge;
• severe cramping pain in the lower abdomen;
• slight nausea.

If a biopsy of the cervix is ​​performed, the bleeding is complicated by the listed complaints - medical attention is urgently required, since an infection has occurred. Intensive antibacterial therapy is prescribed as treatment. When bleeding after a cervical biopsy is severe, measures are taken to stop it. After the cervical biopsy procedure, only scant bloody discharge is normally possible; any other discharge is a reason to visit the clinic. It should be noted that bleeding after a cervical biopsy can be caused by a poor blood clotting system in women, so before writing a referral, the doctor must prescribe the necessary tests. Screening for viral infections (hepatitis), HIV infections, and AIDS is also necessary.

The presence of a disease such as cervical erosion is itself an indication for a biopsy. A cervical biopsy is prescribed for erosion at the discretion of the doctor. Before the procedure, it is advisable to obtain the results of a PAP test (smear of flora from the genital tract for the presence of malignant cells) and colposcopy. It is this examination that allows, under magnification, to identify altered areas - iodine-negative zones that appear when using Lugol's solution. However, a cervical biopsy for erosion is not a prerequisite, and the decision to prescribe this procedure is made after a comprehensive examination. A cervical biopsy during erosion allows you to exclude or detect cervical cancer at the earliest stages, which will allow you to start treatment on time and completely get rid of this terrible diagnosis.

As a rule, the results of a cervical biopsy indicate various pathologies. With their help, a final and accurate diagnosis is established. The suspected diagnosis can also be removed (a biopsy of the cervix during erosion can exclude cancer).

Cellular changes are divided by severity, there are three of them:

• cervical dysplasia of the first degree (one third of modified cells);
• cervical dysplasia of the second and third degrees (indicates the presence of a large number of abnormal cells).

For first-degree cervical dysplasia, treatment is prescribed at the discretion of the doctor based on the results of flora smears and colposcopy. The second and third degrees require mandatory treatment.

Thus, a cervical biopsy is a medical procedure, the results of which determine an accurate diagnosis. And remember: if you develop heavy bleeding after a cervical biopsy, or after an extended cervical biopsy was performed, the discharge becomes foul-smelling, or changes color - contact the clinic immediately, because only an early start of treatment will ensure its success!

The most important and interesting news about infertility treatment and IVF is now in our Telegram channel @probirka_forum Join us!

All of us who have encountered the topic of ART are quite well versed in IVF, ICSI, stimulation schemes

The hormone kisspeptin has been the object of attention of researchers for two decades.

The trend of the modern world is youth, youth and once again youth.

• Infertility
  • Diagnosis of infertility
  • Female infertility
  • Male infertility
  • Laparoscopy
• All about IVF
  • IVF under compulsory medical insurance
  • IVF according to quota
  • Technologies and programs
  • Statistics
  • Embryology
  • Psychology
  • Personal stories
  • IVF and religion
  • Abroad
  • Clinics: pregnancy after IVF
  • Pregnancy and childbirth after IVF
• Donor programs
  • Oocyte donation
  • Sperm donation
• Surrogacy
• Artificial insemination
• Lifestyle
  • Nutrition and diets
  • beauty and health
  • Famous people
• Pharmacology
• Children
  • Health
  • Psychology and development
  • Adoption
• Legislation
  • Regulatory acts
  • Standard documents on surrogacy
• Helpful information
  • Glossary
  • Directory of diseases
  • Clinic rating
  • Calculators
  • Interesting
  • Polls

All materials posted on the website www.probirka.org, including section titles,

are the results of intellectual property, the exclusive rights to which

belong to SweetGroup IT LLC.

Any use (including citation in the manner prescribed by Article 1274 of the Civil

Code of the Russian Federation) site materials, including names of sections, individual pages of the site, is possible only through an active indexed hyperlink to www.probirka.org.

The phrase “TEST TUBE/PROBIRKA.RU” is a commercial designation, the exclusive right to use which as a means of individualizing an organization belongs to SweetGroup IT LLC.

Any use of the commercial designation “TEST TUBE/PROBIRKA.RU” is possible only in the manner established by paragraph 5 of Article 1539 of the Civil Code of the Russian Federation.

©, SweetGroup IT LLC, 16+

G. Moscow, st. Oktyabrskaya, 98, building 2