Histological examination of biopsy material of the cervix, vagina

The doctor prescribes a biopsy of the cervix if during a gynecological examination he notices suspicious changes in the tissues of the cervix. This small procedure allows you to determine whether these changes are benign or malignant. In this process, a piece of tissue is plucked from the surface of the cervix, which is sent for laboratory testing. A cervical biopsy is needed to detect cancer in the early stages or other pathologies that may later develop into cancer.

Indications for cervical biopsy

The gynecologist prescribes tissue sampling for biopsy for any abnormalities on the cervix that he discovers during an examination or colposcopy. Such changes include:

• cervical erosion;
• papillomas, polyps;
• the presence of areas on the mucous membrane with discoloration, which appear under the influence of special solutions used during colposcopy;
• poor smear cytology result.

If you need to confirm some diagnoses, such as endocervicitis, cervical dysplasia, leukoplakia, a biopsy is also required. If the smear contains papillomavirus and other sexually transmitted diseases, a cervical biopsy is also taken, since these viruses can cause cervical cancer.

Treatment of dysplasia CIN 1-2

In this situation, surgical removal of the altered tissues is indicated, followed by histological examination, which makes it possible to reliably assess the degree and depth of damage to the cervix and determine management tactics.

The first stage is the procedure of electrosurgical loop excision (LEEP) of the lesion of the outer part of the cervix with a one-time pass with a visually determined transformation zone and subsequent curettage of the mucous membrane of the cervical canal.

When the transformation zone is located deep in the cervical canal, it is necessary to perform a circular (cone-shaped) biopsy, since changes in the mucosa in the form of dysplasia in most cases are determined precisely in the zone of transition of squamous epithelium to cylindrical; then the cervical canal mucosa is also scraped. Circular (cone-shaped) biopsy differs from conization in the volume of tissue removed - in the first case, the minimum necessary part of the neck is removed, which is necessary to confirm the diagnosis. A more sophisticated approach is justified by the fact that although dysplasia is classified as a precancerous condition, it is still a benign condition. The second stage is therapy aimed at improving tissue regeneration and eliminating the virus.

Contraindications

There are not many contraindications for cervical biopsy. These are mainly poor blood clotting, inflammation of the cervix or vagina, and sexually transmitted infections (STIs).

A biopsy, although small, is still a surgical intervention, which in rare cases can lead to uterine bleeding, so it is not indicated for patients with poor blood clotting. This complication can occur due to the fact that there are many blood vessels in the cervix, and with poor clotting, they begin to bleed heavily. Women who do not have this pathology are not in danger during a cervical biopsy.

But diseases in which the blood does not clot well are quite rare, but sexually transmitted infections are a very common reason for canceling a biopsy. Therefore, before the procedure, the doctor must prescribe tests for the presence of STIs. This includes a smear and blood test. If sexually transmitted diseases such as gonorrhea, syphilis, trichomoniasis, chlamydia, etc. are detected, the biopsy is postponed until the patient has completed the necessary course of treatment and recovered. The same applies to inflammatory processes in the vagina and cervix. Such precautions are due to the fact that during the procedure the mucous membrane of the cervix is ​​damaged, and there is a risk of infection in the wound, and this can already cause serious pathology.

When is it prescribed and what allows for diagnosis?

A biopsy may be prescribed for:

• bleeding during menopause/premenopause;
• intermenstrual bleeding during hormone therapy;
• menstrual irregularities;
• suspected endometriosis/endometrial hyperplasia;
• uterine fibroids (in order to determine the structure of the endometrium and make the right decision on the extent of surgical intervention);
• endometritis;
• suspected malignant processes;
• infertility and recurrent miscarriage;
• the need to monitor the effectiveness of hormonal treatment.

The result of histological examination of the taken material is the diagnosis. With the help of a biopsy, it is possible to determine the pathology of the endometrium, structural changes, and inflammatory processes.

Cervical biopsy methods

There are several ways to perform a cervical biopsy. Usually, local anesthesia is used during the procedure, but some women tolerate it quite well without anesthesia. In rare cases, general anesthesia may be performed.

The most common method is a biopsy done with a scalpel. This method also gives the most reliable results. First, the cervix is ​​exposed with special instruments, then a solution is injected that colors it and highlights pathological areas. Then one of these lesions is carefully excised - this is the material for histological examination.

Currently, cervical biopsy performed using a laser or alternating current is becoming increasingly popular. This method is considered less invasive, but has one drawback: it may damage the tissue taken for histology, which will significantly affect the results of the analysis. And the main advantage is that there is no bleeding and after the biopsy, no sutures or adhesions form on the neck. This moment is very important for those women who have yet to give birth.

The attending gynecologist decides exactly how the cervical biopsy will be performed. To do this, he takes into account all factors: the woman’s age, chronic diseases, features of the physiological state, the size of the mucosal lesion, etc. In most cases, the procedure is carried out directly in the gynecological office, but some types of biopsy may require a stay in the hospital for a couple of days.

Preparation for the procedure

Regardless of which method was chosen, it is important to properly prepare for the procedure: first of all, undergo a set of diagnostic measures. These include

• general blood analysis;
• blood test for antibodies to HIV, syphilis, hepatitis;
• smear from the vagina and cervix for flora, oncocytology.

If you are planning an intervention under anesthesia, the doctor will definitely tell you about the rules for preparing for it: you should limit eating and drinking a few hours before the procedure.
As for the ideal day of the cycle for a biopsy, it is determined individually. Thus, in case of infertility associated with dysfunction of the corpus luteum or absence of ovulation, the procedure is performed before menstruation or at its beginning. In case of heavy menstruation, it is recommended to carry out the procedure no later than 10 days. For intermenstrual bleeding, a scraping will be taken immediately after the discharge begins. If cancer is suspected, part of the tissue can be taken any day. If hormone therapy has been carried out and it is necessary to evaluate its results, choose the time between the 17th and 25th day of the cycle.

Cervical biopsy results

Cervical biopsy results are usually available in two weeks. Depending on what the histology reveals, the doctor prescribes further treatment. If the analysis reveals atypical cells in the mucosa, this confirms cervical dysplasia and shows how much it has developed. Also, the results of a biopsy can identify cancer cells, thereby confirming or refuting the presence of oncology.

Quite often, the purpose of a biopsy is not only diagnosis, but treatment of certain diseases. So, in case of dysplasia, during the procedure the affected area is removed, and all the material is sent to the laboratory for histology in order to exclude malignant pathology.

What to expect during the procedure

A cervical biopsy may be performed in a doctor's office at a health care facility, as an outpatient setting, or during a hospital stay. Some biopsy procedures require only local anesthesia. Others require regional or general anesthesia. How the test is performed may vary depending on the condition and the physician's practice.

Typically, a cervical biopsy follows this process:

1. The patient needs to undress completely and put on a hospital gown.
2. Before the procedure, you need to empty your bladder.
3. A woman lies on a chair, supporting her legs, as during a gynecological examination.
4. The doctor will place an instrument called a speculum into your vagina. This will expand the vaginal walls to reach the cervix.
5. Often a healthcare professional will use a colposcope. This is an instrument with a special lens, like a microscope, to help see cervical tissue. The doctor will use a colposcope to open the vagina. It will not enter the vagina.
6. The doctor will use a colposcope to look at your cervix to look for any problem areas on the cervix or vagina.
7. The doctor may clean and soak the cervix with a vinegar solution (acetic acid solution). This solution helps make abnormal tissue appear white so it is easier to see. At this time, the woman may feel a slight burning sensation. An iodine solution can be used to cover the cervix. This is called the Schiller test.
8. The type of biopsy will depend on the size and shape of the abnormal cells and where they are located. The doctor may numb the area using a small injection needle. The doctor may use forceps to hold the cervix for the biopsy.
9. The amount of tissue removed and its removal depend on the type of biopsy. For a simple cervical biopsy, one or more small tissue samples will be removed using a special type of forceps. When this is done, the patient may feel a slight pressure or cramp. Cells from inside the cervical canal can be removed with a special instrument called an endocervical curette or endocervical brush. It may also cause some cramping. The doctor may also use a probe (electrocautery) or stitches to stop the bleeding.
10. After all this, the doctor will send the tissue to the laboratory for testing.

Most women experience little or no discomfort during a cervical biopsy. However, the woman may experience some mild discomfort in the following days.

Discharge after cervical biopsy

What consequences does a cervical biopsy have for a woman? The most unpleasant thing is bloody discharge that appears due to a violation of the integrity of the mucous membrane. The discharge may be accompanied by aching pain in the lower abdomen. But these are completely acceptable consequences, and they are considered normal for such a procedure. A woman should only worry if the discharge does not stop after a few days, but, on the contrary, intensifies, and if it has an unpleasant odor, which indicates the presence of an infection. To avoid such complications, as well as uterine bleeding, a woman must follow several rules after a cervical biopsy. You cannot take a hot bath, visit a bathhouse or sauna, sunbathe in the sun, you must refrain from sexual intercourse until the mucous membranes heal, do not lift heavy objects, and avoid strenuous physical exertion. If no complications arise during the rehabilitation period, then recovery occurs within a week, and the woman can easily return to her usual lifestyle and previous activities.

Primary appointment with an obstetrician-gynecologist: 2200 RUR.

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Histological examination.

The presented method of examination under a microscope allows you to accurately confirm/refute the presence or absence of pathological cells and malignant neoplasms in the body. To carry out histology, doctors distinguish the following methods for collecting biomaterial:

1. Smears and scrapings.
2. Tissue section and needle puncture.
3. Using aspiration.

After preparation, the collected sample is examined under a microscope and in this regard the following optical systems and instruments can be used:

• Classic light or scanning microscope.
• Fluorescent and Fritz Zernike type microscopes.

In addition, doctors also have express testing in their arsenal, which is used in the conditions of surgery. This diagnostic method is used if, during surgery, neoplasms that are suspicious to doctors were discovered. This is exactly what testing is used for, allowing an accurate diagnosis to be made.

Types of biopsy

1. Curettage is a classic method. The cervical canal is opened using special instruments and first the cervical canal and then its cavity are scraped out. Scrapings are made with a curette under local anesthesia or general anesthesia.

2. Curettage in the form of line scrapings (trains). To do this, use a small curette. The material is taken from the fundus of the uterus to the cervical canal. The method is not suitable for uterine bleeding.

3.Aspiration biopsy is performed by suctioning sections of the mucous membrane. May cause discomfort. The study is not carried out if uterine cancer is suspected, since it is impossible to determine the exact location of the tumor and the extent of its spread.

4. Pipelle endometrial biopsy is the most modern and safe method. The tissue is collected using a special soft tube - a pipel; inside it has a piston, like a syringe. The pipel is inserted into the uterine cavity and the piston is pulled out halfway, this creates negative pressure in the cylinder, and endometrial tissue is sucked inside. The procedure lasts several minutes; there is no need to dilate the cervical canal, since the diameter of the pipe is only 3 mm. The procedure is completely painless, complications or negative consequences after it are excluded.