Biopsy in gynecology
Last reviewed: 23.04.2024
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Diagnosis and differential diagnosis of diseases of the vulva, vagina, cervix, endometrium. This diagnostic method plays a decisive role in the detection of background, precancerous conditions and malignant neoplasms.
In gynecological practice incision biopsy (excision of tissue piece), sighting (under the control of advanced colposcopy or hysteroscopy) and aspiration (material for research is obtained by aspiration) is used.
It is possible to excise a piece of pathological formation or total biopsy - excision of the entire pathologically altered site, located superficially on a small extent.
An incisional biopsy is performed using a scalpel.
Cervical biopsy
A cervical biopsy is performed if there is a suspicion of cancer and other diseases.
Excision of the cervical tissue is performed after colposcopic examination, as it allows to accurately determine the cervical site for biopsy.
When knife biopsy with a scalpel, a wedge-shaped tissue site is excised. For this, the cervix of the uterus is exposed with mirrors, fixed with bullet forceps and pulled up to the area of the entrance to the vagina. Scalpel excise the area of the cervix with the underlying tissue. On the wound, if necessary, 1-2 catgut sutures are applied. A biopsy can also be made with a loop or looped electrode. The excised piece of tissue is sent for histological examination.
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Technique of knife cervical biopsy
After disinfecting the vulva, the skin of the perineum and the vagina with iodine solution, the cervix is exposed with mirrors, treated with alcohol, seized with bullet forceps and reduced. The wedge excision of the tissue with the base outward (larger than 1 cm) and the apex in the thickness of the tissue is performed with the scalpel in such a way that the pathologically altered tissue (erosion, leukoplakia, etc.) and healthy tissue enter it. Do not grasp the epithelial cover of the cut piece with tweezers, so as not to damage it. Bleeding from the wound is stopped by a tamponade of the vagina or by applying 1-2 catgut sutures to the wound. The selection of the site for sampling is best done with the help of a colposcope. If this is not possible, you can use the greasing of the neck with Lugol's solution. A biopsy is made from a site that does not absorb the paint.
For aspiration biopsy, aspirate is taken from the uterine cavity on the 25th-26th day of the menstrual cycle in menstruating women, in the absence of a regular cycle, in the perimenopausal period - 25-30 days after bleeding. Aspiration can be performed using a Brown syringe with an intrauterine cannula. Aspirated contents are applied to a slide and a thin smear is prepared. The method can be used as a screening method.
For it, the vagina is exposed by mirrors. The cervix of the uterus (front lip) is captured by bullet forceps. After probing the uterus, the tip from the syringe is brought to the bottom of the uterus. Then, while simultaneously sipping the plunger of the syringe onto itself, the tip is withdrawn alternately sideways, thus sucking the contents from different parts of the endometrium. Often, this also produces pieces of tissue sufficient for histological examination.
Endometrial biopsy
It is performed on an outpatient basis with the use of a special instrument (curette from the company "Pipel"), which allows to obtain an endometrial site by aspiration.