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The endometrial pipel biopsy is a method of collecting material from the endometrium of the uterus, which is performed in a safer way than during a traditional biopsy, during this procedure the cervix is not dilated. During a pipel biopsy, a small flexible tube, about 3 mm in diameter, is used. Inside the tube is a plunger, which is similar to the plunger on a syringe. By inserting this tube into the uterus, it is possible to collect a small amount of endometrial cells.
A huge advantage of this procedure is that it does not contribute to pain or other discomfort. Also, this type of manipulation does not require preliminary anesthesia, and there is no need to dilate the cervix before the procedure. Many methods for detecting diseases of the female genital area are very often ineffective, while a pipel biopsy makes it possible to detect abnormalities even if the disease is in a latent stage. The only drawback is the need to carry out the procedure 2-3 times to get a reliable result.
In general, doctors take biopsies of areas that look abnormal and use them to look for cancer, precancerous cells, infections, and other conditions. For some biopsies, the doctor inserts a needle into the skin and draws out a sample; in other cases, the tissue is removed during a surgical procedure.
An endometrial biopsy takes a sample of tissue from the uterus (endometrium). An endometrial biopsy is used to detect cancer. Endometrial cancer may explain unexpected vaginal bleeding, especially if the bleeding occurs after menopause.
Often, ultrasound is used as the first test to check for endometrial cancer. The lining of the uterus looks like a “streak” on ultrasound and is usually a thin line.
If a woman with unexpected vaginal bleeding has a thick line of lining in the uterus, an endometrial biopsy may be used to more accurately determine cancer later.
Features of
When introducing a pipel into the uterine cavity, the doctor must pull the piston halfway out of the tube. During this, negative pressure will be created and, at the same time, the absorption of endometrial tissue. The procedure lasts about 30 seconds, which is a big advantage. Another huge advantage is that the pipel biopsy is performed with a disposable pipel, so you don’t have to worry about infections.
This biopsy method has a much lower cost than others.
Stages of manipulation
This test is done in a doctor’s office. It starts with a gynecological examination. Then, after cleaning the vagina with antibacterial soap, the doctor may inject or spray a local anesthetic to numb the cervix.
The cervix is the entrance to the uterus and is visible a few centimeters into the vagina. In most cases, the doctor places a clamp on the cervix to hold it still. The doctor will use a flexible, sterile plastic instrument that looks like a drinking straw.
The doctor inserts it through the opening in the cervix and positions it a few centimeters into the uterus. Then he pulls out a thin piston from the center of the pipe. When the rod is pulled out, the pipel becomes hollow and creates suction, pulling some of the cells from the uterine tissue into the device. To get a good sample, the doctor will move the pipel back and forth several times before removing it. The tissue sample is deposited in a special liquid to be examined later under a microscope. The whole procedure takes about 10 minutes. It does not cause pain, the patient, most often, does not even feel anything.
Indications for the procedure
Pipel biopsy is very easy for patients to tolerate, unlike other methods, such as aspiration biopsy. But still there are some rules for conducting and specific indications. This diagnostic method is performed on a day of the cycle that is suitable for the specific pathology being determined. That is, depending on what kind of pathology the doctor is trying to detect with his help.
Indications for the procedure may be:
- the presence of bleeding, both with menopause and with regular menstruation;
- infertility when other test results are normal;
- suspected tumors and fibroids;
- inflammatory diseases;
- before IVF;
- to assess the effectiveness of hormonal treatment.
The doctor may do this type of biopsy if the Pap test shows that the patient has “precancerous” cells in the uterus.
A biopsy may also be done if you have heavy or prolonged, irregular periods, no periods, bleeding after menopause, or after taking tamoxifen.
An endometrial biopsy cannot eliminate or stop any of these symptoms. But it can help the doctor find out what might be causing this anomaly. Possible causes of abnormal bleeding include polyps or fibroids (small or large growths in the uterus), an infection of the uterus such as endometritis, endometrial cancer, or thyroid problems.
Contraindications to the procedure
Contraindications for carrying out may be:
- blood clotting disorders;
- the presence of acute inflammatory disease of the pelvic organs;
- having an acute vaginal or cervical infection;
- cervical cancer;
- stenosis, or severe narrowing of the cervix.
Also a contraindication is the presence of pregnancy, or suspicion of it.
Preparation for a pipel biopsy
There is no specific preparation for this manipulation and it is minimal. Before a pipel biopsy, sexual intercourse is contraindicated, as well as the use of tampons and vaginal suppositories, since the biopsy requires the natural environment of the uterus.
After the pipel biopsy
Unfavorable symptoms after this procedure, the appearance of which you should immediately consult a doctor, are:
- the occurrence of heavy periods, during which two sanitary pads are filled for 4 hours;
- the presence of long-term brown discharge with an unpleasant odor, discharges of more than a week are considered long-term;
- a very rare complication may be the appearance of pain that cannot be eliminated with painkillers;
- the appearance of elevated temperature (above 37,5) may also indicate the development of an inflammatory or infectious process.
There are practically no complications and consequences after this manipulation. Very rare complications can be infectious diseases, or small pathological spotting, which stops on its own, as it is a natural reaction as a result of mechanical action. Uterine contractions may occur, which disappear during the day, or immediately if antispasmodics are taken.
Depending on the characteristics of the patient’s individual medical history, the doctor may give special recommendations, which are also very important to follow.
Similar Methods
Pipel biopsy is deservedly considered one of the most modern methods of taking material for examining the uterine cavity. In terms of its efficiency, it can be compared with an aspiration biopsy, but at the same time, its advantage is a sparing effect and, subsequently, the absence of mechanical damage. An aspiration biopsy allows you to take a sample of the mucosa in a similar way, but this procedure does not use a flexible tube. This method cannot be indicated in the presence of cervical cancer.
Explanation of the analysis
The results of a pipel biopsy are usually ready within a week. You need to contact qualified specialists, since only an experienced and good doctor can correctly decipher the analysis, who will discuss the results with the patient. Based on what they show, she will also explain if any treatment is needed.
There is also a chance that the results may not be accurate. This means it is not clear if there are cancer cells in the uterus. If this is the case, a more complex medical procedure called dilation and curettage may be required. During this procedure, the doctor scrapes off a larger sample of tissue from the uterus for testing in a laboratory.
Endometrial biopsies are not ideal. Because a sample of random tissue is taken, they can sometimes miss precancerous or cancerous tumors. If the symptoms do not disappear, you need to see a doctor again. More information may require a different type of test.
Improving IVF Efficiency
In our time, a pipel biopsy has begun to be used as a method to increase the likelihood of successful egg fertilization during IVF.
There is no explanation for this phenomenon in scientists, but it was noticed that if a pipel biopsy was performed before fertilization, then the chances of the procedure being successful in a woman were higher.
This method is being actively studied and developed, and in the future it can help make the IVF procedure more effective and reduce its cost.