Cervical biopsy positive. Discharge after cervical biopsy: norm and pathology. How is a cervical biopsy performed?

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

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

Purpose of the procedure

Usually it is prescribed after any pathology was found in the cervical region during an external examination or taking a smear. This usually occurs when signs of precancerous changes or cancer are detected, as well as when human papillomavirus is detected, which can cause a malignant tumor of the organ. A biopsy is also indicated for diagnosis. genital warts and polyps.

What does this study reveal?

It provides complete information about the structure of the 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 form the correct treatment plan for the patient.

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

When is a biopsy performed?

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

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

• 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 can be hidden; such a picture is observed, in particular, with leukoplakia of the cervix;
• punctuation, or red dots on the surface of the mucosa, caused by vascular proliferation;
• mosaic, which is areas of branched stromal (submucosal) papillae, separated by small vessels;
• atypical transformation zone, combining several of the above features;
• an uneven or bumpy surface, which may be a sign of cancer;
• warts;
• inflammation;
• atrophy;
• true erosion;
• polyp;
• endometriosis.

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

In addition, a biopsy is performed with a combination of colposcopic signs of papillomavirus infection in combination with the detection of this virus of high oncogenicity:

Such changes may be early sign 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 clear signs of malignancy;
• large numbers of cancer cells.

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

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

It is necessary to ask the 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, with colpitis or acute respiratory infection. It is not carried out in case of blood diseases accompanied by a pronounced violation of blood clotting (thrombocytopenia, hemophilia).

The main reason why a biopsy is postponed for a while is infectious diseases genitals. In addition, if general anesthesia is needed, there may be restrictions associated with drug allergies, severe heart disease, epilepsy, and diabetes.

Varieties of manipulation

Types of cervical biopsy:

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

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

Training

The procedure is planned in accordance with the menstrual cycle. On what day of the cycle do the manipulation? Usually 5-7 days after the first day of menstruation. This is necessary for the healing of the wound before the onset of the next menstruation, which reduces the likelihood of subsequent inflammation. In addition, endometrial cells that enter an unhealed wound during menstruation can gain a foothold there and further cause endometriosis.

The following studies are assigned:

• blood and urine analysis;
• if indicated, determination of the level of bilirubin in the blood, liver tests, creatinine, urea and sugar;
• coagulogram (blood clotting test);
• smear for detection of 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 tell your doctor about the medications you are taking. It is necessary to stop drugs 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 medicines or food;
• recurrent abnormal bleeding in the patient or her family members;
• the presence of diabetes, high blood pressure, heart disease;
• previous deep vein thrombosis or pulmonary embolism;
• previous surgical interventions (removal of the appendix, gallbladder, and so on) and features of recovery after them.

At least one day before the procedure, it is necessary to stop vaginal douching, do not use tampons, do not use therapeutic vaginal creams or suppositories.

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

Before the biopsy, a routine examination of the patient and a gynecological examination are performed. After talking with the doctor about the need for the procedure, the order of its implementation, possible complications the woman signs the consent to perform the manipulation.

If anesthesia is planned, preparation for a cervical biopsy is accompanied by a refusal to take food, fluids and drugs for 12 hours before the procedure.

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

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

Manipulation order

How is a cervical biopsy performed?

In accordance with the volume of tissue to be removed, it can be performed in the antenatal clinic using local anesthesia or in a hospital under anesthesia.

The procedure starts like a regular gynecological examination. For pain relief, irrigation of the cervix with a spray of lidocaine or the introduction of this drug directly into the tissue of the organ is used. If a circular biopsy of the cervix is ​​​​to be performed, spinal, epidural or intravenous anesthesia is necessary, which is used only in a hospital setting.

A dilator is inserted into the vagina, the cervix is ​​grasped 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 performed 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.

Does it hurt to do a cervical biopsy?

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

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

A piece of tissue is taken from the pathological site found during colposcopy. If there are several such foci, and they look heterogeneous, several samples are taken. The doctor cuts out with a scalpel a wedge-shaped area on the border of a healthy and altered part of the cervix. It should be large enough: 5 mm wide and up to 5 mm deep to capture the underlying tissue. This is necessary to assess the degree of penetration of altered cells under the epithelium.

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

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

After the procedure, separate catgut sutures are applied to the wound in the neck area, which will subsequently dissolve. If a knife biopsy was performed, a hemostatic sponge or swab moistened with 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 needed, since the heat “solders” the damaged vessels, and the blood stops immediately.

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

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

Conization, or a 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, a Rogovenko tip, a radioknife are 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 manipulation. Removal of tissues should be carried out so that all the altered cells and part of a healthy cervix are included in the biopsy.

This study is carried out in such cases:

• damage to the cervical canal, which spreads from the neck;
• canal precancer according to diagnostic curettage;
• suspicion of tumor invasion into the underlying tissues during colposcopy, which was not confirmed during a 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 the supervision of doctors for 1-2 days. A sick leave is issued to her for up to 10 days.

In the early days, mild pain in the lower abdomen and slight spotting may disturb. Sometimes they have a greenish tint due to the treatment of the neck with an iodine solution. These signs persist for no more than a week. If the pain after the biopsy is uncomfortable, 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 medicines that a doctor may prescribe in the first days after a biopsy:

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

Suppositories can be prescribed that accelerate healing and prevent scar formation, for example, Depantol.

Women are advised to wear cotton underwear and use absorbent pads. It is necessary to wash daily with soap without fragrances and dry the perineal area well. You can drive a car only after a day.

What not to do after a biopsy: lift objects heavier than 3 kg, use vaginal swabs or douche 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, the restriction of sexual life after a puncture biopsy lasts only for a week. Within 2-4 weeks you do not need to take a bath, visit the sauna, swimming pool.

Wound healing 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 the usual time, since the procedure does not affect the hormonal status and the state of the endometrium. There may be a slight shift in the cycle associated with the emotional reaction of the patient or with the characteristics of the recovery period.

Possible Complications

Risk factors that increase the likelihood of complications:

• obesity;
• smoking;
• elderly age;
• high sugar and/or glycosylated hemoglobin levels in people with diabetes;
• impaired renal function with increased levels of urea and creatinine in the blood;
• violation of the liver with an increase in the level of bilirubin, transaminases and other liver tests;
• chronic lung diseases;
• coagulation 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 conditions such as:

• pain in the lower abdomen;
• vaginal discharge with an unpleasant odor and itching in the perineum;
• high body temperature;
• the appearance of abundant secretions after they have almost disappeared;
• secretion of dark blood clots;
• yellow discharge;
• deterioration in general condition.

You should go to the hospital if there is bleeding from the vagina, and this is not menstrual bleeding. A delay in menstruation after a biopsy for more than a week may be a sign of an onset pregnancy, which occurred when the restrictions on sexual life. In any case, if the menstrual cycle fails, you need to visit a gynecologist.

Sometimes complications can arise due to an allergy to an anesthetic drug. In this case, a reaction in the form of urticaria, angioedema, or even anaphylactic shock is possible. These effects develop almost immediately after the administration of the drug, so doctors can provide immediate assistance to the patient.

During spinal or epidural anesthesia, a woman may feel 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 performs 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 neck is possible, which further prevents conception and the normal course of pregnancy. With a large amount of tissue removed, a cylindrical epithelium from its canal can grow on the surface of the neck, and ectopia (pseudo-erosion) will occur.

results

What does a cervical biopsy show?

With the help of a histological examination of the material obtained, the doctor determines whether there are altered cells on the surface of the organ. These violations may not threaten serious consequences or be a sign of precancer and malignant tumors.

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

Deciphering the results of the analyzes allows us to attribute the detected changes to 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, cervical-vaginal fistula).

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

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

Directly malignant formations:

• preclinical - early stage asymptomatic disease (cancer in situ, with initial invasion, microcarcinoma);
• clinically pronounced (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 that allows in many cases to recognize cancer at an early stage and help the patient in time.

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

A biopsy guided by biopsy improves the quality of diagnosis 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 second study is prescribed only in case of emergency. Injury to the cervix can lead to its cicatricial changes, which will make it difficult to bear pregnancy and childbirth. Re-conization is most often performed for the purpose of treatment, not 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 result of the study is usually ready 2 weeks after the biopsy, but in some institutions this period is reduced to 3 days.

Many women, after receiving biopsy data, feel confused and do not understand what this information means. If the doctor's explanations seem not 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

The removal of a piece of tissue from the neck further causes the formation of a small scar, consisting of connective tissue. It is inelastic and does not stretch during childbirth. Therefore, at the birth of a child, the risk of cervical rupture increases.

Large scars can deform the cervix, as a result of which the walls of the cervical canal do not close tightly. This can lead to threatened miscarriage and other complications.

Therefore, a biopsy of the cervix of the nulliparous should be carried out as carefully as possible. In such women, electroexcision or diathermocoagulation (removal of tissue with an electrically heated loop) should not be used, as this procedure causes a small burn of the surrounding mucosa. This increases the likelihood of a scar. Best Option for women planning pregnancy in the future - radio wave biopsy.

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

A biopsy of the cervix during pregnancy is prescribed only in exceptional cases, for example, to diagnose cancer, in which it is impossible to bear a child. Usually it is not carried out 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 birth.

Conization is performed only when there is a justified suspicion of cancer. Curettage of the cervical canal during pregnancy is not used.

Sexual life is allowed 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 healed without complications, you can have sex and become pregnant.

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Biopsy of the cervix

A cervical biopsy is the plucking/cutting off of a piece of tissue from the surface of the cervix, with or without scraping the cervical canal.

Biopsy of the cervix - indications. The indication for a biopsy is the identification of a pathological site / sites on the cervix / vagina during colposcopy.

Biopsies are usually performed on:

Areas of white epithelium that appear after application acetic acid;

Iodine-negative zones on the surface of the cervix.

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

A biopsy of the cervix is ​​always performed under the control of colposcopy:

Or with the help of special tweezers, then a piece of epithelium is plucked from the surface of the cervix;

Or with the help of the Surgidron apparatus; then a piece of cervical epithelium is cut out.

A cervical biopsy may be performed immediately after a colposcopy. The doctor may also schedule the biopsy for another day. In most cases, a biopsy is performed in the first phase of the menstrual cycle, i.e. 3-5 days after the end of menstruation. Why is it 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 in a day.

Cervical biopsy - possible complications:

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

The development of infection / inflammation at the biopsy site (sometimes a course of antibiotic treatment is required).

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

Biopsy of the cervix - instructions after the biopsy.

After a cervical biopsy, you may have:

Moderate pulling pains in the lower abdomen, sometimes cramping - an average of 3-5 days;

Minor/moderate bleeding from the genital tract - an average of 5-10 days

You should call the clinic/your gynecologist immediately if:

Bloody discharge from the genital tract is more abundant than your normal period;

You have copious bloody discharge from the genital tract or many clots;

You have severe pain in the lower abdomen;

Body temperature above 37.5;

You notice unusual, foul-smelling discharge

Cervical biopsy what you should not do:

Lift weights over 3kg

Have intimacy next 2 weeks

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

Take aspirin; this drug thins the blood and prevents blood clots 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

An impressive fear in women causes such a phenomenon as discharge after a cervical biopsy, bleeding after a cervical biopsy. How disturbing these symptoms are, whether it is worth worrying about this, what results of a cervical biopsy are normal - these issues should be dealt with in detail.

A biopsy of the cervix is ​​a gynecological procedure, the purpose of which is to take one or more pieces of mucosal tissue for histological examination. At its core, such manipulation can be regarded as a minor surgical intervention, which does not exclude complications during this period. Every woman who has been assigned such an analysis should be informed about this. Discharge after a cervical biopsy and moderate bleeding after a cervical biopsy are present in every woman, so you should not be afraid of this.

Discharge after cervical biopsy

Bleeding after a cervical biopsy is a fairly common occurrence and is not regarded as a complication, but rather as a natural healing process. During this period, a woman may experience unexpressed pulling pains in the lower abdomen, as during menstruation. As it heals, the spotting after a cervical biopsy gradually becomes more scarce, the wound scars, and after five to six days the patient can return to normal. After a biopsy of the cervix is ​​performed, the discharge can persist for quite a long time. To avoid complications, it is enough to follow the rules of personal hygiene and medical recommendations:

• use sanitary napkins;
• do not use a syringe;
• do not visit the pool, bath, sauna;
• exclude heavy physical exertion;
• refuse intimate relationships (the term will be indicated by the doctor);
• do not take drugs that contain aspirin (aspirin thins the blood and bleeding may increase).

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

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

Dangerous symptoms after the procedure

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

If a biopsy of the cervix was performed, bleeding was complicated by the listed complaints - urgent medical attention is required, since there is an infection. As treatment, intensive antibiotic therapy is prescribed. When bleeding after a cervical biopsy is severe, measures are taken to stop it. After the biopsy of the cervix, the discharge is normally only scanty bloody, any other is a reason to visit the clinic. It should be noted that bleeding after a cervical biopsy can be provoked by a poor blood clotting system in women, therefore, before writing a referral, the doctor must prescribe the necessary tests. It is also necessary to test for viral infections(hepatitis), HIV infection, AIDS.

The presence of a disease such as cervical erosion is in itself an indication for a biopsy. A cervical biopsy is prescribed for erosion at the discretion of the doctor. Before the procedure, it is desirable to obtain the results of a PAP test (a smear of the flora from the genital tract for the presence of malignant cells), colposcopy. It is this examination that allows, under magnification, to identify altered areas - iodine-negative zones, which appear when using Lugol's solution. However, a biopsy of the cervix with erosion is not a prerequisite, and the decision to prescribe this procedure is made after a comprehensive examination. A biopsy of the cervix 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 biopsy of the cervix indicate various pathologies. With their help, a final and accurate diagnosis is established. A presumptive diagnosis can also be removed (a biopsy of the cervix with erosion can rule out cancer).

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

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

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

Thus, a biopsy of the cervix is ​​​​a medical manipulation, the results of which determine the exact diagnosis. And remember: if you develop heavy bleeding after a cervical biopsy, or after an extended cervical biopsy was performed, the discharge became fetid, changed color - urgently contact the clinic, because only an early start of treatment will ensure its success!

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Processes that violate the integrity of the cervical mucosa can eventually acquire a pathological course. long time erosion may not have any symptoms. A woman learns about her only after visiting a gynecologist, who, during a mirror examination, assesses the condition of the mucous membranes of the organs reproductive system.

It is unlikely that erosion will be able to heal on its own. As a rule, physicians use certain types of treatment that help eliminate the displacement of the cylindrical epithelium lining the cervix:

• Treatment with suppositories, tampons soaked in a medicinal solution, douching.
• Elimination of damaged mucosa in an operative way using electrosurgery, cryosurgery, laser surgery, radio wave surgery.

But, before starting treatment, the doctor needs to take a biopsy, which involves taking tissue from the damaged surface for histological examination of the material to detect malignant cells.

What it is? Cervical biopsy is the only method that can be used to accurately diagnose the degree of malignancy pathological changes, which may be present even when the tumor is not yet visually determined.

Preparing for a biopsy

Since the procedure involves the removal of tissues from the affected area of ​​​​the external cervical os, the result of these manipulations will be small wounds on the surface of the cervical canal.

In order to prevent the onset of the development of inflammatory processes in the places where the material for histological examination is taken, the doctor will prescribe a number of additional tests before the biopsy of the cervix.

• . It is taken from the vagina and determines the presence of pathogenic microorganisms that may be pathogens, chlamydia or. In addition, the analysis shows the concentration of leukocytes.
• Blood test for STDs. The results are evaluated in conjunction with a smear for the pathogenic flora of the vagina.

Preliminary examination of the cervix

A biopsy of the cervix, performed during erosion, involves a preliminary examination of the surface of the external pharynx using a special optical device - a colposcope. It allows the gynecologist to examine the affected area with multiple magnification and determine whether there are signs of malignant changes in the mucous membrane.

The examination procedure is called a colposcopy. Currently, biopsy without prior colposcopy is not performed in Russian clinics.

A detailed examination of the cervix can also be considered preparation for the collection of material for histological examination, but in some medical institutions it is customary to take a biopsy during a colposcopy, while in others, a biopsy is scheduled for another day. But at the same time, there should always be a strict sequence: first, an examination with a colposcope, and only then - tissue sampling for analysis.

Types of colposcopy

• Simple colposcopy - performed without the use of special solutions for the treatment of the cervix. With the help of it, the color of the mucosa, its relief, and the size of the external pharynx are determined.
• Extended colposcopy - is carried out using special solutions and in conjunction with additional tests that are aimed at identifying pathological changes in the structure of the external pharynx.

Despite the existence of several types of biopsy, the methodology for its implementation in all cases is approximately the same.

1. The cervix is ​​treated with a cotton pad with a solution of iodine, which either evenly stains it or helps to identify foci of localization of pathological changes in the structure of the mucous membrane.
2. A gynecological speculum is inserted into the vagina, the doctor examines the external os of the cervix.
3. Bullet forceps are inserted with which the cervix is ​​fixed. Then the neck is brought down towards the entrance to the vagina.
4. With the help of devices, the doctor pinches off a piece of tissue from the surface of the cervix. Moreover, if staining with iodine revealed the presence of foci of a pathologically altered structure of the mucous membranes, then the material should be taken from the border area between the affected area and healthy tissues. If there are several such foci, a biopsy is taken from all.
5. The cut-off material is placed in a formalin solution and sent for histological examination.
6. A cotton swab is applied to the wound to eliminate minor bleeding. No stitches are required on the surface of the cervix.

During the biopsy, a woman may experience pain and pulling sensations in the lower abdomen. But they are minor and short-lived, so anesthesia is not provided. Over the next few hours, a raw pain in the lower abdomen may be felt, but it does not require the use of analgesics. Menstruation after a biopsy should come on time, in the usual amount.

Types of biopsy

Gynecologists perform tissue sampling different ways. The choice of a certain type of biopsy depends on the state of the cervix and whether there is a pathologically altered epithelium on its surface.

Colposcopic biopsy- carried out during colposcopy, if the tests showed the presence of lesions on the mucous membrane of the cervical canal, which are at risk of becoming (or have already become) malignant.

Tissue sampling is done with a biopsy needle. However, if it is required to take an analysis from the border area of ​​the epithelium, so that both healthy and pathologically altered cells get into the field of study, then it is difficult to do this with a biopsy needle.

Conchotomy biopsy- one of the most popular types of cervical biopsy. A piece of tissue from the external pharynx is plucked off with the help of a conchotome, a tool that is a scissors bent at a right angle with forceps at the ends.

Conchotomy biopsy allows you to take an analysis from the border of a healthy and pathologically altered area of ​​the cervical mucosa. When pinching a piece of tissue, the patient feels short-term pain, and during the day a few drops of spotting may appear.

radio wave biopsy- involves the use of a radio wave knife to cut off a section of the mucous membrane of the cervix. It is considered a sparing type of biopsy, after which there are no scars, there is no bleeding and there is almost no pain during the procedure.

Loop biopsy- involves the use of a tool with a loop. A current is passed through it - this helps to exfoliate areas of the epithelium, which causes suspicion in the gynecologist during a visual examination. This method is not recommended for women who are going to have a baby in the future, as scars remain on the cervix after it.

There is also a division of the biopsy into several types according to the localization of tissue sampling for analysis:

• Endocervical biopsy - scraping cervical fluid from the cervix. For manipulation, a special tool is used - a curette.
• - a type of biopsy in which a fairly large area of ​​tissue is cut off for a more detailed histological examination. It is performed in cases where the gynecologist detects well-distinguished pathologies on the mucous membrane of the cervix. Conization is carried out in a hospital and involves the use of anesthesia.
• Trepanobiopsy - involves the collection of several pieces of epithelium from different places of the cervix. As a rule, it is used for multiple foci of pathologically altered tissues.

The cut piece of tissue is placed in formalin and sent to the laboratory for histology. In 2-3 weeks, a medical report will be ready, which, as a rule, contains many terms that are incomprehensible to ordinary women.

Abbreviations

• ASC-US are atypical cells of unknown origin found in squamous epithelium.
• ASC-H - atypical cells with a high probability of precancerous changes found in squamous epithelium
• AGC are atypical cells found in columnar epithelium.
• LSIL - atypical cells of unknown origin.
• HSIL - precancerous changes in the structure of the squamous epithelium of the cervix.
• AIS - precancerous changes in the structure of the columnar epithelium of the cervical mucosa.

Terminology

• Adenomatosis is a precancerous condition of the mucous membrane of the cervix. It happens both diffuse, when atypical changes in the structure of the endometrium spreads over the entire surface of the cervix, and focal, when pathologically altered tissues can be found only in some parts of the organ.
• Acanthosis is a thickening of the epidermal layer. Not considered cancer or precancer. Most often it is benign, only in some cases the growth of the epidermis becomes an oncological disease.
• - pathological changes in the epithelium of the cervix, which are considered a precancerous condition. It has 3 degrees: CIN 1 (weak), CIN 2 (medium), CIN 3 (severe).
• Carcinoma is a malignant disease of the cervix. At the advanced stage, the removal of the uterus and cervical canal is indicated.
• Koilocytes are cells whose presence is a sign of the human papillomavirus (HPV). If they are detected, it is necessary to pass an analysis to determine the type of HPV.
• Microcarcinoma is a malignant disease of the cervix of a small invasion (up to 3 mm). Responds well enough to treatment.
• Leukoplakia (Hyperkeratosis) - an excessively high rate of division of horny cells. As a result, during the study, keratinization of the cervix is ​​noted. There are two types: simple, not dangerous, and proliferative, which is a precancerous condition that has a greater tendency to become malignant.
• Parakeratosis - excessive keratinization of the mucous surface of the cervix. It is considered a precancerous condition. They are classified according to the cause of occurrence and the form of manifestation of pathological changes.
• Squamous metaplasia is the replacement of a single-layer cylindrical epithelium with a multi-layer one. It is considered a precancerous condition. It provokes the appearance of foci of dysplasia.
• Cervicitis is an inflammation of the cervical canal. May be acute and chronic.

The results of a cervical biopsy should not be deciphered on your own. It is necessary to show them to a gynecologist who will be able to correctly assess the health of the reproductive system, based not only on the data obtained from the laboratory, but also on the results of colposcopy.

Since gynecological manipulation involves taking a piece of tissue, a wound surface is formed on the cervix. The volume and nature of discharge after a biopsy will depend on the type of intervention performed. The more traumatic the biopsy was, the more blood can be seen on the panty liner.

Normally, the consequences of taking material from the surface of the cervix should not lead to bleeding. If the doctor used a biopsy needle or performed the procedure using the radio wave method, then spotting may be absent.

In other cases (except for conization), the discharge appears in the form of a few drops of blood or a short yellow-brown daub, which gradually turns into yellow discharge, and then disappears completely.

Biopsy Contraindications

• Infectious respiratory diseases with fever.
• Urogenital infections in acute form.
• The presence of menstruation.
• The presence of pregnancy at any time.
• Poor blood clotting.
• With caution in hepatitis B and C and HIV

A biopsy is the only way to reliably determine at what stage pathological changes in the epithelium of the cervix are. Despite the pain of the procedure, neglecting it is dangerous for health - especially in cases where the doctor strongly recommended it.

When a patient comes to the gynecologist with complaints of cycle disorders or unusual discharge, a colposcopy and ultrasound of the cervix are usually performed. If there are doubts about the nature of the detected pathologies, then a biopsy is prescribed. In this case, it is not at all necessary that a bad diagnosis will be confirmed. The main thing is to detect the problem in order to start treatment in time. A biopsy of the cervix is ​​performed in various ways. When choosing, it is taken into account whether the woman has any contraindications (allergies, inflammatory diseases), and also whether she plans to become pregnant in the future.

Content:

Indications for a biopsy

Ultrasound and colposcopy can only detect a pathological area of ​​the surface of the cervix, roughly estimate its size. Unlike them, a biopsy makes it possible to study the structure of the affected cells. In this way, you can find out exactly what their nature is, whether there are atypical (precancerous) or malignant changes.

Before a biopsy of the cervix, an extended colposcopy is performed, during which the mucous membrane is treated with certain reagents and what changes occur. First of all, using a cotton swab, lubricate the surface with a 3% solution of acetic acid, and after 1 minute, look for white (so-called acetowhite) spots on it. If they appear, it means that there are damages in the tissues of the cervix.

The surface of the neck is also treated with iodine, which makes it possible to detect areas of inflammation, viral tissue damage. Pathology is indicated by the appearance of so-called iodine-negative (not stained with iodine) spots.

Based on the results of an extended colposcopy, the doctor decides whether a biopsy of the cervix is ​​necessary. Such an examination is prescribed in the following cases:

• during extended colposcopy, acetowhite and iodine-negative spots were found;
• there are areas of erosion or keratinization (leukoplakia) of the epithelium of the cervix;
• a cytological examination of a smear (PAP test) showed the presence of atypical cells (increased size, with two nuclei);
• polyps or warts (genital warts) are found on the cervix.

Video: Features of a cervical biopsy

Biopsy methods

Methods for the implementation of the procedure are selected taking into account the alleged diagnosis, as well as the presence of contraindications. Some types of biopsy are used not only in diagnostic, but also in medicinal purposes.

Depending on the technique used, local anesthesia is performed (an anesthetic drug is injected into the cervix before the procedure), epidural or spinal anesthesia (pain relief by injecting an anesthetic into the spine). In some cases, general anesthesia is used. The biopsy procedure lasts from a few seconds to 30 minutes. It depends on its purpose and the chosen technique.

Depending on the purpose of the procedure, the amount and type of material being sampled, the following types of procedure are distinguished:

1. Puncture (simple) biopsy. Only a very small tissue sample is taken from the surface to be examined. As a rule, the procedure is performed without anesthesia in a polyclinic.
2. Endocervical biopsy of the cervix. Mucus is taken from the cervical canal for examination, which is scraped off with a special surgical spoon - a curette.
3. Electrosurgical biopsy (loop or radio wave). Using an electric loop or radio knife, a piece of material is removed.
4. Wedge biopsy (conization). A wedge of affected tissue is cut out with a scalpel or laser. The method is used when it is necessary to extract a sufficiently large amount of material from a large area.
5. Trepanobiopsy - a sample is taken from several areas at once, which allows you to assess the total area of ​​\u200b\u200bthe lesion.

Classification of types of biopsy according to the method of sampling

A biopsy of the cervix is ​​​​performed on the 7-13th day of the cycle, so that the wound has time to heal before the start of the next menstruation. Sampling can be done using a special needle, tongs or other devices and instruments. The methods of the procedure differ in the degree of pain and the likelihood of complications.

Aspiration biopsy (pipel biopsy). Sampling is carried out using a pipel - a soft tube inserted into the vagina. Cells of diseased tissue are sucked into it and then examined under a microscope. This method is the most gentle.

Targeted biopsy of the cervix. It is performed directly during the colposcopic examination. A thin column of affected tissue containing several layers of cells is taken for analysis. For this, a special needle is used. The method is practically painless. The procedure takes a few seconds. In this case, the woman feels only a weak prick. Complications, as a rule, do not happen. Manipulation is carried out in a conventional gynecological office.

Conchotomy biopsy. To select a tissue sample, a device resembling scissors with sharp ends (conchotom) is used. Local anesthesia is performed. The cervix is ​​slightly more traumatized than with an aspiration biopsy, but the patient does not need to be hospitalized. There may be traces of blood in the discharge for several days after the manipulation.

radio wave biopsy. A small piece of tissue is cut off with a special "radio knife", for which the Surgitron apparatus is used. The procedure is simple and performed under local anesthesia. The advantage of the method is the complete absence of a scar at the site of tissue sampling, so a cervical biopsy can be performed in this way when examining women planning to give birth to children. 2-3 days after the procedure, no traces remain on the neck. While the wound heals, a woman may experience scanty spotting.

laser biopsy. A laser beam is used as a knife. The procedure is performed in a hospital under a short general anesthesia. Small spotting appears within 2-4 days after the biopsy.

Loop biopsy (electroexcision). An electric knife is used, which is a thin wire loop through which an electric current is passed. In this way, you can not only remove a rather thick section from the affected tissue, but also remove a small damaged area. This procedure is much less painful than scalpel surgery. Local anesthesia is applied. Within a few days, spotting appears. The disadvantage is that after complete healing, a small scar is formed. Therefore, this method of conducting a biopsy of the cervix is ​​not used when examining girls and women planning a pregnancy, since the presence of scars on the cervix complicates childbirth later.

Extended (knife) biopsy. Using a scalpel, a specimen is cut from the affected area for examination. Unlike targeted biopsy, not only diseased tissue is selected for research, but also surrounding healthy tissue, which may contain atypical cells. The method is used both for the study and for the treatment of diseases of the cervix.

There are the following types of extended biopsy:

• wedge-shaped - a triangular pattern is cut;
• circular (circulating) - a vast area is cut out around the pathological area. For this, a scalpel or radio knife is used.

A knife biopsy of the cervix is ​​performed in a hospital under general anesthesia. Sometimes epidural and spinal anesthesia is used. Complete healing of the wound occurs in 2-4 weeks. A woman may experience pain for several more days after the operation.

Video: How a radio wave biopsy is performed

Preparation for the procedure

In preparation for the biopsy procedure after undergoing an ultrasound and colposcopic examination, laboratory blood tests for HIV, syphilis, and hepatitis are required. With the help of immunological methods (ELISA, PCR), the presence in the body of pathogens of trichomoniasis, mycoplasmosis, gonorrhea and other latent infections, which are often the cause of cervical diseases, is determined.

Bacteriological and cytological analyzes of a smear from the vagina and cervix are carried out to detect inflammatory processes, abnormalities in the structure of the cells of the affected tissues. Blood clotting is checked.

The doctor warns the patient that 2 days before the biopsy of the cervix, it is necessary to stop using hygienic tampons, douching, and introducing any medications into the vagina. It is required to refrain from sexual intercourse.

If the procedure will be carried out under anesthesia, then 8 hours before it is necessary to stop eating.

A warning: Before the procedure, be sure to warn the doctor about the presence of allergies to any drugs or materials.

Possible Complications

The likelihood of complications depends on the method of the procedure, individual features body of a woman, compliance with the rules of personal hygiene. If the patient is too physically active in the first days after the procedure or her blood clotting is reduced, then bleeding from the wound remaining on the cervix may open.

An infection can get into the wound if a woman does not pay enough attention to the hygienic care of the genitals. At the same time, her body temperature rises, purulent discharge with blood clots appears. For several days after the procedure, the patient feels a slight pulling pain in the lower abdomen.

To avoid complications after a biopsy, a woman should give up sports, heavy lifting, and long walking for several days. At this time, you can not swim in the bath, go to the bathhouse or pool. It is not recommended to have sex for 1-3 weeks (depending on the type of procedure).

You should consult a doctor in the following cases:

• after a biopsy, menstrual flow became more abundant, lasting more than 1 week;
• fetid purulent discharge appeared.

Among other things, the body temperature rises, which indicates an inflammatory process in the body.

Contraindications for the procedure

A biopsy of the cervix is ​​not performed if a preliminary examination showed the presence of inflammatory processes in the vagina and cervix. Necessary treatment is carried out in advance.

A biopsy is not done during menstruation. Pregnancy is a contraindication because early dates the likelihood of miscarriage increases, and in the later - premature birth. Usually the procedure is carried out no earlier than 6 weeks after delivery. A biopsy during pregnancy is performed only when there is a threat rapid development cancerous tumor.

The procedure is not performed if the woman has blood diseases.

A warning: When visiting a gynecologist about planning a pregnancy, a woman must necessarily inform him that she underwent a cervical biopsy.

Deciphering the results

The results obtained after a biopsy contain information about the presence of so-called koilocytes (atypical cells that appear when infected with the human papillomavirus).

In addition, a biopsy shows the presence of dysplasia, that is, changes in the structure of the deep layers of the epithelium of the cervix. Dysplasia can turn into cancer.

The presence of leukoplakia, acanthosis and other processes associated with the degeneration of the epithelium of the cervix, the death of its cells is determined. Moreover, these diseases occur in benign, precancerous and malignant forms. Based on the results of the biopsy, the doctor decides on the method of treatment or the need to remove the affected tissue.

Video: How a vinegar test is performed. Biopsy process

Biopsy of the cervix. How to prepare for it? Description of the procedure and general recommendations in front of her.

Many analyzes and examinations make it possible to identify diseases at an early stage of development, to start complex treatment in a timely manner. Today we will learn what a cervical biopsy is, what is its purpose. Let's consider the issue in sufficient detail. A biopsy of the cervix is ​​a special medical manipulation, during which the tissue of the cervix is ​​taken. The resulting tissues are then analyzed, making it possible to establish a diagnosis, and then immediately begin appropriate therapy.

When there are indications for a biopsy, the doctor prescribes it at the most convenient time for the patient. The date will depend on the timing of the menstrual cycle. Tissue sampling is performed in the gynecologist's office when there is no need for anesthesia.

A biopsy of the cervix is ​​performed under anesthesia in most cases. If it is required, then the procedure is carried out during hospitalization for two days. The doctor must tell the patient how the biopsy will be performed. Detailed recommendations are given for proper preparation to the procedure. Then you will need to return to your doctor's office when about a week has passed since the biopsy.

Biopsy methods

Sighting

The targeted biopsy method is quite widespread. His experts consider the most accurate. In addition, with this technique, the effect of negative effects on the patient's body is reduced. However, this procedure requires good technical support.

During a colposcopy, the doctor uses the thinnest needle. This needle is used to collect cells that cause some suspicion from a specialist. Such an analysis is recognized as the most effective for detecting cervical cancer, as well as for dysplasia.

Laser biopsy: features of the technique

Laser biopsy of the cervix is ​​a fairly accurate, reliable procedure. But for its implementation, it will be necessary to introduce a short-term anesthesia. Such an analysis can only be performed under stationary conditions.

Using a laser, a specific area of ​​the cervix is ​​removed. Experts recognize this operation less traumatic. It takes quite a bit of time to heal in the future. Patients should be aware that when a cervical biopsy is performed with a laser, quite unpleasant residual effects will be observed. There are discharges of reddish-brown, light pink shades. Such effects can be observed for several days, but there is nothing hazardous to health in this.

radio wave biopsy

Many doctors recommend using the technique of radio wave tissue sampling from the cervix. Experts say that the use of the so-called "radio knife" significantly reduces the risk of possible side effects. Here are some of the key benefits of the procedure.

• In a short time, the cervix heals, since with such an instrument everything is done carefully, with minimal tissue damage.
• Allocations are scarce, so they will not create problems either.
• There are practically no complications after the procedure.
• Of great importance is the fact that such an analysis does not require the use of anesthesia.

Sometimes people are primarily interested in the specific cost of a cervical biopsy. However, specific prices can only be found in the appropriate clinic, where you are going to take this complex analysis.

Wedge Biopsy

This method of tissue sampling is far from the safest, most effective. Although it is used quite often, since it does not require the use of special sophisticated equipment.

In the process of performing a wedge biopsy of the cervix, the doctor uses a scalpel. This is a full-fledged operation that can be carried out exclusively in stationary conditions. A surgical scalpel is used. It is with the use of a scalpel that a specialist excises a wedge-shaped area directly on the cervix. At the same time, not only diseased areas in the tissues are taken. Healthy particles are also needed: this is necessary for an adequate analysis.

After the operation, sutures are required. Such a surgical intervention occurs only under anesthesia. The healing process takes a long time. Unfortunately, during the rehabilitation period there will be discharge, probably plentiful. Pain also accompanies healing.

Loop fabric fence

A loop-type biopsy is associated with the use of an electric current. A special loop is applied to a specific area on the cervix. Then an electric current runs through the loop. It causes cell death. This technique is used not only as part of the biopsy procedure. It is in demand in the complex treatment of diseases of the cervix. The so-called cauterization is still used quite often. Experts note that the technique is not quite modern, sometimes provokes complications. Unfortunately, often after a loop biopsy of the cervix, scars remain on the tissues.

Circular biopsy

The technique of circular biopsy is also known. It is different from all the methods of tissue sampling that we have considered earlier. In the process of a circular biopsy, tissues are also taken from a section of the cervical canal. This is an extended biopsy. Usually, specialists use a radioknife, a scalpel to remove tissues. General anesthesia is mandatory, the procedure is allowed only in stationary conditions. For several days of the recovery period, there are usually discharges, patients are worried about pain.

After the procedure

Experts note that after performing a biopsy, you need to behave correctly so that complications do not exactly arise. Here are some important recommendations that you should definitely follow.

1. Douching is prohibited.
2. You can't lift weights.
3. It is forbidden to take a bath, go to the bath.
4. The use of vaginal tampons is also prohibited.
5. Intimacy is prohibited.

All these precautions must be taken for at least two weeks. Further, everything will depend on the specific recommendations of the attending physician, the patient's condition.

Classification of types of biopsy according to the method of sampling

Only a specialist will be able to accurately determine the best way to biopsy the cervix. Also, the doctor will prescribe a period when it is better to take tissue for further analysis.

There are several main methods of analysis:

• wedge-shaped;
• radio wave biopsy;
• sighting;
• circular;
• laser;
• loop.

The procedure is shown for erosions, for detecting changes in the tissues of the organ, as well as for polyps. Cervical hyperkeratosis is quite common, and a biopsy procedure is also performed with it. Also, a biopsy is necessary if abnormalities are detected in the laboratory analysis of a smear for cytology.

Tissue analysis helps to identify the oncological diseases themselves, as well as a variety of ailments that precede them. Unfortunately, the study is forbidden to conduct with poor blood clotting, as well as during the development of inflammatory processes.

Preparation for the procedure

It is important to know exactly how to prepare for a biopsy. It is necessary to follow all the recommendations and advice of the doctor so that the procedure goes well and does not cause negative consequences.

The patient passes a certain range of tests before the biopsy. Assign smears for various infections, blood tests for HIV, for hepatitis, as well as for RW. The state of the neck of the organ by the beginning of critical days is also of great importance. That is why a biopsy is performed immediately after menstruation. Then, by the next critical days, the cervix manages to heal, no longer has damage.

• It is important to carefully perform all hygiene procedures immediately before tissue sampling.
• You should take a shower.
• Food should not be taken in the evening.
• Intimacy is prohibited two days before the biopsy.
• You should not use medicines, as well as vaginal care products.

Only with competent preparation for the delivery of the analysis will it be possible to conduct it effectively.

Possible Complications

First of all, it is important to know all the likely symptoms of complications that arise after a cervical biopsy. Here are some signs that should immediately alert:

• increase in body temperature;
• pain in the lower abdomen;
• vaginal discharge;
• itching in the perineal area;
• yellow, dark discharge;
• the release of darkened blood clots;
• the reappearance of secretions in large quantities when they have already ended;
• general weakness, dizziness, feeling unwell.

If these symptoms appear, you should immediately consult a doctor. For any violations of the menstrual cycle, it is also necessary to go to an appointment with a gynecologist.

Doctors note: in some cases, complications begin due to allergic reactions to the drug, which acts as an anesthetic. The best solution is to make appropriate tests in advance in order to find out which anesthesia is more suitable.

Deciphering the results

When conducting such a histological analysis, specialists determine whether there are cells with changes on the surface of the uterus. Such violations are practically safe, but they can also be cardinal, characteristic of the presence of a malignant tumor, a precancerous condition. There are mild, severe and moderate dysplasia, as well as carcinoma - an early stage of oncological disease.

Analyzes are deciphered. All identified changes are attributed to one of three groups:

• background;
• precancerous;
• cervical cancer.

It is on these data that the doctor makes an accurate diagnosis, forms a program complex treatment cervical biopsy

In some cases, after a Pap test, examination on a gynecological chair, or a gynecologist, a diagnostic procedure such as a cervical biopsy may be performed. This study involves the taking of one or more samples of cervical tissue and their histological analysis to determine abnormalities, precancerous or cancerous degeneration of cells.

In order for such a diagnostic method to give the most reliable results, it is necessary to determine the indications and contraindications for its implementation, select the correct date for its implementation and the type of tissue sampling technique. Before the procedure, the woman must undergo necessary training, the correctness of which will also determine the reliability of the analysis.

In this article, we will introduce you to the indications, contraindications, methods for preparing and performing a cervical biopsy.

Indications

If during a colposcopy the doctor finds changes on the cervix, it is possible that in order to clarify the diagnosis, he will prescribe a biopsy to the patient.

A gynecologist may prescribe such a diagnostic procedure for any suspicion of pathological changes in the tissues of the cervix.

Most often, a biopsy is prescribed in the following clinical cases:

• doubtful or negative results (smear for cytology);
• presence on the cervix, warts, polyps;
• identification of suspicious changes during colposcopy (atypical vessels, iodine-negative areas, coarse mosaic and punctuation, acetowhite epithelium, etc.).

Contraindications

Sometimes a cervical biopsy cannot be performed until certain contraindications are resolved:

• infectious and inflammatory processes in the genitals;
• disorders in the blood coagulation system;
• menstruation.

Another relative contraindication to performing a biopsy may be pregnancy. In such cases, this diagnostic procedure is not always carried out.

When can a cervical biopsy be performed during pregnancy?

When pathological changes are detected in the tissues of the cervix during pregnancy, the decision to take a biopsy is always made individually.

In the early (up to 12 weeks) or late terms, such a procedure may be unsafe and cause miscarriage or premature delivery. That is why gynecologists usually recommend performing tissue sampling in the second trimester of pregnancy, when the risk of such complications becomes minimal.

If other studies show that the identified pathological foci in the tissues of the cervix do not require immediate diagnosis, then a biopsy can be performed already in postpartum period. In such cases, the study is carried out 6 weeks after delivery.

Types of cervical biopsy

Cervical tissue sampling can be done using different methods. The choice of one method or another depends on the preliminary diagnosis and a number of other parameters, and some of the biopsy techniques are not only diagnostic, but also therapeutic procedures.

There are such types of biopsy of the cervix:

1. Aiming (or puncture). This technique is the most common and is performed during a colposcopy. The most suspicious tissue areas are taken for analysis. To obtain them, a special biopsy needle is used, which is able to hold a column of tissues in itself. This procedure can be performed on an outpatient basis and does not require spinal, epidural or general anesthesia. During the procedure, the patient feels only a slight tingling or some pressure, which disappears after only 5-10 seconds.
2. Conchotomy. This type of biopsy is almost no different from a puncture biopsy, but a conchot is used to perform it (an instrument resembling its appearance scissors). The procedure can be performed on an outpatient basis, and local anesthesia is used for pain relief. After taking material for analysis, a woman may have spotting for some time.
3. Loop (or electrosurgical, electroexcision). During such a procedure, the altered areas of the cervical tissue are, as it were, peeled off using an instrument similar in shape to a loop. An electric current passes through it, which ensures the separation of the necessary tissues. The procedure can be performed on an outpatient basis after local anesthesia. It is believed that this type of biopsy is capable of distorting the results of the analysis, since “charred” particles are present in the taken tissues. After taking a sample of the material in this way, healing takes longer and the patient may experience bloody discharge from the vagina for several weeks. In addition, some experts do not recommend this procedure for women planning pregnancy in the future, because after tissue sampling, cicatricial changes may form on the neck that interfere with normal conception or gestation.
4. Wedge-shaped (or knife, extended, cold-knife, conization of the cervix). This procedure is carried out using a conventional surgical scalpel. A small, triangular piece of the cervix is ​​taken as a tissue sample. The incisions are made in such a way that the most suspicious layers of this part of the uterus are taken for analysis. This method of material sampling can be not only diagnostic, but also therapeutic. It is always performed in a hospital setting, because it needs sufficient anesthesia (general anesthesia, spinal or epidural anesthesia). After the intervention, the woman can be discharged on the same or the next day. Over the next few weeks, she may feel mild pain in the lower abdomen and observe bleeding of varying degrees of profusion from the vagina.
5. Circular (or circular). This method is a type of conization of the cervix and is performed with a scalpel or radio wave knife. During the intervention, a large area of ​​tissue is taken with the obligatory capture of a part of the cervical canal. This method can be prescribed for diagnostic or therapeutic purposes. It is performed under general anesthesia, spinal or epidural anesthesia in a hospital setting. As after conization of the cervix, a woman may feel pain in the lower abdomen for several weeks after the procedure and observe bloody discharge of varying degrees of profusion from the vagina.
6. radio wave. This technique is performed using a radio wave knife of the Surgitron apparatus and does not leave significant damage to the cervix. After tissue sampling, a woman may experience small spotting, but they stop after 2-3 days. This procedure rarely causes complications and there are no cicatricial changes on the organ. Often, this type of biopsy is recommended for women who are still planning a pregnancy.
7. laser. Tissue sampling for analysis is carried out using a laser knife in a hospital, since such an intervention requires general anesthesia. This technique rarely causes any complications, is less traumatic and does not require long-term rehabilitation (bleeding stops in the first days after the procedure).
8. Endocervical curettage. This biopsy technique is somewhat different from the previous ones, since it involves curettage of the cervical canal. Thanks to this manipulation, it is possible to obtain tissues directly from the cervical canal in order to detect atypical cells in them. The procedure can be performed after performing intravenous anesthesia.

What day of the menstrual cycle is the biopsy performed?

A biopsy is performed on the 5th-7th day of the menstrual cycle, immediately after the end of menstruation.

by the most auspicious days for tissue sampling, the first days are considered - 5-7 days from the first day of menstruation, immediately after their completion. Experts recommend performing a biopsy on these days so that the tissue damage formed after the procedure has time to heal completely before the next monthly bleeding begins.

What Tests Should Be Done Before a Biopsy?

Cervical tissue sampling is an invasive procedure and after it is performed, damage remains on the surface of the organ, which can become an entrance gate for infection or a source of bleeding. To exclude such complications of a biopsy, a woman is assigned a number of diagnostic studies:

• clinical blood test;
• coagulogram;
• tests to detect infections: smear for microflora, analysis for latent infection, blood tests for hepatitis, syphilis and HIV;
• smear for cytology.

How to Prepare for a Biopsy

To obtain the most reliable results of the study and prevent complications in preparation for a biopsy, a woman should follow a number of rules:

1. 2 days before the procedure, refuse sex.
2. 2-3 days before the study, stop douching, do not use tampons and do not inject drugs into the vagina.
3. If it is necessary to perform local anesthesia, conduct a test to identify possible allergic reaction to the anesthetic used.
4. If it is necessary to perform general anesthesia, get advice from an anesthesiologist and, if necessary, follow his recommendations (conducting additional studies, taking a sedative the day before the procedure, etc.).
5. Before the procedure, take a hygienic shower.
6. If general anesthesia is planned, then the last meal and liquid should take place 8-12 hours before the procedure.
7. Sign the consent documents for the biopsy.

What type of anesthesia is used for the procedure

The intensity of pain during a cervical biopsy depends on the following parameters:

• method of performing the tissue sampling procedure;
• the level of pain sensitivity of the patient;
• scope of intervention.

If there is only one small focus for tissue sampling, anesthesia may not be performed, because there are no pain receptors on the cervix. If a larger invasive intervention is planned or the patient is very sensitive to pain, worried or nervous, then local anesthetics can be used to eliminate pain. Such drugs are applied to the cervix in the form of a spray or injected into its tissues by injection. In addition, a woman is advised to relax during tissue sampling. This condition reduces the likelihood of contractions of the uterus and makes the pain less noticeable.

For some types of biopsy, general anesthesia, epidural or spinal anesthesia may be recommended. In such cases, the woman should consult an anesthesiologist. If necessary, this specialist can prescribe additional diagnostic studies (ECG, tests, etc.), which will allow him to assess the general state of health and choose the most appropriate drugs for the safe administration of pain relief.

How the study is done

How a cervical biopsy is performed will depend on the technique chosen by the doctor. After the appointment of a particular procedure, he must necessarily acquaint the patient with the basic principles of its implementation.

Biopsy of the cervix on an outpatient basis

If the procedure is to be performed in a clinic, spinal, epidural or general anesthesia will not be used for the procedure.

The biopsy will be performed as follows:

1. The patient lies on the gynecological chair, as for a routine examination.
2. A speculum is inserted into the vagina and a bright light is directed to the cervix.
3. If necessary, it is carried out (irrigation of the cervix with a solution of a local anesthetic or its administration as an injection).
4. A sample of suspicious tissue areas is taken and the resulting material is sent to the laboratory for histological analysis.
5. After the procedure is completed, the patient can go home.

The duration of this procedure is no more than half an hour. After its completion, the specialist sets the date for the next examination, gives the patient recommendations about some restrictions and introduces the symptoms, in the event of which she should consult a doctor.

Biopsy of the cervix in a hospital

If a woman is scheduled for a type of biopsy to be performed after spinal, epidural, or intravenous anesthesia, then she will need to be hospitalized for 1-2 days. The procedure is performed in an operating room on a gynecological chair.

After performing spinal or epidural anesthesia, the woman is conscious, but does not feel the lower half of the body, and after general anesthesia, she falls asleep. Depending on the clinical case the duration of such an intervention can be from 40 minutes to 1.5 hours.

After the biopsy is completed, the patient should remain under medical supervision for several hours or until the next morning. After that, in the absence of complications, she is discharged and will have to follow a number of medical recommendations. At discharge, the doctor sets the date for the next examination.

After the procedure

Some women experience mild pain in the lower abdomen and vagina for several days after a cervical biopsy.

If the biopsy was performed in a clinic, then the woman is given a sick leave for 1-2 days. When carrying out the procedure in a hospital, a disability certificate is usually issued for 7-10 days. The results of the study are obtained after 10-14 days, and the next appointment and examination by a gynecologist is carried out after 4-6 weeks.

After a biopsy, almost all women have bloody discharge from the vagina. Their duration and abundance depends on the method of material sampling used. After performing a radio wave, laser, puncture or conchotomy biopsy, there is a slight discharge, which stops after 2-3 days. If a woman underwent a wedge-shaped, circular or loop biopsy, then the discharge is observed for several weeks. In the early days, they are quite plentiful and resemble discharge during menstruation, and then become spotting.

After the biopsy procedure, tampons should not be inserted and only pads should be used. Sometimes special solutions are used during the biopsy. In such cases, the discharge may be brown or greenish in color for several days. This should not scare a woman.

In addition, after such a study for several days, some women may feel slight pain in the lower abdomen or in the vagina. To eliminate them, you do not need to take an analgesic, and soon they are eliminated on their own.

After performing a biopsy, a woman should follow the following doctor's recommendations:

1. Refrain from physical activity and sexual acts. At a minimum, such a restriction should be observed during the first 14 days, but depending on the method of sampling material for research, the period may be different. More precisely, the duration of these restrictions will be determined by the doctor.
2. Do not use tampons, vaginal dosage forms(candles, creams, tablets, etc.) and do not douche.
3. Do not take a bath, do not visit saunas, baths, pools. For hygienic purposes, use only the shower.
4. Do not lift weights over 3 kg.

When to see a doctor immediately

In some cases, after a biopsy, a woman may bleed or develop an infectious complication. The following symptoms should prompt immediate medical attention:

• profuse bleeding (scarlet or dark blood with clots);
• discharge is similar in abundance to menstruation, lasts more than 7 days;
• mild but long lasting spotting more than 2-3 weeks;
• the appearance of yellowish discharge with an unpleasant odor;
• temperature rise above 37.5 °C;
• intense pain in the lower abdomen or in the vagina.

Possible Complications

In most cases, after conchotomy, puncture, laser and radio wave biopsy, no undesirable consequences occur. After a loop, circular or conical biopsy, cicatricial changes may remain on the neck. In some cases, they can become an obstacle to future conception and normal pregnancy.