Cervical biopsy: decoding the result of thatafter it you can not, preparation

Update: October 2018 A cervical biopsy is “pinching off”
кусочка слизистой с подозрительного участка шейки uterus. Biopsy
any body is the most reliable way to deliver
definitive diagnosis because it is being investigated directly
pathological tissue, and in this case a unique way
clarify the type of disease and, most importantly, identify cancer
early lesions. With этом не требуется разрезать живот
or chest. The procedure is carried out quickly and not
most often does not require hospitalization.

From anatomy

It would seem that the very phrase “cervix” suggests that
the neck is part of something. Historically, that is,
there is a body of the uterus and neck. But at многолетних наблюдениях, лечении
a variety of pathologies, monitoring pregnant women became
develop the view that the cervix is ​​still a very special organ with
its structure and specific diseases.

The length of the cervix is ​​normally about 3-4 cm, width about 2.5-3 cm.
Its shape is cylindrical, the outer pharynx opens into the vagina, and
внутренний в полость uterus.

We pay attention to this aspect because the diseases of the neck
uterus – it is now not uncommon even in young and birthless
women.

And this is all the more alarming, because the cervix is
visually accessible organ. And by all standards, the patient should
visit the gynecologist once a year. And in this visit she must
take a swab on the flora (it turns out that there is inflammation,
vaginal dysbiosis and so on) and cytology
from the cervix (scraping cancer cells from the cervix), also the doctor
examines the cervix in the mirrors.

Indications or who needs to do a biopsy of the cervix

Cervical dysplasia

Cervical dysplasia – это атипические (патологические)
changes in the tissues of the vaginal part of the neck. Unlike erosion,
dysplasia penetrates deeper, has three stages and threatens the development
pathological process up to cancer. In these
In cases of instrumental and laboratory diagnosis play a key
role because a woman can not be bothered by anything
severe stage of the disease. There is no pain, no unusual discharge,
ни нарушения menstrual cycle.  With выполнении биопсии
the accuracy of diagnosis is almost 100%, which means that
we will be able to decide on treatment / surgery / observation as much as possible
quickly.

Cervical ectopia

Cervical ectopia – это такое состояние, когда ткань, которая
normally located in the cervical canal (inside the cervix) as if
�”Creeps” out and we find it on the outer throat of the neck.
In itself, this state is not dangerous, but in order to calm down
and just be observed in a planned manner 1 time per year, it is necessary
exclude more formidable diagnoses.

Leukoplakia necks

Leukoplakia is the formation of “white plaques” on the cervical mucosa
uterus. The word “leukoplakia” itself means “white plaque”. On the neck
uterus areas are formed that have a denser structure and
uneven stained during colposcopy. With
Biopsy solves the fundamental issue – it is simple
leukoplakia and its observed, or is it atypical leukoplakia
(precancerous condition), which should be actively treated. Treatment in
This case may imply a very wide spectrum.
interventions, from destruction (electric current, laser) to
remove part or all of the neck.

Cervical Polyps

Cervical Polyps матки – это выросты слизистой, которые напоминают
warts and have a diverse and often mixed origin
(hormonal failure, genital infections, mechanical injuries during
abortion and diagnostic curettage, age-related changes).

Polyps can not manifest themselves, and then, on examination,
gynecologist this becomes a godsend. And it may happen that
a woman comes exactly with complaints of bleeding after
sexual intercourse, pain and other manifestations. Anyway polyps
should be removed and examined histologically. And in this case we
также более всего опасаемся рака шейки uterus.

Genital warts

Genital warts  или аногенитальные бородавки – это
education on the mucous membranes (including the neck) and skin. it
the disease is caused by the human papillomavirus and also threatens
reincarnation in cancer. With биопсии определяется то, на какой стадии,
at the moment there is a disease and is it not necessary to take
more action than observation and medication
(antiviral drugs).

Questionable or abnormal Papanicola test result
(dad-test)

Pap test or habitual “cytology” from the cervix is
screening test, that is, a survey that is conducted to all without
exceptions for women who applied at least once a year. it
necessary in order to identify suspicion of oncology. If in
scrape from the cervix is ​​detected suspicion of cancer cells, it is not
should hesitate and perform a biopsy.

Changes detected during colposcopy

Colposcopy – This is an examination of the cervix under a microscope, while
the neck is treated with iodine and acetoacetic acid solutions.
There are standards for how the neck should look normal and after
treatment solutions. If the colposcopic picture is not
corresponds to the norm, then it is necessary to deepen the diagnosis and in some
cases perform a biopsy.

Detection of HPV infection

HPV (Human Papillomavirus) is an oncogenic virus that
sexually transmitted and can cause cervical cancer
uterus. HPV has a number of strains (types of virus) that are dangerous in
different degrees and cause different types of lesions (from papillomas and
anogenital warts before cancer). If the examination revealed
high oncogenic risk in HPV scraping (16, 18, 31, 33,
39), then it is desirable to pursue the maximum. Cervical cancer,
detected early, especially cancer in situ, is fine
treatable and extremely rarely recurs.

In situ cancer is literally “cancer in place,” that is, a small
a cluster of cancer cells that have not yet spread and
There is a chance to recover completely.

Contraindications for cervical biopsy

Acute inflammation of the cervix or vagina

Inflammation во влагалище является временным противопоказанием к
biopsy. Biopsy предполагает некоторую травму слизистых
and if there is infection, the process can spread and deepen,
which will add additional problems and may be fraught
complications.

I and III trimesters of pregnancy

In the first trimester, manipulation of the neck can trigger a threat
miscarriage. it обусловлено механическим воздействием на ткань шейки,
pain and risk of inflammation.

In the second trimester, the situation in many respects
stable, the child is already growing, it is tightly attached (unlike I
trimester), but still not so big in size.

In the third trimester of pregnancy, the baby is already large, the neck
uterus is shortened and in vivo, and if we add
also our intervention, we can provoke premature
childbirth. In this case, diagnostic manipulations should be postponed to
�”after childbirth”. After giving birth, a woman should come to the precinct
gynecologist (or the gynecologist, who was observed by
pregnancy) a couple of days after discharge from the hospital, and then
in 1.5-2 months. Here in the second visit the question should be solved
Do I need an in-depth examination. At this point, generic tissues
paths have almost recovered, and diagnostics will be
reliable.

Blood clotting disorder

Disorder of blood coagulation is expressed in varying degrees. With
severe coagulation disorders, frequent bleeding, spontaneous
bruising with different sizes, you must first select all
possible minimally invasive (non-traumatic) research methods, and to
biopsy to resort, in a pinch.

If the coagulation disorder is non-critical, then
perform the procedure under the cover of drugs for coagulation
blood. Names and regimen of medication you appoint a therapist or
hematologist (specialist in blood diseases).

This also includes patients who take
blood thinning drugs. We must remember that patients
they are sick not only with what they came to us. It is possible that
women in the past have had a stroke, myocardial infarction and vein thrombosis, and
she takes aspirin, warfarin, xarelto, or others
blood thinning drugs. If we assign a biopsy procedure, then
should clarify which drugs the patient is taking. With выяснении
such facts, the patient must visit
general practitioner / cardiologist / vascular surgeon to clarify whether
cancel the drug and how long before the biopsy should be done.
And also when to resume taking, in order and to avoid bleeding from
genital tract and does not provoke the formation of blood clots.

Menstruation period

During menstruation, firstly, little is visible, and you can take
biopsy is not from the most suspicious site. And secondly, it
irrational because there is a risk of inflammation
bleeding, etc. You should wait until the end of menstruation, and
then perform a biopsy.

Examination before biopsy

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

How is a biopsy done? Does it hurt?

Biopsy обычно назначается на 5-6 сутки после менструации, то
there are about 9-13 days of the cycle (should be considered from 1 day
menses). If a woman is in menopause and there are no menses, then in any
day subject to the above contraindications.

Biopsy шейки матки может проводиться несколькими способами. View
interventions depend on the patient’s age, on giving birth or
No, preliminary diagnosis and complaints. Almost after all
species biopsy patient feels some pain during
procedures (it is very short in time) and 5-6 days after.

Biopsy Types

Target biopsy

A colposcope is used for targeted biopsy.
The colposcope is a special microscope for examining the cervix and
vagina. This minimizes the risk of inaccurate diagnosis and
get a reliable result. Therefore this kind of research
It’s considered the simplest and most accurate
mentioned first.

The patient lies on a chair, a gynecologist inserts into the vagina
mirrors and adjusts the colposcope to get the most clear
Pictures.

When the gynecologist determines for himself the most suspicious
plots, then puts on them iodine solution. It allows you to make them
even clearer and mark the boundaries.

Further tactics may vary. It happens konhotomny and
aspiration biopsy.

In the first case, from each suspicious area a special
tool – conchotome (similar to scissors with a pointed end)
a piece of mucous is taken, about 3 × 5 mm.

In the second, a special needle is used, and then from each
a puncture is taken of the desired site (a column is sucked into the needle
fabrics). If a lot of plots, then each piece is placed in
separate container and marked accordingly.

The biopsy sites are then processed and the patient is allowed to go home.
If there are complaints of heavy bleeding,
body temperature, then maybe referral to gynecological
hospital

Normally, after a biopsy, the patient within 5-6 days are noted
moderate to poor bleeding as well
discomfort and moderately painful sensations in the perineum.

Radio wave

In this case, an apparatus is used to take a biopsy.
�”Surgitron”. The essence of the procedure is that the biopsy (a piece of
tissue) is captured by the loop through which they pass
radio wave charge. The positive points of this method are
what:

  • the fabric does not heat up and results are not distorted
    histology,
  • This method can be used for nonparty, because
    scars are formed and the neck is not deformed,
  • there is no risk of bleeding, since after exposure vessels
    soldered
  • no risk of infection.

Knife

This type of biopsy is already being done in the hospital (day or
round-the-clock) and is more extensive intervention than
previous methods.

It is necessary to prepare, pass the brush strokes on flora and, if this
necessary, then treat inflammation. If necessary, you will have to
to be tested for genital infections. Undertreated inflammation in the background
which carried out the knife intervention, can lead to
spread of infection throughout the pelvis and will have to do
open surgery. These are completely undesirable complications and they are better.
to warn.

A woman warned that for 2 days should not live sexual
life, put candles / tablets and tampons into the vagina
douche.

On the day of surgery in the morning you can not drink and eat;
to smoke

The procedure is performed under anesthesia, type of anesthesia.
elected individually. The most commonly used short-term
intravenous anesthesia. The same anesthesia is used in the case of
medical abortions, medical diagnostic
scraping and hysteroscopy (examination of the uterine cavity using
video equipment). Local can also be used.
anesthesia.

Further, the technique is similar to the aiming biopsy: the cervix is ​​removed in
mirrors, adjust the colposcope and treat the mucosa with a solution
iodine.  The suspicious area is excised completely, obtained
The tissue is placed in a stabilizing solution (formalin 10%).

Circular

In this case, the mucosa “circle” is surgically removed from
outer throat cervix. This type of intervention combines
diagnostic treatment with therapeutic.

Cervical curettage

In this case, the material is taken not only from the outer throat of the neck.
uterus. Scraping of the cervical canal is also performed.
Histological material is also packaged in separate containers.
This is necessary in order to determine the localization of the pathological
process and determine the method of treatment.

What can be learned after a biopsy

According to the results of the biopsy, we make the final diagnosis that
determines further treatment tactics.

The result of a biopsy excludes cancer or confirms it. With
excluding cancer, the histological conclusion should confirm
another diagnosis: polyp, condyloma, leukoplakia, erosion, and others.

Depending on the conclusion, treatment tactics can significantly
vary. From local erosion treatment to surgical
operations.

What are the consequences after cervical biopsy?

Lower abdominal pain

Usually pains are cramping or pulling
low to moderate intensity. With резких болях,
accompanied by fever, bleeding,
discharge with an unpleasant odor, lower blood pressure
(weakness, dizziness, nausea) – you must turn to
duty gynecology.

Normally, there may be mild or moderate pain over the womb up to 5
days

Bloody issues

Discharges (bleeding), moderate to scanty
слизисто-сукровичных, могут быть в норме до 5-7 days Abundant
bleeding is a reason to call an ambulance brigade.

Monthly after cervical biopsy

Violations may occur after the biopsy procedure.
menstrual cycle. In most cases, periods come as
usually, but may become more painful in the first 1-2 cycles.

An earlier arrival of menstruation is due to hormonal disruption,
infectious complications after the procedure. Bloody issues в
1 week after the diagnosis should not be considered monthly,
it goes healing mucous. Normal menstruation should
accompanied by your usual sensations. Someone before
monthly swelling of the chest, someone notices swelling or excessive
эмоциональность  и раздражительность. If bleeding
started but you are not sure that this is normal menstruation, then
better to go to the doctor again.

Delayed menstruation after biopsy is also not uncommon and most often
associated with psycho-emotional stress experienced by a woman
going to the procedure for the first time. With ненаступлении менструации в
normal terms make sure you are not pregnant
(test strips for chorionic gonadotropin in the urine or known
all pregnancy test). Delay no more than 1 cycle should not
strongly scare the patient. If the next cycle of monthly came as
usually, additional examination and treatment is not necessary. If not
came, then you need to go to the gynecologist.

Inflammation

As a rule, this is a consequence of an undertreated, latent infection or
violations of the regime (below we will tell you what not to do after
biopsy procedures). With появлении непривычных выделений, зуда и
a burning sensation in the perineum, increased urination urgently needed
consult a gynecologist at the place of residence.

What not to do after a biopsy

Live sex life

Depending on the type of intervention is not recommended to live
sex life from 5 days to two weeks. Then for 1 2
months is recommended to use a condom.

Go to the bath, sauna

And other thermal procedures are also prohibited. During
about two weeks should also not do wraps, massage and
take hot baths. Only a short warm shower.

Use hygienic tampons

Тампоны не дают кровянистым выделениям оттекать из vagina.
With ненарушенной слизистой это не страшно, при регулярной смене
tampons (maximum 8 hours) flora violation does not occur. But at
the presence of damage on the mucous membrane is necessary to ensure full
outflow.

Use vaginal tablets / capsules / suppositories

Without the appointment of a gynecologist no candles “for prevention”
should not be introduced, you can slow down the healing process and create
conditions for the development of complications.

Swim in the river, lake

It is clear that there is no clear water in open reservoirs. And then
biopsy in a woman in the vagina almost open wound.
Bacteria may cause severe inflammation.

Physically loaded

The strain of the abdominals leads to temporary disruption.
blood supply in the pelvis.

Where can I perform a cervical biopsy. Price of the procedure

A biopsy of the cervix is ​​performed in women’s day hospitals
consultations, offices of cervical pathology, round-the-clock
gynecological hospitals and equipped private clinics.

In the direction of the LCD and the appointment of a local obstetrician-gynecologist
in state clinics biopsy is performed free of charge.

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

Conclusion: in this way, a cervical biopsy is available,
informative and safe (subject to all rules) method
диагностики рака и других заболеваний шейки uterus. if you
offer to perform a biopsy, then do not be afraid. Watch out for
yourself and be healthy!

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