Histology of the uterus, cervix: why and how it is carried out, explanation

Histology in gynecology is an important method for studying the female body. If you have not yet come across this study, then it is reasonable to ask a question about more well-known methods, for example, a blood test (general or hCG test ), or a gynecological smear.

These are important tests. But then what is histology in gynecology? In general, histology analysis is not an essential test. For a primary assessment of the condition of the body, the same blood tests and smears are quite sufficient.

However, gynecology deals with that part of the female body that is the basis of the female body. And to assess its condition, in some cases, an extremely accurate research method is required.

The most reliable and informative method for studying the female body is histological examination. There are diagnoses that cannot be made without a histological analysis. In particular, this method makes it possible to identify malignant neoplasms in the female genital area.

Preparation for the procedure

There is no specialized training for taking an oncocytology test, but there are recommendations that should be followed to obtain an accurate result.

For example:

You can take a smear on any day, but excluding menstruation days. The preferred period of the menstrual cycle is the first week after menstruation.
If an inflammatory process is observed in the genitourinary area, then before collecting biomaterial the inflammation should be cured so that the answers to oncocytology do not result in a false positive result.
During the previous two days, no other tests can be taken from the cervical area. This can be traumatic to the sensitive tissue in this area.
You cannot conduct an ultrasound examination with a transvaginal sensor 1 day before the planned procedure.
Sexual intercourse should be avoided for 3 days to prevent foreign cells from entering the collected material for analysis (sperm, condom lubricant, partner bacteria).
Vaginal suppositories and creams should not be used for 3 days before the test, as medical residues from these products may affect the test result.

Recovery period

In the first few days, a woman may be bothered by bleeding after curettage. They can be minimized if you lie in bed for the first day, getting up only in extreme cases. To avoid complications after the procedure, gynecologists prescribe a course of antibiotics. For your own safety, you should not ignore this recommendation.

Within a month after curettage and histological examination, women are prohibited from:

Have sex. This is necessary so that the cervix closes completely and no infection gets into the affected area.
Douche.
Use vaginal tampons.
Take hot baths, visit baths or saunas.
Lift weights.

The menstrual cycle is restored approximately 4 months after the procedure, because the ovaries are sensitive to treatment of this kind. They need to get used to the renewed endometrium and start working in sync with it.

Recovery will be faster if you rest more and strictly follow doctors' recommendations.

Carrying out the procedure

First, the obstetrician-gynecologist examines the vagina and cervix in speculums and assesses the condition of the mucous membranes; a digital gynecological examination should not be done before the smear. If the epithelium covers a large amount of mucus, it must be removed. Then the cervix is scraped (exocervix), using an Eyre spatula. After this, a scraping is taken from the cervical canal (endocervix), and the material is collected using a special cytobrush (Cervix Brash). It is inserted into the canal and 4-5 circular movements are performed. After collection, the resulting material is applied to glass, the smear is air-dried and fixed with alcohol or a special preparation (for Papanicolaou examination). The resulting preparations are then placed in a container and delivered to the laboratory. If liquid oncocytology is performed, then the brush is immersed in a liquid fixative, rinsed, and the tip of the brush is removed and left in the fixative.

The next stage of the study is laboratory. Laboratory assistants register the samples received. Then the smears are stained with special dyes (according to Leishman). Liquid cytology preparations are centrifuged or filtered.

The finished preparations are sent to the analytical stage, which is carried out using microscopy. The evaluation criteria are:

Cell type;
Cell sizes;
Inclusions in cells;
Maturity;
Features and changes of kernels;
Cytoplasm.

After evaluating the results, the laboratory issues a conclusion, which is sent to the attending physician.

Algorithm for histology of neoplasms

The first thing you need to do is consult a doctor (gynecologist, gastroenterologist, ENT specialist, therapist, dermatologist, surgeon) - the choice of doctor depends on the symptoms. The doctor collects the necessary biological material (aspiration, suction, puncture, collection of secretions from the tumor, mucosal smear).

The jar with the formaldehyde solution is marked, indicating the patient's data, the date and area of collection of the histological sample. The doctor issues a referral for histology, in which he indicates all the necessary data, including bad habits. On the day of tissue collection, after all documentation has been completed, the excised tissues in formaldehyde solution are transferred to the pathologist.

The doctor first stains the obtained samples (special dyes are used), then the process of complete dehydration occurs. After dehydration, the samples are placed in paraffin. The cube of the resulting paraffin is cut into thin slices, which are then placed on glass and examined by a specialist under a powerful microscope.

If no errors were made during the collection of tissues and cells, as well as in the histology algorithm, the results are as accurate as possible and allow you to diagnose the type and stage of the tumor. Taking materials for research will in no way speed up or stop the development of the tumor. A great danger to the human body is the constant traumatization of the neoplasm, as well as late diagnosis.

The average duration of histology of neoplasms after tissue sampling is three days. The doctor may also prescribe an emergency diagnostic test. It is usually prescribed during the operation.

Often the outcome of the operation will depend on the result obtained. Emergency diagnostics do not involve drying samples; they are simply frozen. The patient can receive the results in the form of a conclusion, or they will be transferred directly to the attending physician.

In any case, the attending doctor will decipher the conclusion in order to decide on further actions. Often, after receiving the results, the patient is referred for additional studies. The doctor can also refer you to other specialists in this field.

Tissue samples for research

The uterus is a hollow organ consisting of muscle tissue and resembles an inverted pear in appearance. The narrow side connects to the neck, which extends into the vagina. The cavity is lined with endometrium, which consists of two layers:

basal, consisting of stem cells;
functional, which is rejected during menstruation if pregnancy does not occur.

For histological examination, the functional layer is separated in the uterine cavity. The surface layer of the endometrium is also separated from the cervical canal - the place where the cervix connects to the body of the uterus.

How is a uterine scraping done?

After the tests have been collected and gynecological infections, if any, have been treated, the patient is given a referral for diagnostic manipulation.

8 hours before the procedure you should not eat or drink - all actions are carried out under anesthesia, so certain rules must be followed. A cleansing enema is not performed, but before surgery it is necessary to empty the bladder.

The external genitals are treated with an antiseptic, often iodine, then speculums are installed, and the patient is given anesthesia. The patient no longer feels the removal of the uterus and its fixation with bullet forceps. In some cases, it is necessary to resort to the use of Hegar dilators, with the help of which the cervical canal is expanded. There is no need to fear that surgeons may injure the gynecological organs - they carry out manipulations taking into account their position. Expanders are introduced gradually, starting with the smallest diameter. After nothing interferes with the diagnostic procedure, a sharp spoon-curette is inserted into the uterus, with which the endometrial layer is separated. First the neck is scraped out, then the front wall, the back wall, and the corners. Tissue samples from different parts of the uterus are placed in separate tubes.

If hyteroscopy is performed, then an examination is required to assess the quality of the work done. The procedure takes from 15 minutes to an hour, depending on the nature of the pathological changes and the number of procedures required

Curettage for a frozen pregnancy in the early stages takes 15 minutes; hysteroscopic surgery for submucous myoma or uterine cancer requires 1-1.5 hours, since the bumpy surface has to be handled very carefully.

The patient’s condition can be maintained with a saline drip, but sometimes they can do without it.

In case of force majeure circumstances, they always have time to take the necessary measures - there is a doctor, an operating room nurse and an anesthesiologist in the manipulation room. There is no need to worry - this is one of the most mastered and safe medical operations.

Direction in biology

What does histology study? This biological science uses a microscope to examine the structure of body tissues. This table describes the subsections of histology.

Name	Study microscopic structure
Cytology	Cells
Embryology	embryo
General histology	Fabrics
Private histology	Organs

What general histology studies: the structure of the tissues that make up organs. In gynecology, it is important to study the condition of the endometrium of the uterus. What private histology studies: the structure of organs, which consist of characteristic textures.

Methodology of the procedure

Scraping from the cervix or from its cavity is carried out as follows:

The surgeon collects biological material.
He sends it for laboratory analysis.
Gets the result.
Makes a diagnosis.

At first glance, the research methodology is simple to implement, but everything is not as simple as it seems at first glance. The reason is that between submitting the material for analysis and obtaining the result, a huge amount of time passes, during which the laboratory technician processes the resulting epithelial cells.

What to do during the study:

the resulting biological material is processed;
then cuts are made;
tissues are immersed in special solutions (contain reagents that help determine the nature of the cell).

Initially, the resulting biological material is impregnated with paraffin and turns into a briquette of a certain size. This is a very lengthy and labor-intensive process that requires certain skills from the laboratory assistant.

After the briquette is fully formed, cuts are made on its surface or the tissue is cut off in a thin layer. Such “probes” are subject to additional processing. They are dipped into various reagents (solutions and liquids).

Such procedures help in diagnosing various diseases; if the material comes into contact with certain reagents, the laboratory assistant will note this as a result of the analysis.

The procedures are carried out using a microscope. The specialist carefully studies the reaction of cells to a particular substance and makes certain notes.

A laboratory technician only needs a small piece of tissue soaked in paraffin and a number of reagents to determine the presence or absence of tumors and other diseases in a patient. The medical worker takes a test tube with a solution and immerses a piece (slice) of biological material into it. Afterwards, the laboratory assistant looks at the tissue reaction that occurred upon contact with the reagent and makes notes on the form.

If tissues change color and react to contact with the reagent accordingly, this indicates the presence of pathology.

The procedure allows us to detect the presence of cancer cells at an early stage of development, as well as diagnose endometriosis and other dangerous gynecological diseases in a woman.

But in addition to a lot of advantages, the procedure also has several disadvantages:

You will have to wait quite a long time for the results of the analysis.
The accuracy of the study when carried out using the emergency method leaves much to be desired.

It will take some time to saturate biological material with paraffin or wax. This is a long process that is carried out in laboratory conditions.

What can the analysis show?

Using a histological examination, the doctor can examine the tissue or organ at the cellular level.
This method makes it possible to detect the following processes in the body:

Inflammatory processes in acute or chronic form.
Find hemorrhages, blood clots and other disorders associated with the circulatory system.
Find new formations, find out what they are: benign or malignant.
Determine the level of malignancy if doctors notice a cancerous tumor.

Various processes can be detected.
Thanks to such an examination, one can find out whether foreign bacteria, parasites and other foreign bodies are present in the tissue. This is just a small list of the capabilities histology has.

Very often, examination of a scraping of the surface of the uterus allows you to determine the presence of any changes on different days of menstruation. The results obtained during such examinations make it possible to find out how the ovaries work. And this, in turn, is very important data that makes it possible to cure many diseases, for example, female infertility.

When examining the cervix with this method, it is possible to detect diseases that have just begun to develop, if, of course, conservative treatment does not bring positive results.

People who receive an examination report indicating the presence of a cancerous tumor dream that there is an error in it. It's a pity, but there are never any mistakes in such research. If this happens, it is very rare.

This method is considered the most accurate, and therefore it allows you to detect cancer cells and the reasons why they arose. Despite the fact that the method is the most accurate, doctors say that there is a small percentage of erroneous, incorrect results. But if the sample collection and examination process are followed correctly, such errors are simply excluded.

Histology analysis is not prescribed in all cases. Histology of neoplasms is necessary to determine the inflammatory process in the gastrointestinal tract, to diagnose pathological changes in the female genital organs, to determine the causes of infertility, and to diagnose cancer.

In rare cases, analysis shows false results; according to statistics, 98% of histology shows true results, which makes it possible to establish a diagnosis and determine further actions.

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Histological picture as the results of hysteroscopy

According to the process occurring in the uterus, a histological picture is visible. During histological examination of the polyp, depending on its origin, a glandular structure of the growth of convoluted glands is visible (more often found at a young age); with a fibrous polyp, the histological picture is represented by connective tissue (this type is observed in old age); There is also glandular-fibrous - where the structure is represented by convoluted glands in combination with connective tissue.

When removing a myomatous node, hysteroscopy histology is also performed, the interpretation of the results of which focuses on the presence of fibrous-fibrous strands, represented by connective tissue and cartilage-like tissue. In the case when the pathological focus is not identified and separate diagnostic curettage is performed after hysteroscopy surgery, histology analysis and its assessment will be carried out in accordance with the day of the patient’s menstrual cycle

That is, if a woman is in the first phase of the menstrual cycle, during which hysteroscopy is often performed, the scraping may contain fragments of thin straight glands and some fragments of the basal layer. If the tissue is taken on the twentieth day of the cycle, then the result of hysteroscopy of the uterus, according to the histological conclusion, will look like large cells of a lush endometrium with convoluted glands and increased blood supply. This histology transcript after hysteroscopy corresponds to the norm

In the case where the pathological focus is not identified and separate diagnostic curettage is performed after hysteroscopy, histology analysis and its assessment will be carried out in accordance with the day of the patient’s menstrual cycle. That is, if a woman is in the first phase of the menstrual cycle, during which hysteroscopy is often performed, the scraping may contain fragments of thin straight glands and some fragments of the basal layer. If the tissue is taken on the twentieth day of the cycle, then the result of hysteroscopy of the uterus, according to the histological conclusion, will look like large cells of a lush endometrium with convoluted glands and increased blood supply. This histology interpretation after hysteroscopy corresponds to the norm.

But, if there are pathological areas among the normal endometrium, in this case the histological picture will correspond to the pathological process: glandular endometrial hyperplasia, endometrial hyperplasia with atypia, glandular-cystic hyperplasia, glandular-stromal hyperplasia, as well as hypoplastic processes. According to the degree of processes associated with the atypical component, mild, moderate and severe are distinguished.

There are some common similarities of endometrial hyperplasia, which manifest themselves in the form of proliferative processes of glandular structures, in other words, the proliferation of glands that lose their normal appearance, but do not have signs of atypia. It is also possible to have cystic enlargements of the above glands. If the stroma of the uterine mucosa is involved in the process, this histological picture will be characteristic of glandular-stromal hyperplasia.

In any case, each hysteroscopy with a histological examination, and ultimately a mandatory pathohistological conclusion, to establish the diagnosis and the ongoing process. In order to provide reliable information to the doctor and the patient about the state of her health, in addition to the histological biomaterial, clinical data (day of the menstrual cycle, number of births, place of collection of the material) must be sent to the pathohistological laboratory. It should be borne in mind that each case is unique, and the body of every woman cannot be repeated, which requires an exclusively individual approach to the interpretation of the histological report and subsequent treatment.

Results and interpretation of histology analysis

Please note that the research results will be ready within 5 to 12 days. And these deadlines are based on the technical capabilities of conducting the study. Speeding up may skew the results. If you have a benign tumor, you don’t want to suddenly receive a message about a malignant one. Wait.

Deciphering the result yourself without the appropriate education and experience is a recipe for hysterics.

Attention. There will be no recommendations on the results form. They are given only by the attending physician, who observes the situation over time.

If you suddenly have doubts about the results of the study or recommendations, no one forbids you to get additional advice from another specialist. This is the so-called second opinion. And there will be no crime in this. In the end, it is your health.

Indications for cervical biopsy

The indication for a cervical biopsy procedure is the detection in the patient of:

changes of unspecified etiology (pathological changes in the cervical mucosa identified during colposcopy);
dysplasia (precancerous pathology, in which atypical cells with a tendency to malignancy are found in the normal epithelium);
ectopia (cervical erosion, endocervicosis) - pathological damage to the mucous membranes of the cervix with the appearance of bleeding erosions with a heterogeneous surface (biopsy of the cervix for erosion is the most reliable sensitive diagnostic method);
leukoplakia (pathological thickening, proliferation and keratinization of the squamous epithelial layer);
polyps (local benign neoplasms that rarely have the potential for malignant degeneration);
genital warts (genital warts) – cone-shaped growths on the mucous membrane that are viral in nature and transmitted through sexual contact;
iodine-negative areas (identification of areas of the mucous membrane that are not stained with iodine solutions may indicate the presence of atrophic changes in the mucous membranes, dysplasia, leukoplakia, etc.);
acetowhite epithelium (areas of the mucous membrane that have turned white after treatment with solutions of acetic acids) - the presence of such epithelium may indicate the development of leukoplakia, the presence of human papillomavirus infections (HPV), etc.;
atypical vascular growths, abnormally tortuous capillaries, etc.;
gross damage to epithelial tissues.

Also, a histological biopsy of the cervix is indicated if koilocytes (appear during HPV infection), atypical cells in the squamous epithelium (ASC-US, ASC-H), atypical cells in the cylindrical (AGC) and squamous epithelium (HSIL) are detected in the Pap smear. as well as precancerous changes in the mucosa.

If indicated, immunohistochemical screening for cervical cancer using tumor markers may be required. This study is carried out for the purpose of early diagnosis of cervical dysplasia, which has a high risk of malignancy.

Immunohistochemical screenings are indicated when identifying:

cervical intraepithelial neoplasia grade 2-3;
HPV (human papillomavirus) with high degrees of oncogenic risks;
Any neoplastic processes in the mucous membranes of the cervix (the study is carried out to clarify the diagnosis, make a prognosis, assess the sensitivity of the tumor to chemotherapy, hormones, radiation therapy, etc.).

You may also need a procedure called cervical conization (a surgical diagnostic and therapeutic method in which the outer part of the cervix containing atypical epithelium is removed, while the removed part of the cervix has a conical shape, which determines the name of the procedure)

Conization surgery of the cervix is indicated if the patient has:

ectropion (eversion of the cervix);
the presence of atypical cells in the Pap smear;
erosive lesions of the cervix;
cervical dysplasia of the 2nd and 3rd degree;
cervical intraepithelial neoplasia;
neoplasia and erosions affecting both the vagina and cervix;
cystic neoplasms in the cervix;
postpartum cervical deformities;
precancerous conditions in the cervical mucosa;
suspicion of cervical cancer.

What will histological analysis tell you?

Histological examination requires strict indications. It is impossible to undergo it as a preventive screening, since it checks a specific organ, and not the general state of health. The analysis is carried out for patients who have certain health problems, namely tumors, the nature of which can be malignant.

Indications for histology are:

clarification of the nature of the developing neoplasm;
clarifying the reasons why pregnancy does not occur;
analysis of the health of the female genitourinary system;
determination of inflammation in the stomach and intestines.

Almost half of the cases when a diagnosis such as histology is prescribed is a suspicion of a cancerous tumor in the human body. Moreover, not only the formed tumors are studied, but also the tissues of organs in which neoplasms could potentially arise. This analysis is also effective for diagnosing the condition of the digestive organs, reproductive and reproductive systems of men and women.

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Types and methods of histological examination of the cervix

Today, histological practice uses several methods for studying biopsy and surgical material. Depending on the state of the object, they are divided into supravital (studying living cells) and postvital (studying dead fixed objects).

All histological analyzes are carried out by microscopic methods (using a microscope). In this case, according to medical indications, a histochemical or immunohistochemical method for examining samples can be used.

In modern medicine, three main types of biopsy are used:

Puncture of the tissue being examined with a hollow needle and its subsequent sampling (fine-needle aspiration biopsy).
Partial excision of a mass or organ during surgery (incisional biopsy)
Complete removal of the entire tumor or organ during surgery (excisional biopsy).

When a histological examination of cervical tissue is prescribed to a patient, in accordance with medical indications, one of four types of biopsy is performed:

Trephine biopsy - taking samples from areas where abnormalities were found;

Wedge biopsy (conization). This is an operation that involves removing cone-shaped pieces of tissue. It is performed using a scalpel, laser beam or radio wave excision;

Endocervical curettage (scraping);

Electrosurgical loop biopsy is the excision of tissue with a thin wire loop under the influence of a weak electric current.

How does the procedure work?

Progress of the procedure

CMM biopsy involves taking material from areas of the epithelium that appear after using 3% acetic acid or 3% Lugol's solution with glycerin.

Planned histology of the cervix involves performing a biopsy 4-6 days after the end of menstruation (in this case, the injured surface will completely heal before the next menstruation). Samples of material for research are taken from the most suspicious areas. If multiple pathological foci are detected, taking not one, but several samples is indicated

It is very important that the biopsy material reaches 5 mm in width, and the stroma (connective tissue of the cervix) must be captured along with the squamous epithelium.

Before starting the analysis, the patient is prescribed a bacterioscopic examination (taking smears for flora). In the event that a woman is diagnosed with an infectious disease, she undergoes a course of treatment before undergoing a histological biopsy.

After the procedure, the risk of serious complications is negligible. Therefore, this study, if necessary, can be prescribed even to pregnant women.

The main contraindication to a biopsy is severe coagulopathy (blood clotting disorder).

Indications for histological examination of cervical tissues

Detection of abnormalities found during a standard gynecological examination. They may be associated with genital infections, as well as with the occurrence of neoplasms in the genital organs.
Obtaining the maximum amount of information and predicting the outcome of treatment.
Making an accurate diagnosis (determining clear criteria for tissue and cellular signs of various gynecological pathologies).

Interpretation of results

Interpretation of the results of histological examination is carried out in accordance with the provided classification system. The absence of cellular changes is considered as the norm, and if a small amount is detected, an inflammatory process or benign cellular changes are considered. Histological examination of the cervix is an indispensable technique for infertility, suspected development of a precancerous condition or the occurrence of a malignant neoplasm.

Factors on which the diagnosis depends

Incorrectly selected area for collecting material;

Technical errors in the preparation of histological specimens;

Professionalism of the pathologist.

In conclusion, I would like to note that the reliability of histological examination in diagnosing precancerous pathologies and cervical cancer reaches 98.6%.

How is the analysis carried out?

Making such equipment is a very complex process. It includes the following steps:

Fixation. It is used to preserve the intravital structure of tissues and each cell. Prevents them from decomposing bacterially, digests cellular enzymes. This step requires a fixative liquid such as formalin.
Wiring. Dehydration of tissues occurs, which are prepared for the next stage, that is, for pouring. The tissue and fixing liquid is removed, and then the fabric is impregnated with paraffin and becomes much harder. This is necessary to ensure that the cutting of the fabric is of better quality. If the tissue remains soft, it may wrinkle, making it difficult to detect pathology. Previously, wiring was done in several stages and manually. Today this process has been significantly improved.
Filling. It is needed to create a solid block, which is then cut. The fabric is filled with paraffin in small cassettes. As a result, a small block of paraffin is formed.
Cutting. Thin sections are made using microtomes. These devices have thin and very sharp blades.
Coloring. In order to carry out microscopy of tissue, it is stained. Before this, the slice is placed on a special glass and straightened. To conduct additional examination, a huge number of staining methods have been developed. The most ideal method is chosen by the doctor himself. It all depends on the purpose of the examination. Painting is carried out using automatic machines or manually.

Carrying out the technique is very difficult

Conclusion. The final stage is placing the painted piece under glass. This is done using a special product that has a transparent structure and has the ability to refract light. This stage makes it possible to keep the fabric unchanged for several years. This is necessary, for example, to resume the investigation after 1 year, 2 years, and so on.

The histological examination method is considered accessible and provides accurate information. It allows you to detect a large number of diseases, determine the nature of the disease and the level of severity. As a result, the attending doctor can prescribe the necessary treatment.

The duration of the examination depends on several important factors. If the laboratory has old equipment, it means that the analysis takes a long time. But there is no medical institution that could give accurate results after 7 days. As a rule, the average period for completing the examination is 10 days.

The period for receiving results is 7-10 days

Sometimes other factors also influence the timing. For example, the professionalism of medical staff, the delivery time of the tissue being studied, the quality of the reagents used.
If the institution where tissue sampling is planned is equipped with its own laboratory, then the examination time is greatly reduced. If the tissue examination is planned to be carried out in a completely different city, then the time increases by several days.
There is only one method that allows you to conduct an examination in the shortest possible time - this is an express examination. This examination is carried out during surgery if the doctor needs to make the right decision.
As a rule, ultrasound or CT helps to detect and identify the nature of the tumor. Consequently, doctors are already giving a tentative conclusion about how the operation will proceed. But sometimes, during tissue incision, the resulting neoplasm does not correspond to the previously stated prognosis.
Express testing is a method that quickly determines the presence of cancer cells in tissues. When they are detected, the area of surgical intervention expands, since in this case the tissue that controls the tumor has to be removed.

Every person knows how tests are taken: for this purpose, blood is taken from a finger or a vein. How is such a study, such as pathohistological, carried out? After all, this diagnosis requires taking tissue from internal organs. Having determined which organ of the body requires detailed study, its cells are collected. To do this, the doctor can do:

smear;
imprint;
slice;
film.

.gif” data-lazy-type=”image” data-src=”/wp-content/uploads/2016/11/histologicheskij-analiz-3.jpg” alt=”collection of biomaterial for histological analysis by tissue puncture” width= ”640″ height=”480″ /{amp}gt; Collection of biomaterial for histological analysis using tissue puncture method

If a study such as pathohistological requires examination of internal organs, local or general anesthesia will be required. Smears are taken “live”, without anesthesia, as this is a painless procedure. Some types of tissue collection require hospitalization, others require a standard visit to the clinic.

When all components of the sample are colored, the analysis itself is performed. A laboratory technician examines the cells of a microorganism under a microscope to determine their danger and threat to the health and life of the patient.

.gif” data-lazy-type=”image” data-src=”/wp-content/uploads/2016/11/histologicheskij-analiz-5.jpg” alt=”Equipment for histological analysis” width=”640″ height=”480″ /{amp}gt; Equipment for histological analysis

The next research method is to preserve the obtained samples. Using special balms, organ parts can be stored for a long time. Such balms are used to transport samples to clinics (when the laboratory is located in another city) and study in various ways. This “preservation” helps to carry out analysis several days after the samples were taken from the patient.

The duration of the study depends on many factors. The more outdated the equipment is in the laboratory, the longer it will take to wait for a histological answer. But no clinic will perform the analysis earlier than 7 days in advance. On average, histology takes up to 10 days.

Factors such as the professionalism of the staff, the speed of delivery of the sample being studied to the laboratory, compliance with the rules for its transportation, and the quality of the reagents used may also affect the deadlines. If the clinic where the biomaterial is collected has its own laboratory, then the time required to complete the study is significantly reduced.

.gif” data-lazy-type=”image” data-src=”/wp-content/uploads/2016/11/histologicheskij-analiz-2.jpg” alt=”Slide with cells for histological analysis” width=” 640″ height=”480″ /{amp}gt; Slide with cells for histological analysis

But the shortest method of histology is express diagnostics. It is performed during surgery, helping to make decisions about the course of surgery. Usually, ultrasound and computed tomography help to guess the nature of the tumor that has arisen, and therefore doctors already assume how the operation will go.

But often, when tissue is dissected, the detected tumor does not correspond to predictions. Express diagnostics helps to quickly determine whether there are cancer cells in tissues. If they are detected, the area of surgical intervention will be expanded, since all tissues with which the tumor had contact will be removed.

Histological examination of neoplasms is prescribed to analyze the dynamics of the growth of a malignant tumor, changes in tissues that occurred after therapy (the effectiveness of treatment is checked), establishing indications for radical surgery, differentiating malignant and benign neoplasms, the presence of a tumor in the early stages of its development, staging the maximum accurate diagnosis.

If the results of the study demonstrate the presence of a pathological process, the doctor selects an effective treatment package in accordance with the diagnosis. It is important to remember that timely diagnosis is the key to successful and short-term treatment, which is possible without surgical intervention.

Two methods are used for research: studying tissues that were obtained during surgery and biopsy (targeted excision of a small piece of tissue for research).

It is important to understand that any wart can be cancer, and a mole can be a malignant tumor, and only histological diagnosis will determine the type of tumor.

The subject for research is material from fabrics of different origins. It is examined under a microscope after pre-staining the preparation.

Microscopic examination allows us to detect the following processes occurring in tissues:

inflammation
blood flow disturbance,
internal hemorrhages,
vascular thrombosis,
detection of cancer cells,
presence of malignant tissue.

Important! Histology studies the microscopic structure of organs and textures. Using the method, it is possible to establish the presence of an inflammatory process and detect cancer cells before the appearance of clinical symptoms.

Everyone knows how to take a blood test, but how to do histology, how long does it take? Histology can be carried out in several ways - the study can be carried out using blood, secretions, or directly studying the tissues themselves. A histological smear is done in urology and gynecology. Therefore, the analysis may be carried out in different ways, but the quality of diagnosis is the same in any case.

If it is necessary to conduct an examination of internal organs, painkillers may be required; painless procedures (for example, smears) are performed without anesthesia. Some types of research are carried out in a clinic, others can only be done in a hospital setting.

Rules for collecting material, procedure progress

Patients often need clarification of what cervical histology represents, how it differs from a regular smear, and in what cases a test is justified. On forums, women ask questions about the differences between histology and cytology. The latter studies only the structure of individual cells and can identify malignant ones. Histology examines the structure of the tissue as a whole and allows one to assess the prevalence of the pathological process and the presence of atypical blood vessels.

Before studying the cellular composition, material is taken - a biopsy of the cervix. There are different ways to take material, so certain points are discussed with the doctor to select the optimal method. The following ways to take tissue from the cervix are distinguished:

smear-imprint;
scraping (scraping);
puncture;
aspiration;
incisional or excisional biopsy.

It is considered optimal to extract the pathologically altered area at the border with normal tissue. It is not recommended to sample a necrotic, heavily blood-soaked area - the histology result may be distorted.

The duration of the study is 7–10 days: this is due to the peculiarities of the methodology. Formaldehyde or ethanol is used to fix a piece of tissue, and the material is transported to a histology laboratory. After fixation, the scraping is dehydrated to ensure durability and compaction of the tissue. The biopsy is then “filled”: it is impregnated with drugs, creating a dense block that can be cut. Sections are made with a microtome, a device that produces thin plates that can be placed on glass. Another step is staining the sections. The most commonly used standard dyes are hematoxylin-eosin. However, in certain cases it is possible to use other specific dyes. The final stage: fixation of the obtained elements with a second slide and microscopy.

Most often, a conventional light microscope is used. With more powerful equipment of the clinic, it is possible to use an electronic one - it is more accurate and allows for multiple magnification. However, this is not always necessary, and maintenance of such equipment is expensive.

Histology of the cervix

The uterus is the main reproductive organ of a woman; it consists of the fundus, body and cervix. The last part is located inside the vaginal cavity. A section of tissue from the cervix or body can be taken for histological examination. These analyzes differ both in the technology of taking material and in the interpretation of the results.

In addition, diseases of the cervix and uterine body are different, so the indications for the procedures are also different.

Indications

Complaints of pain in the lower abdomen, irregular menstrual cycle, pain during sexual intercourse, infertility and many other symptoms may be a reason to perform an analysis.

Histological examination of the cervix is performed in the following cases:

Leukoplakia of the cervix is a precancerous disease with cellular atypia.
Uneven surface of tissue detected during speculum examination or colposcopy.
Detection of abnormal cells during screening cytological examination of the cervical epithelium.
Uneven reaction between cervical cells and acetic acid solution.

With the help of histological examination, a specialist will be able to confidently diagnose cervical cancer, dysplasia, endometriosis, fibroids and other diseases.

Before performing histology, speculum examination of the cervix, cytological analysis and colposcopic examination are necessary.

Execution method

To understand the value of the method, you should understand the methodology for carrying out the procedure. Taking material for histology involves cutting the tissue, in contrast to cytology, when only scrapings are taken from the surface.

Perform the procedure as follows:

The woman is on a gynecological chair, and a colposcope device is inserted into the vagina, thanks to which the doctor examines the cervix and finds the altered area.
The drug is obtained using various technologies: needle biopsy, excision using an electric knife, laser technique, radio knife, scalpel biopsy.
The resulting material is sent to the laboratory.
The area of the damaged cervix is treated with a hemostatic tampon.
If bleeding continues, the wound is sutured.

Since this method is a low-traumatic procedure, it is especially recommended for young and nulliparous girls.

In order for the study to proceed without complications, and for the histology result to be reliable, it is necessary to adhere to certain rules. Preparation for the procedure includes:

Taking blood tests for viral hepatitis and HIV antigens.
Carrying out smears from the posterior vaginal fornix to detect pathogenic microbes.
Examination of a cervical smear for cytology, bacteriology and PCR.
Sexual abstinence for two days before the biopsy.
Avoid douching and using tampons for 48 hours before the test.

In addition to the above aspects, you should not forget to tell your doctor if you are allergic to any medications or latex.

Equally important for women’s health is compliance with the rules after taking the drug:

Intimacy is not recommended for 10 days after the procedure.
To avoid bleeding, doctors prohibit lifting weights.
You should not douche for at least two weeks.
It is recommended not to take a bath, but to perform hygiene with a shower.
Do not take medications without the instructions of a specialist; drugs that affect blood clotting are especially dangerous.
Do not overheat; this rule excludes going to the sauna and bathhouse.

Research technique

What happens to the area of tissue taken for research? The biopsy is sent to the laboratory, where after special processing it is analyzed under a microscope:

A laboratory technician treats a fragment of tissue with a liquid that prevents cells from disintegrating. Water is removed from the preparation, as a result of which the tissue becomes denser.
Using paraffin or another embedding preparation, a dense block of tissue is made.
A microtome is used to make a thin section of tissue.
The taken material is processed using special painting methods.
A small section of tissue is placed under glass and microscopy is performed.
Normal cervical epithelium is usually brown in color, and all cells are the same size and shape.
With pathology, the color of the tissue being examined changes or the epithelium is not stained at all. The cells may be irregular in shape or size.

The speed of obtaining research results depends on the workload of the laboratory and equipment. On average, information can be obtained after 3–7 days.

Any histological specimen is assessed manually by a specialist, since to make a diagnosis it is necessary to detect a number of pathological changes.

The presence of diseases is indicated by the following parameters:

The order and histological structure of individual cell layers have been changed.
In the outer layer, cell maturation activity is increased (detection of enlarged ribosomes in the cytoplasm of epithelial cells).
A histochemical study revealed a decrease in glycogen synthesis.
The space between individual epithelial cells within one layer increases.
Pathological changes affect the nucleus or cytoplasm of the cell.
The epithelium becomes irregularly shaped, for example, cylindrical instead of flat.

Based on the results of the listed signs, the degree of cell atypia is determined:

The changes are background.
The pathology affects half of the layers of epithelial tissue.
Atypia was found in more than half of the cell layers.

The laboratory doctor does not make a diagnosis, he only issues a conclusion based on the results of the biopsy. The treating doctor compares the results obtained with the clinical picture and medical history, as well as the interpretation of other diagnostic methods, after which a reliable diagnosis can be made.

Contraindications and complications

Many women are interested in the negative aspects of the study. In most cases, taking a biopsy is painless because there are no nerve receptors in the cervix.

A biopsy is not recommended for the following conditions:

Various diseases accompanied by hypocoagulation. In this case, the blood takes a long time to clot and serious blood loss is possible.
Active inflammation in the vaginal area, endometrium, caused by infectious agents.
Period of menstruation.
At any stage of pregnancy.

Ignoring contraindications can lead to complications:

Bleeding from the damaged area of the cervix and blood loss of varying severity.
Inflammatory diseases in the area of damaged tissue - suppuration.
Extensive scar, atresia of the cervical canal, hematometra.
Damage to tissue in the tumor area can cause it to accelerate its growth.

Follow your doctor's instructions to minimize the risk of complications.

Histology of the uterine body

For histological examination, not only a biopsy specimen can be taken from the cervix, but also from the body of the organ. Usually the condition of the inner layer, the endometrium, is analyzed.

This analysis is indicated for the following conditions:

Chronic inflammatory process in the endometrial area.
Hyperplasia and polypous tissue proliferation.
Suspicion of endometrial cancer.
Acyclic uterine bleeding.
For infertility and frozen pregnancy.
After an inconclusive cytology test.
The occurrence of bleeding from the uterus during the postmenopausal period.

Even less often, a similar procedure is used to examine the middle layer of the uterine wall - the myometrium. This test is performed to diagnose fibroids or organ cancer.

Procedure technique

The procedure for taking material can be carried out using various methods. Here are just a few of them:

Aspiration biopsy. In this procedure, after colposcopy, a special probe is inserted into the organ cavity. The uterus is then filled with saline and sodium citrate. The contents are drawn into a special syringe, tissue is isolated from it and sent for histological examination. This method is one of the least informative.
Diagnostic curettage of the uterine cavity is the most informative method. During this study, general anesthesia is performed. The woman's external genitalia are treated with antiseptics, after which a cervical dilator is inserted. Using a blunt curette, the doctor scrapes out the entire mucous membrane of the uterus, without damaging the endometrium itself. All tissues are sent for histological examination.
A modern option for taking materials is pipel biopsy. Using this method, a special small syringe is inserted into the uterus. It captures a cylindrical section of the endometrium. The disadvantage is the limited size of the drug, so the method is used for diagnosing diffuse processes, for example, endometrial hyperplasia.
Taking with endobrush. During this procedure, the cervical canal is also expanded, and a special instrument is inserted using a probe. Endobrush has a brush at the end, which produces rotational movements. After this, the instrument is removed and the collected material is sent to the laboratory.

Proper preparation for the procedure

At least two days before curettage, it is necessary to exclude:

sexual intercourse;
douching;
washing the external genitalia using cosmetics.

Taking any medications must be agreed upon with your doctor. The fact is that many drugs can affect blood clotting, which can cause serious blood loss after surgery.

The curettage procedure is carried out in the second half of the menstrual cycle, when the woman does not have menstruation. Otherwise, the result may not be entirely correct, and surgery at the beginning of the cycle will provoke prolonged bleeding. This happens because the uterine mucosa grows before ovulation, stops developing closer to menstruation, and then is completely rejected.

If the time of curettage is chosen incorrectly, then the hormones synthesized by the ovaries will come into conflict with the endometrial layer that is unnaturally small for this time of the cycle and will not allow it to grow to the required size.

Before the procedure, you must undergo the following examinations:

general blood analysis;
Ultrasound of the uterus;
ECG;
vaginal smear;
blood for hepatitis B and C, RW, AIDS;
diagnostics of blood clotting.

It is also necessary to thoroughly remove all vegetation from the pubis and perineum. On the morning of the procedure, you should not eat or drink anything.

Biopsy

Histology and biopsy are not different manipulations. To conduct a microscopic examination, it is necessary to select a piece of tissue from the location of the probable lesion. A biopsy is the process of removing material for histological analysis. To undergo the procedure, a woman must fulfill the following preconditions:

exclude dietary supplements from the diet for 14 days;
abstain from intimate relations for 3-5 days;
donate blood and do a vaginal smear for genital infections;
carry out all tests before the planned menstruation;
if the patient is taking medications, you should consult a doctor to avoid bleeding when collecting material;
two days before the procedure, you must stop douching, as well as the use of cosmetics for the care of the genitals.

The following types of biopsy are available:

Strokes are imprints.
Punctures. The puncture is made with a thin needle.
Trephine biopsy. The material is extracted using a thick needle.
Stereobiopsy. For monitoring, ultrasound or another device is used, with the help of which the operator sees the tip of the sampling instrument.
Brush biopsy. A sampling wire with small brushes is inserted through the catheter.
Excision. Selection occurs from the affected organ during surgery.
Transurethral. This is done using a cystoscope.
Aspiration. It is performed through a needle with a syringe or using special devices.

Important! A biopsy is a method of collecting material intended for histological studies.

Indications, contraindications, preparation for the procedure

In gynecological practice, the technique is used to assess the condition of the uterus, cervix, and fetal elements after an abortion or miscarriage. In what cases is a histological examination of the cervix performed:

infertility;
presence of human papillomavirus;
erosion (ectopia);
condylomas, polyps of the cervical canal;
presence of signs of inflammation in the smear;
dysplasia;
in order to clarify an unclear diagnosis;
suspected cancer;
to determine the extent of surgical intervention.

The main cause of cervical cancer is human papillomavirus (HPV). There is a vaccine that must be used before sexual activity begins, then the risk of developing cancer is minimal. In adulthood, the effectiveness of vaccination will depend on the persistence of the virus. If a representative of the fair sex is infected with HPV, but does not yet have dysplasia, vaccination will protect against the pathogenic effects of the virus.

Contraindications for sampling:

the presence of acute inflammatory processes of the genital organs;
diseases of the blood coagulation system;
during the menstrual cycle.

Preparation for cervical histology includes: avoidance of sexual intercourse, douching, and local treatment 2 days before the procedure. Following simple rules minimizes the chance of error. Tissue collection for analysis occurs before two-manual vaginal examination and colposcopy.

Features after scraping

Curettage (cleaning the inner surface of the uterus from various pathologies using a surgical device - a curette) with further histology is carried out:

in case of a frozen pregnancy or stillbirth of a baby;
excessive growth of the endometrium;
suspected uterine cancer;
frequent intermenstrual bleeding;
preparation for surgery;
the need to remove a polyp on or inside the cervix;
infertility;
after a miscarriage, since parts of the fetal tissue may remain in the cavity of the reproductive organ, which can cause infection;
chronic endometritis;
bloody discharge during menopause.

Histology after curettage shows the exact causes of dangerous diseases of the female reproductive system, as well as their nature.

The most common ones that cause pathological growths include:

secretion of estrogen in greater quantities than progesterone;
disruption of the endocrine glands;
consequences of abortion;
severe and frequent stress;
sexually transmitted diseases, inflammation, infections of the female reproductive system.

After hysteroscopy with curettage has been performed, the gynecologist prescribes treatment based on the results of the tests obtained. In a woman (if all the doctor’s recommendations are followed and postoperative therapy is carried out correctly), a new layer of endometrium grows in the uterine cavity.

To obtain the most informative and reliable results of the study, you need to prepare for curettage, following all the doctor’s recommendations.

Histological examination of biopsy material and material obtained during surgical interventions (endoscopic material; tissues of the female reproductive system; skin, soft tissues; hematopoiesis