Endometrial tissue sampling using pipelle versus dilatation and curettage for the assessment of endometrium in patients of perimenopausal and post-menopausal age: a prospective study

Nina Navakumar; Dhanya Dinesh; P. K. Syamala Devi

doi:10.18203/2320-1770.ijrcog20183857

Authors

Nina Navakumar Department of High Risk Pregnancy and Fetal Medicine, Fernandez Hospital, Hyderabad, India
Dhanya Dinesh Department of Gynecology and Oncology, Believers’ Church Medical College and Hospital, Tiruvalla, Kerala, India
P. K. Syamala Devi Department of Obstetrics and Gynecology, KIMS Hospital, Trivandrum, Kerala, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20183857

Keywords:

Dilatation and curettage, Endometrial sampling, Pipelle biopsy

Abstract

Background: The aim of this study is to compare the accuracy and adequacy of endometrial sampling using pipelle biopsy with dilatation and uterine curettage (D and C) and hysterectomy specimen in the assessment of endometrium in patients of perimenopausal and postmenopausal age.

Methods: One hundred fifty patients of perimenopausal and postmenopausal age who attended the Gynecology OPD of KIMS Hospital from June 2012 to May 2014 with complaints of abnormal uterine bleeding or who were found to have abnormally thickened endometrium by ultrasonography were included in the study.

Results: Adequate specimen could be obtained through pipelle biopsy in 86.7% of the patients, compared to 76% with adequate sample in case of D and C. Comparing histopathology reports between Pipelle and DandC specimens, the confidence interval was 92.7%, 95% lying in the range between 86.54% to 96.53%. 68 of the 150 patients had undergone hysterectomy for various reasons. Comparing histopathology reports between Pipelle and hysterectomy specimens, the confidence interval was 94.2%; 95% of study population lies within the C.I range of 84.05 %-98.79% while accounting for the whole population, which shows that Pipelle endometrial sampling can be considered to be almost accurate as HPE by hysterectomy specimen. Comparing the difficulty of the procedure, Pipelle biopsy was found to be easier in perimenopausal patients when compared to post-menopausal patients and the difference was statistically significant. Mode of delivery did not seem to affect the ease of Pipelle endometrial sampling as per present observations.

Conclusions: Endometrial tissue sampling using Pipelle was found to be as reliable as D and C and hysterectomy specimen on histopathologic examination for the assessment of endometrium in perimenopausal and post-menopausal age group. Pipelle endometrial sampling was found to be yield adequate specimen when compared with D and C.

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References

Yasmin F, Farrukh R, Kamal F. Efficacy of pipelle as a tool for endometrial biopsy. Biomedica. 2007;23:116-9.

Choudry A, Javaid M. Clinical usefulness of Pipelle endometrial sampling. Pak Armed Forces Med J. 2005;55:122-5.

Seltzer V, Benjamin F, Deutsch S. Perimenopausal bleeding patterns and pathologic findings. J Am Med Women’s Association.1990;45:132-4.

Dijkhuizen FP, Mol BW, Brölmann HA, Heintz AP. The accuracy of endometrial sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia: a meta‐analysis. Cancer. 2000;89(8):1765-72.

Seamark CJ. The demise of the D&C. J Royal Soc Med. 1998;91(2):76-9.

Williams AR, Brechin S, Porter AJ, Warner P, Critchley HO. Factors affecting adequacy of Pipelle and Tao Brush endometrial sampling. BJOG: An Int J Obstet Gynaecol. 2008;115(8):1028-36.

Bakour SH, Khan KS, Gupta JK. Controlled analysis of factors associated with insufficient sample on outpatient endometrial biopsy. Br J Obstet Gynaecol. 2000;107:1312-4.

Fakhar S, Saeed G, Khan A, Alam A. Validity of pipelle endometrial sampling in patients with abnormal uterine bleeding. Annals Saudi Med. 2008;28(3):188.

Feldman S, Berkowitz RS, Tosteson ANA. Cost-effectiveness of strategies to evaluate postmenopausal bleeding. Obstet Gynecol. 1993;81:968-75.

Ben-Baruch G, Seidman DS, Schiff E, Moran O, Menczer J. Outpatient endometrial sampling with the Pipelle curette. Gynecol Obstet Investig. 1994;37(4):260-2.

Epstein E, Valentin L. Intraobserver and interobserver reproducibility of ultrasound measurements of endometrial thickness in postmenopausal women. Ultrasound Obstet Gynecol 2002;20:486-91.

Machado F, Moreno J, Carazo M, Leon J, Fiol G, Serna R. Accuracy of endometrial biopsy with the Cornier pipelle for diagnosis of endometrial cancer and atypical hyperplasia. Europ J Gynaecol Oncol. 2003;24(3-4):279-81.

Gordon SJ, Westgate. J. The incidence and management of failed pipelle sampling in a general outpatient clinic. Aust Nzj Obstet Gynecol. 1999;39:115-8.

Stoval TG, Ling FW, Morgan PL. A prospective, randomized comparison of the pipelle endometrial sampling device with the novak curette. Am J Obstet Gynecol. 1991;165:1287-90.