A diagnostic value of Pipelle endometrial sampling in comparison with dilatation and curettage among patients with abnormal uterine bleeding.

• Maheshwari Vaijinath,  
• Rashmi Sameer Desai,*  
• Nachiketha S Vishwaradhya,  
• Venkatesh Kariganur Vasudevamurthy

Abstract

Background: Pipelle aspirator and Dilatation and Curettage (D&C) commonly used to obtain the endometrial sample in patients of abnormal uterine bleed (AUB). This study was conducted to determine the reliability of pipelle device in acquiring an adequate representative endometrial sample when compared to D&C. Methodology: This prospective comparative study was conducted in a tertiary care hospital in India. One hundred cases of AUB attending the outpatient clinic due to endometrial causes (thick endometrium≥ 12mm in the reproductive and ≥ 4mm in postmenopausal age) were included for the study. Exclusion criteria: AUB due to proven endometrial polyp, coagulopathy. The endometrial sample was taken by the Pipelle device and D&C on the same day. A pathologist, who was blinded to the methods of sample collection, reported the same. The histopathology reports of the Pipelle were compared with that of the D&C sample and the D&C report was considered the gold standard. A 2×2 table of true positive (TP) true negative (TN), False positive (FP) and False negative (FN) was prepared and used for calculating sensitivity, specificity of the pipelle method when compared to D&C. Results: The pathologists classified 96% of the pipelle and 100% of D&C samples as adequate. Higher age, postmenopausal status and thinner endometrium were associated with inadequate sample in pipelle. Pipelle sample had 100% sensitivity and specificity for detecting endometrial carcinoma, hyperplasia, with or without atypia. Pipelle method could not identify any of the polyp, diagnosed with D&C. Pipelle had good correlation for detecting proliferative, secretory endometrium and endometritis. Conclusion: Pipelle device provides adequate sample for histopatholgical examination 96% of the patients. Pipelle sample is 100% sensitive and specific for diagnosing endometrial carcinoma, endometrial hyperplasia with or without atypia. Pipelle method is ineffective for diagnosing polyp.

Keywords

Abnormal uterine bleeding, Pipelle, endometrial sampling, endometrial thickness. ,Dilatation and Curretage