A prospective study on the efficacy of Pipelle biopsy to diagnose endometrial pathology in patients with abnormal uterine bleeding

Abstract

Background: Abnormal uterine bleeding is one of the most common problem encountered in gynaecology clinics. Assessment of endometrial pathology is recommended to rule out malignancy and premalignant conditions. Endometrial sampling can be done by Pipelle biopsy in outpatient units as well as by conventional dilatation and curettage in an operation theatre setup. Our study aims to find out the efficacy of office endometrial biopsy in terms of its sample adequacy, diagnostic accuracy and patient acceptability.Methods: 120 women presenting with abnormal uterine bleeding were included. A detailed history along with clinical examination findings are entered in the proforma. Ultrasound scan was done for all of them to identify pelvic pathology and endometrial thickness. Endometrial sampling was then done with Pipelle without anaesthesia. Histopathology reports are collected and sample adequacy and pattern were analysed. Patients are subsequently followed up for a period up to one year. Those who underwent hysterectomy are analysed for the endometrial pathology in hysterectomy specimen which is used as gold standard and compared with Pipelle endometrial sampling histopathology.Results: Sample adequacy for Pipelle biopsy was found to be 96%. Diagnostic accuracy for atypical hyperplasia and adenocarcinoma is 92.5% and 94% respectively. In hysterectomy specimens, carcinoma endometrium coexisted with atypical hyperplasia in 40% of cases with atypical hyperplasia in pipelle biopsy report.Conclusions: Thus, Pipelle endometrial biopsy is a cost-effective method for endometrial sampling except for focal lesions.

Assessing the Efficacy of Pipelle Sampling as Outpatient Diagnostic Test in a Tertiary Care Hospital-Rawalpindi, 2020

“…This is also supported by a similar study done by Muzaffar et al 18 The incidence of the non-neoplastic lesion in our study was 91% and 4% were neoplastic lesions. This is similar to studies conducted by Mathew et al 16 , and Abdelazim IA et al 20 , and Chaudhary A et al 19 where sample adequacy was 96%, 97.9%, and 95% respectively and in our study, the sample adequacy was 95%. There were 05 cases of inadequate samples which is in comparison to a study conducted by Fakhar S et al 9 , where there were 02 inadequate samples and a similar study by Mathew et al 16 had 05 inadequate samples.…”

“…Our study showed 78% sensitivity, 89% specificity for endometrial hyperplasia with atypia with 50% positive, and 97% negative predictive value. This is similar to a study by Mathew et al 16 and Sanam M et al 22 05 inadequate samples in our study were in the post-menopausal age group, they went on to have diagnostic dilation and curettage which showed atrophic endometrium on histopathology. This is comparable to a study done by Asif et al 21 where inadequate samples were 04%.…”

“…13% of chronic endometritis cases were observed in the reproductive age group. In this study, Pipelle was seen to have 100% specificity and positive predictive value, 52% sensitivity, and 94% negative predictive value for endometrial carcinoma and these findings are similar to a study done by Mathew et al 16 where Pipelle showed 50% sensitivity and 100% specificity for detecting endometrial carcinoma. Our study showed 78% sensitivity, 89% specificity for endometrial hyperplasia with atypia with 50% positive, and 97% negative predictive value.…”

“…It is a thin, plastic suction tube about 3mm in diameter with graduated markings designed on it. 15 The most common presenting complaint in our study was heavy menstrual bleeding (38%) followed by post-menopausal bleeding (27%) which is in comparison to a study performed by Mathew et al 16 and Samal et al 17 , where heavy menstrual bleeding was the leading complaint in the per-imenopausal age group. This is also supported by a similar study done by Muzaffar et al 18 The incidence of the non-neoplastic lesion in our study was 91% and 4% were neoplastic lesions.…”

A randomized comparative study to compare Karman's cannula and pipelle biopsy for evaluation of abnormal uterine bleeding

“…In the study by Zutshi et al .,[ 10 ] no significant difference in pain score was observed in Karman cannula and Endosampler groups, with both showing less pain. Mathew and Thomas[ 29 ] observed that most of the patients required no analgesics after Karman cannula use. Thus, it can be said that Karman cannula and Pipelle use is associated with less pain, however, between both of them, we advocate Karman cannula in terms of pain threshold.…”