Evaluation of Postmenopausal Bleeding by Using Pipelle Curette and Hysteroscopic-Guided Biopsy: A Comparative Study

Abstract

The health aspects in postmenopausal women including postmenopausal bleeding have gained importance in the present days as the life expectancy has increased. AIMS To compare the diagnostic accuracy of Pipelle biopsy and hysteroscopic-guided biopsy in the detection of endometrial pathologies in women with postmenopausal bleeding and to calculate sensitivity, specificity, predictive values for Pipelle endometrial sample in comparison to hysteroscopic-guided biopsy. MATERIALS AND METHODS This was a prospective comparative study carried out in the Department of Obstetrics and Gynaecology over a period of one year nine months in 100 postmenopausal women attending Gynaecology Outpatient Department and having postmenopausal bleeding as the chief complaint. RESULTS In our study, mean age of women presented with postmenopausal bleeding was 54.76±8.02 years. The mean duration of menopause was 7.95±5.40 years. 66% cases were para 4 or above. 62 cases (62%) had one or more risk factors hypertension being the most common present in 22 cases (22%). Majority of women with postmenopausal bleeding had endometrial thickness between 5-8 mm (44%) on TVS. Histopathological findings of Pipelle endometrial biopsy compared with hysteroscopic-guided biopsy in diagnosing polyps showed statistically significant difference with p value 0.0, whereas, for atrophic, proliferative endometrium, hyperplasias, carcinoma, it was statistically insignificant (p value >0.05). Sensitivity of Pipelle for detecting focal endometrial lesions is lesser than hysteroscopic biopsy. CONCLUSION Endometrial sampling with Pipelle alone is not effective for diagnosing focal endometrial lesions. Hence, Pipelle can be used as a first line investigation for histopathological evaluation of postmenopausal bleeding. Whenever focal lesions are suspected as on a TVS, a hysteroscopic biopsy is preferable.