Factors affecting adequacy of Pipelle and Tao Brush endometrial sampling

Abstract

Objective To compare factors influencing adequacy of endometrial samples obtained using two outpatient sampling devices -Pipelle and Tao Brush.Design Pragmatic unblinded trial with investigation schedule randomised separately within two groups according to endometrial cancer risk.Setting Gynaecology outpatient clinic of a large city hospital in Edinburgh, Scotland.Population All women referred to a gynaecology outpatient clinic during a 28-month period complaining of abnormal vaginal bleeding.Methods Women were assigned to two 'risk groups' for endometrial cancer ('high risk' for postmenopausal women and 'moderate risk' for premenopausal women aged over 40 years or with other risk factors). Women in each risk group had both types of biopsy and were randomised to two outpatient visualisations: hysteroscopy and/or transvaginal ultrasound scan.Main outcome measures Completion of the investigation, adequacy of sample and acceptability of investigation to women.Results In 200 high-risk women, adequate samples were significantly more likely to be obtained by Tao Brush than Pipelle (P < 0.001). Nulliparity was strongly associated with failed insertion for both devices (P < 0.001). Inadequate samples were strongly associated with postmenopausal status only for Pipelle (P < 0.001), and among premenopausal women, for both samplers, with nulliparity (P < 0.001). A significantly greater proportion of women preferred the Tao Brush to the Pipelle endometrial sampler (P < 0.001).Conclusions In postmenopausal women, Tao Brush sampling offers advantages over use of Pipelle, and the former should be considered as an alternative or additional sampling device in this group of women.

Assessment of the usefulness of pipelle biopsy in gynecological diagnostics

“…Different authors report a percentage of non-diagnostic examinations of between 3 and 16% [13,[16][17][18]. In their meta-analysis Dijkuzen et al estimated that 10.4% of pipelle biopsies involve ineffective sampling of uterine cavity material [4].…”

Investigation of Women with Postmenopausal Uterine Bleeding: Clinical Practice Recommendations

“…However, in randomized trials from Scotland, the Tao Brush (Cook Medical; Bloomington, IN; USA) was found to be superior to the Pipelle catheter in obtaining a satisfactory endometrial sample (72% to 43%) 56,57 (Class 1b). Endometrial cytology with liquid-based techniques has also been described to have a high sensitivity for carcinoma, but it has not been compared with blind sampling 58 (Class 3).…”

Reproducibility of Endometrial Pathologic Findings Obtained on Hysteroscopy, Transvaginal Sonography, and Gel Infusion Sonography in Women With Postmenopausal Bleeding

“…In meta-analysis the reported range of sampling failure was 0 to 58% with pipelle endometrial sampling [16]. Two studies confirmed a high failure rate (51% and 64%, of which 30% and 48% were insufficient samples) [17,18]. Malignancy cannot be excluded in women with insufficient ES [19,20], and HY is often added.…”