Pipelle biopsy and dilatation and curettage in clinical practice: are factors affecting their effectiveness the same?

Abstract

Aim: Endometrial biopsy is one of the most commonly performed gynecological procedures. Apart from patient safety, the most important is to obtain an adequate specimen allowing histopathological diagnosis. The aim of the study was to determine the rate of endometrial sampling failure and factors affecting the quality of specimen obtained for histopathological examination among patients who underwent Pipelle biopsy and dilatation and curettage (D&C). Methods: Patients who underwent endometrial biopsy (Pipelle, D&C) at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, between June 2013 and July 2017, were included in the study. The influence of menopausal status, body mass index, obstetric history, endometrial thickness, indications for the biopsy and doctors' experience were analyzed with regard to the effectiveness of the procedure. Results: Overall, 895 endometrial sampling procedures were performed. Three hundred and thirty-nine (37.9%) patients underwent Pipelle biopsy, while 556 (62.1%) had D&C. Insufficient samples were found in 60 (17.3%) and 88 (15.8%) patients, respectively. Age, menopausal status and indications were factors affecting both procedures, while the number of previous vaginal deliveries, body mass index and endometrial thickness influenced the effectiveness of Pipelle biopsy. Doctors' experience did not influence the specimen adequacy. Conclusion: None of the methods guarantee obtaining adequate specimens. D&C might be preferred in postmenopausal women. The effectiveness of both procedures is independent of doctors' experience.

Factors Associated with Insufficient Endometrial Sampling in Postmenopausal Women

“…They stated that although the endometrial aspiration with the Karman cannula seems to be a simple and inexpensive technique for detecting endometrial pathology, they offer other investigations such as hysteroscopy for patients in whom creation of negative pressure in the uterus is unsuccessful or who still have further uterine bleeding with undetermined endometrial pathology. We found no significant association between insufficient samples and the factors that affect insufficient biopsy results including BMI, nulliparity, use of hormone replacement therapy and indications for the biopsy which is in contrast to the results of previous reports (15,20,22,28,29).…”

Current role of Pipelle endometrial sampling in early diagnosis of endometrial cancer

“…There are numbers of modalities that serve to obtain endometrial samples including classic dilation and curettage procedure (D&C), hysteroscopy, Pipelle sampling, biopsy with Vabra Z-sampler, Mi-Mark cell sampler, Isaacs cell sampler, Gynoscann device, Endorette, Tao Brush, SAP-1 device, etc. (16)(17)(18)(19). Nowadays, sampling with miniature endometrial biopsy outpatient device, such as Pipelle, is the first-choice approach (1,16).…”

“…(16)(17)(18)(19). Nowadays, sampling with miniature endometrial biopsy outpatient device, such as Pipelle, is the first-choice approach (1,16). However, none of the above-mentioned methods allow scraping the whole uterine cavity; therefore, it is upon the clinician to choose the appropriate technique for each particular patient (16).…”

“…Factors affecting the Pipelle biopsy efficiency and failure rate Currently, there is still lack of data about factors influencing the effectiveness of Pipelle biopsy and D&C. Failure to obtain adequate samples for histological examination is one of the major issues associated with the Pipelle procedure (46,48). Identification of factors that may have an impact on the efficacy of endometrial sampling could help in the selection of the diagnostic technique for each particular patient (16).…”

Is Valsalva maneuver an alternative to use tenaculum for endometrial sampling procedure in cases where the cervix cannot be passed spontaneously with pipelle? A randomized study

“…Dilatation, curettage and office procedures are the main methods for endometrial biopsy (EB). Despite more invasiveness, dilatation and curettage also do not guarantee to obtain sufficient specimen from the uterine cavity, 1 they require hospital admission in general anesthesia and cost a lot.…”