The Incidence and Management of Failed Pipelle Sampling in a General Outpatient Clinic

Abstract

A prospective audit was performed on 100 consecutive patients who underwent Pipelle endometrial sampling in a general outpatient clinic setting. The indications for sampling were abnormal menstrual bleeding (AMB, 65), intermenstrual or postcoital bleeding (IMB/PCB, 7), postmenopausal bleeding (PMB, 28). An insufficient sample was obtained in 33 women: (AMB 14, 21.5%); IMB/PCB, (0); PMB 19,68%). In 3 women the Pipelle was unable to be introduced through the cervix; in the remainder an insufficient sample for histological diagnosis was obtained. Registrars and resident doctors were more likely to sample insufficiently. In the AMB group all but 1 woman with an insufficient sample had further investigations or treatment but 7 of 19 (37%) of PMB patients had no further investigations. Where definitive histology was available, endometrial polyps or submucous fibroids were found in half of the cases with an inadequate Pipelle sample. Pipelle sampling detected only 1 of the 2 cases of endometrial cancer in this study.

Investigation of Women with Postmenopausal Uterine Bleeding: Clinical Practice Recommendations

“…Office-based sampling is usually performed with disposable catheters that allow for the application of suction to obtain a specimen. Any method of sampling the endometrial cavity misses a proportion of endometrial cancers 24 (Class 1b), 47,48 (Class 3), 49 Collectively, these data would suggest that women with "nondiagnostic" endometrial biopsy specimens should have additional uterine evaluations with TVUS, contrast sonography, hysteroscopy, or a combination of any of these procedures.…”

“…However, considering the false-negative rates associated with either approach, the indications for reassessment should be rather liberal considering one or a combination of repeat TVUS, repeat endometrial biopsy, and contrast sonography or hysteroscopy 64,106 (Class 5), 49 (Class 6), 107 (Class 7). Determination of the specific order and combinations of these investigations will depend on the clinical judgment of, and resources available to, the clinician.…”

Endometrial biopsy in women with abnormal uterine bleeding: inadequate and unassessable categorisation is not clinically relevant

“…Endometrial biopsy can be taken either by a Pipelle sampler, as an outpatient procedure, or by a curette under general anaesthesia 1 2. The increasing use of the Pipelle sampler has led to a higher number of specimens with scant tissue, causing problems in assessing adequacy and interpreting artefactual changes 2 3…”

Evaluation of abnormal uterine bleeding: comparison of three outpatient procedures within cohorts defined by age and menopausal status

“…This reflects the rates reported in other clinical trials. 18,67 The present study also considered individual characteristics that may influence the performance of the two endometrial sampling methods. Nulliparity was strongly associated with failure of insertion, whereas for parous women, the vast majority, the failure rate was only 8%.…”

“…It is recognised that outpatient sampling in women with AUB will fail to collect a sample adequate for histological assessment in up to 10% of women. 18 …”