Diagnostic value of Pipelle endometrial sampling in comparison with Dilatation and Curettage among patients with abnormal uterine bleeding.

Abstract

Background: The dilatation of the cervix and curettage of the uterine cavity under general anesthesia has
long been considered the gold standard for the assessment of abnormal uterine bleeding . This method requires laboratory investigation, hospitalization and carries the added risk of general anesthesia ,infection and perforation. The pipelle device can be used on an outpatient basis and is cost effective compared with dilatation and curettage. It can traverse most cervical canals without prior dilation and it is generally well tolerated without analgesia.

Objectives: To determine the reliability of pipelle device in acquiring an adequate endometrial sample comparing to Dilatation & Curettage.

To compare the result of histopathological diagnosis of pipelle sampling with Dilatation &Curettage.
Participants: Women of age >35 years who presented with abnormal uterine bleeding.
Study design: Prospective study.
Method: A prospective study was conducted in the Department of Obstetrics And Gynaecology at SKIMS SRINAGAR from September 2018 for the period of 18 months and was a time bound study.Eighty (80) cases of abnormal uterine bleeding attending the outpatient clinic were included in the study. The pipelle was introduced without performing cervical dilatation and withdrawn outside the uterus with a rotatory movement to get sample. The patients was then transferred to the operation theater for dilatation and curettage. Thereafter, both the samples were sent to pathologist, who were blinded to methods of sampling.

Results: For obtaining the endometrial sample tissue sufficiency rates were 93.8% and 100% by Pipelle and D&C respectively.The diagnosis made by the histopathological examination (HPE) report by the sample obtained from pipelle sample had shown a very high sensitivity,specificity,positive predictive value and negative predictive value, except for the diagnosis of endometrial poyp which the pipelle was not able to detect.

Conclusion: Pipelle device is an easy and convenient method of getting tissue diagnosis.It can be done as an outpatient procedure without anesthesia,when compared to D&C which is done under anesthesia.The sensitivity and specificity of this procedure in detecting endometrial pathologies were comparable with the standard procedure of D&C.

keywords: pipelle biopsy,Dilatation and curettage (D&C), Abnormal uterine bleeding (AUB).