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Comparison the Diagnostic Value of Dilatation and Curettage Versus Endometrial Biopsy by Pipelle - a Clinical Trial

  • Sanam, Moradan (Abnormal Uterine Bleeding Research Center) ;
  • Majid, Mir Mohammad Khani (Department of Community Medicine, Faculty of Medicine, Semnan University of Medical Sciences)
  • Published : 2015.07.13

Abstract

Background: Several methods have been presented for the evaluation of the endometrium in patients with abnormal uterine bleeding, which include minimal invasive and invasive approaches such as diagnostic curettage or endometrial biopsy by Pipelle. Many studies have been performed in order to compare two methods; diagnostic curettage and outpatient endometrial biopsy. This investigation compared sampling adequacy, endometrial histopathology, failure rates, duration and costs between diagnostic curettage in a hospital and endometrial biopsy. Materials and Methods: This single blind clinical trial was performed on 130 patients older than 35 years who was referred to Amir training hospital in 2013 for elective diagnostic curettage because of abnormal uterine bleeding. For all patients eligible for the study, an endometrial sample by Pipelle was taken without anesthesia or dilatation. Then under general anesthesia diagnostic curettage was performed by sharp curette. Sampling duration was calculated and both samples were sent to the same pathologist. The diagnostic values of two methods in the diagnosis of normal endometrium, endometrial hyperplasia and carcinoma were compared. The costs of these two methods were also compared. Data analysis was performed by SPSS (version 16.0) software. Chi-Square, Fisher, and Pearson tests were used and were considered statistically significant at P values less than 0.05. Results: Two methods were agreed upon 88% of sampling adequacy and 94% of pathological results. Specificity of 100% and sensitivity of 90% for detection of proliferative endometrium, secretory endometrium, simple hyperplasia without atypia and 100% for cancer were recorded. Pipelle diagnostic accuracy in comparison with curettage, have been reported over 97%, so the failure rate in this study was below 5%. Sensitivity of Pipelle for detection of atrophic endometrium was reported below 50%. Duration and cost was lower in Pipelle versus curettage. Conclusions: It is concluded that due to high agreement and cohesion coefficient between curettage and Pipelle on the issue of sampling adequacy, histopathology finding (except atrophic endometrium), low failure rate, duration of sampling and cost, Pipelle can be introduced as a suitable alternative of diagnostic curettage.

Keywords

Abnormal uterine bleeding;biopsy of endometrium;diagnostic curettage;pipelle;endometrium sampler

References

  1. Abdelazim IA, AboelezzA, AbdulKareem AF (2013). Pipelle endometrial sampling versus conventional dilatation & curettage in patients with abnormal uterine bleeding. J Turkish German Gynecol Assoc, 14, 1-5. https://doi.org/10.5152/jtgga.2013.01
  2. Agostini A, Collette E, Provansal M, et al (2008). Good practice and accuracy of office hysteroscopy and endometrial biopsy. J Gynecol Obstet Biol Reprod (Paris), 2315, 74774-4.
  3. Antoni J, Folch E, Costa J, Foradada CM, et al (1997). Comparison of cytospat and pipelle endometrial biopsy instruments. Eur J Obsetet Gynecol Repord Biol, 72, 57-61. https://doi.org/10.1016/S0301-2115(96)02658-9
  4. Bano I, Anwar A, Tahir N, Shaheen T (2011). Establishing reliability of pipelle endometrial biopsy in comparison to traditional curettage and future outpatient hysteroscopy. Quart Med Chan, 17, 32-5.
  5. Behnamfar F, Khamehchian T, Mazoochi T, Fahiminejad T (2004). Diagnostic value of endometrial sampling with pipelle suction curettage for identifying endometrial lesions in patients with abnormal uterine bleeding. J Res Med Sci, 3, 123-5.
  6. Berek JS, Berek DL (2012). Berek & Novak's Gynecology. Fifteenth edition. Philadelphia Lippincott William and Wilkins, New York pp 1-2 Numbers 374-431.
  7. Coulter A, Klassen A, Mackenzie IZ, McPherson K (1993). Diagnostic dilatation and curettage: Is it used appropriately. BMJ, 306, 236-9. https://doi.org/10.1136/bmj.306.6872.236
  8. Demirkiran F, Yavuz E, Erenel H, Bese T, arvas M, Sanioglu C (2012). Which is the best technique for endometrial sampling? Aspiration (pipelle) versus dilatation and curettage (D&C). Arch Gynecol Obctet, 286, 1277-82. https://doi.org/10.1007/s00404-012-2438-8
  9. Fakhar S, Saeed G, Khan AM, Alam A (2008).Validity of pipelle endometrial sampling in patients with abnormal uterine bleeding. Ann Saudi Med, 28, 188-91. https://doi.org/10.4103/0256-4947.51721
  10. Fritz MA, Speroff L (2011). In clinical gynecologic endocrinology and infertility, 8th ed. Lippincott Williams and Wilkins, Philadelphia PP 1-2 Numbers 604-10.
  11. Leclair CM, Zia JK, Doom CM, Margan TK, Edelman AB (2011). Pain experienced using two different methods of endometrial biopsy: a randomized controlled trial. Obstet Gynecol, 117, 636-41. https://doi.org/10.1097/AOG.0b013e31820ad45b
  12. Machado F, Moreno J, Carazo M, et al (2003). Accuracy of endometrial biopsy with the cornier pipelle for diagnosis of endometrial cancer and atypical hyperplasia. Eur J Gynaecol Oncol, 24, 279-81.
  13. Mousavifar N, Delavari M, Talaei-Khoei M (2005). Accuracy of pipelle sampler for endometrial assessment. J Babol Univ Med Sci, 8, 53-8.
  14. Naderi T, Asharafganjooie T, Bahrampoor A, Mehrimahani I (2006). Comparison of the diagnostic accuracy of pipelle biopsy, dilatation and curettage and hysrectomy in detection of endometrial lesions. J Kerman University Med Sci, 13, 159-63.
  15. Sany O, Singh K, Jha S (2012). Correlation between preoperative endometrial sampling and final endometrial cancer histology. Eur J Gynaecol Oncol, 33, 142-4.
  16. Sweet MG, Schmit Dalton TA, Weiss PM (2012). Evaluation and management of abnormal uterine bleeding in premenopausal women. American Family Physician, 85, 35-43.
  17. Tanriverdi HA, Barut A, Gun BD, Kaya E (2004). Is pipelle biopsy really adequate for diagnosing endometrial disease. Med Sci Monit, 10, 271-4.
  18. Yarandi F, Izadi-Mood N, Eftekhar Z, Shojaei H, Sarmadi S (2010). Diagnostic accuracy of dilatation and curettage for abnormal uterine bleeding. J Obstet Gynaecol Res, 36, 1049-52. https://doi.org/10.1111/j.1447-0756.2010.01288.x

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