Assessing the Efficacy of Pipelle Sampling as Outpatient Diagnostic Test in a Tertiary Care Hospital-Rawalpindi, 2020
To assess the effectiveness and enlist clinical factors, which may affect effectiveness of Pipelle sampling in diagnosing endometrial pathology in patients with abnormal uterine bleeding and Post-menopausal Bleeding.
‘Analytical Cross-Sectional’ study.
Place and duration:
Gynecology Department at Combined Military Hospital Rawalpindi, in collaboration with Histo-Pathology Department, of six months duration i.e. from 1st December 2019 to 31st May 2020.
Patients and methods:
100 female patients of outpatient department with presenting complaints of either abnormal or post-menopausal bleeding were included in the study in the specified time frame. After informed written consent, Pipelle endometrial sampling was done on outpatient basis, and by consecutive sampling technique using lottery method, sample was sent for histopathological evaluation. Evaluated factors studied were: indications for the procedure, age, parity, age of menarche.
Of the total patients evaluated, 91% (n=100) were non-malignant, while 4% (n=100) were malignant. Inadequate tissue was obtained in 5% samples. Most common histopathological findings among reproductive age group were Proliferative and Secretory phase endometrium 64% (n=100). While in Post-menopausal age group 4% (n=100) were Endometrial carcinoma on histopathology. Inadequate tissue samples 5% (n=100) were noted among the Post-menopausal group. 6% samples showed endometrial hyperplasia. Pipelle Endometrial Sampling had sensitivity and specificity, in diagnosing the endometrial pathologies is summarized in Table 3.
Pipelle Endometrial Sampling is an effective, safe, simple and acceptable procedure for diagnosing endometrial pathology. It is cost effective requiring no anesthesia with high sensitivity and specificity for detecting endometrial pathology.
1. Khrouf M, Terras K. Diagnosis and management of formerly called dysfunctional uterine bleeding according to PALMCOEIN FIGO classification and the new guidelines. J Obstet Gynecal India. 2014 Dec. 64 (6): 388-93 [Medline]
2. Davis E, Sparzak PB. Abnormal uterine bleeding (Dysfunctional Uterine Bleeding). Stat Pearls [Internet] 2018 Jan. [Medline] [Full text]
3. Aston B. Discussion of best practice guidelines for asymptomatic post-menopausal endometrial thickening. Aust NZ J Obstet Gynecol. 2015;55 (1):100-1
4. Saadia A, Mubarik A, Zubair A, Jamal S, Zafar A. Diagnostic accuracy of endometrial curettage in endometrial pathology. J Ayub Med Coll Abbottabad. 2011;23 (1):129-31
5. American College of obstetricians and gynecologists ACOG practice bulletin No.149: Endometrial cancer. Obstet Gynecol. 2015; 125:1006-26, [PubMed] [Google Scholar]
6. American College of obstetricians and gynecologists, ACOG committee opinion no 557: Management of Acute Abnormal uterine bleeding is non-pregnant reproductive-aged women. Obstet Gynecol. 2013; 121:891-6 [PubMed] [Google Scholar]
7. Beebeejaun Y, Varma R. Heavy menstrual flow: current and future trends in management. Rev Obstet Gynecal 2013; 6(3-4): 155-64
8. Piatek S, Panek G, Wielgos M. Assessment of the usefulness of Pipelle biopsy in gynecological diagnostics. Ginekol Pol. 2016; 87(8): 559-64
9. Fakhar S, Saeed G, Khan AH, Alam AY. Validity of Pipelle endometrial sampling in patients with Abnormal uterine bleeding. Ann Saudi Med. 2008; 28(3): 188-191
10. Khan S, Hameed S, Umber A. Histopathological pattern of endometrium on Diagnost D+C in patients with abnormal uterine bleeding. Ann King Edward Med Univ. 2011; 17:166. [Google Scholar]
11. Goldstein SR. Modern evaluation of endometrium. Obstet Gynecol. 2010; 116: 168-76
12. Shams G. Comparison of Pipelle de cornier with conventional dilatation and curettage in terms of patients’ acceptability. J Postgrad Med Inst (Peshawar-Pakistan) 2012; 26: 418-21 [Google Scholar]
13. Opmeer BC, Van Doorn HC, Heintz AP, Burger CW, Bossuyt PM, Mol BW. Improving the existing diagnostic strategy by accounting for characteristics of the women in the diagnostic workup for postmenopausal bleeding BJO. 2007 Jan; 114(1):51-8
14. Van Den Bosch T. Van Schoubroeck D, Domali E, Vergote I, Moerman P, Amant F, Timmerman D. A thin and regular endometrium on ultrasound is very unlikely in patients with endometrial malignancy, ultrasound Obstet Gynecol 2007; 29(6): 674-9
15. Illavarase CR, Jyothi GS, Alva NK. Study of the efficacy of Pipelle Biopsy Technique to diagnose endometrial disease in abnormal uterine bleeding. J Mid-life Health. 2019; 10: 75-80
16. Mathew SM, Thomas PA, Prospective Study on the efficacy of Pipelle biopsy to diagnose endometrial pathology in patients with abnormal uterine bleeding Int J Reprod Contracept Obstet Gynecol 2019; 8: 4238-43
17. Samal K, Vaithy AS, Habeebullah S. Clinicopathological analysis of abnormal uterine bleeding in reproductive and Post-menopausal women in a tertiary care center of South eastern part of India. Indian J Obstet Gynecol Res 2020; 7(1): 66-70
18. Muzaffar M, Akhter KA, Yasmeen S, Rehman MU, Iqbal W, et al. Menstrual irregularities with excessive blood loss: a clinic pathological correlation. J Pak Med Assoc. 2005; 55(11): 486-489
19. Chaudry A, Javaid M. Clinical usefulness of Pipelle endometrial sampling. Pak Armed Forces Med J 2005; 55: 122-125
20. Abdelazim IA, Aboelezz A, Abdul Kareem AF. Pipelle Endometrial sampling versus conventional Dilatation and curettage in patients with Abnormal uterine bleeding, J Turk Ger Gynecol Assoc. 2013; 14(1): 1-5
21. Asif AZ. An acceptable outpatient technique for endometrial biopsy. J College Physician Surg Pak. 1999; 9(1): 14-16
22. Sanam M, Majid MMK. Comparison of the diagnostic value of dilatation and curettage versus endometrial biopsy by Pipelle, a clinical trial. Asian Pacific J Cancer Prevent. 2015;16(12):4971-5
Copyright (c) 2020 Nusrat Noor, Rabiah Anwar, Rabia Akbar, Ghazala Sadaf, Khan M Yaqub
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
All research articles published in the Journal of Rawalpindi Medical College (JRMC) are fully open access: immediately freely available to read, download, and share. Copyrights of all articles published in JRMC are retained by the authors. First publication rights are granted to JRMC. The journal/publisher is not responsible for subsequent uses of the work.
All articles are published under the Creative Commons Attribution (CC BY-SA 4.0) license.