A comparative study between pipelle endometrial sampling and dilatation curettage in abnormal uterine bleeding

Abstract

Objective: To compare the diagnostic accuracy of endometrial aspiration biopsy (EAB) using Pipelle device with dilatation and curettage(D&C) histopathology. Methods: A comparative study of 81 patients with abnormal uterine bleeding carried out in the Department of Obstetrics and Gynecology between November 2018 and October 2019. Endometrial sampling with Pipelle was performed in 81 patients followed by formal D&C under anesthesia after ruling out other causes of AUB. Samples were labeled as A and B and sent to a histopathologist who was blinded as to the method of sampling. The histopathology reports of both samples were compared. Results: Total number of patients enrolled in this study was 81 patients with abnormal uterine bleeding. In present study it was observed that increased endometrial thickness was not always associated with adequate tissue diagnosis. Endometrial thickness of less than 5mm was found in 14.8%, 5-8mm was found in 34.6%, 9-10mm noted in 28.4%, 12-16mm noted in 13.6% & more than 16mm was seen in 8.6% of study subjects. Mean ± SD: 9.87±8.01 mm. If upper limit of normal ET 16mm is taken as cutoff, adequacy rate in Pipelle and D&C were 92.1% and 90.5% respectively and if ET >16mm, adequacy rate in Pipelle and D&C were 72.2% and 77.8% respectively. In present study, it was observed that increased ET was not always associated with adequate sample. Among 14 patients of PMB 11 patients had abnormal ET (61.1%). In 81 cases of Pipelle 11.1% Pipelle sample was scanty and in 1 subject no sample was obtained. Major portion of Pipelle sample (87.7%) was adequate. Of the 81 subjects of D&C, scanty tissue was reported in 8.6% and sample was adequate in 87.7%. No sample was obtained in 3.7%. The Sensitivity of Pipelle in obtaining a adequate tissue comparing it with D&C by applying Fisher exact test is calculated to be 95.71%, Specificity =71.43% Positive predictive value=97.10% and Negative predictive value =62.50%. The accuracy is 93.51%. The calculated p value is