A study to compare the efficacy, inadequacy and patient knowledge of pipelle and dilatation and curettage (D&C) for patients with abnormal uterine bleeding

Abstract

Objective: We aimed to assess the patient knowledge/choice for subsequent procedure, sampling adequacy, and diagnostic accuracy of Pipelle endometrial sampling and conventional D&C in patients with abnormal uterine bleeding (AUB). Methods: This study included total 443 women >40 years of age, with AUB requiring endometrial evaluation. Pipelle biopsy was done without cervical dilation followed by D&C. The histopathology of both the procedures was compared, considering histopathology of the D&C sample as gold standard. Outcomes were compared among the two procedures. Results: Overall accuracy of the Pipelle device was 399(90.67%). Pipelle device was inadequate in 29(6.55%) cases. Pipelle was 100% sensitive and 100% specific for diagnosis of atrophy, endometritis and endometrial carcinoma each. Pipelle was 100% sensitive for diagnosis of proliferative endometrium and secretory endometrium each and 96.48% and 97.92% specific respectively with excellent AUC of 0.98 and 0.99 respectively. Patients’ knowledge/choice for subsequent procedure and procedure associated pain was significantly less for the Pipelle biopsy as compared to D and C. Conclusion: Pipelle is a good, relatively painless, cheap OPD procedure for endometrial aspiration but with the disadvantage of sample inadequacy due to which its routine use remains an enigma for the patient and the doctor.

Keywords

• abnormal uterine bleeding
• pipelle
• d&c