Comparison Between Pipelle Endometrial Sampling and Dilatation and Curettage Among Women with Abnormal Uterine Bleeding

Roza Majid Mohammed; Maryam Bakir  Mahmood

doi:10.56056/amj.2025.375

Authors

Roza Majid Mohammed MBChB, KHCMS/Obstetrics and Gynecology Trainee, Sulaimani Maternity Teaching Hospital, Sulaimani Directorate of Health, Sulaymaniyah, Iraq.
Maryam Bakir Mahmood MBChB, FICOG, DGO, Assistant Professor of Obstetrics and Gynecology at Department of Clinical Medical Sceinces, College of Medicine, University of Sulaimani, Sulaymaniyah, Iraq.

DOI:

https://doi.org/10.56056/amj.2025.375

Keywords:

Dilatation and curettage, Endometrial tissue, Histopathology, Pipelle

Abstract

Background and objectives: Abnormal uterine bleeding is one of the most widespread gynecological complaints that necessitate endometrial biopsy. Obtaining a sufficient specimen allowing a histopathological diagnosis is as important as patients' safety. The purpose of the study was to compare the efficiency of pipelle device to dilatation and curettage in obtaining high-quality endometrial tissue for histopathological analysis.

Methods: A prospective cohort study of 57 patients presented with Abnormal uterine bleeding from June 1^st, 2022 to June 1^st, 2023. The endometrial sampling was accomplished using the pipelle gadget without first performing cervical dilatation. The same patient then underwent conventional Dilatation and Curettage to obtain a second sample. The Dilatation and curettage report was used as a reference when comparing the Pipelle sample's histopathology reports to those of the Dilatation and curettage sample.

Results: The pipelle’s sensitivity was 81.3%, specificity was 100%, with a 100% positive predictive value which makes the accuracy 94.7% in diagnosing secretory endometrium. Furthermore, for proliferative endometrium, it showed a sensitivity, specificity, PPV, and NPV of 100%,98.1%, 75%, and 100% respectively making the accuracy 96.5%. while for hyperplasia without atypia and disordered endometrium, the accuracy was 98.2%. The analysis showed that the histopathology results of the pipelle were in concordance with the results obtained by Dilatation and Curettage, with a p-value of less than 0.001.

Conclusion: The results obtained by pipelle are almost as accurate as Dilatation and curettage, so it can be used in the first-line diagnosis of endometrial biopsy.

Downloads

Download data is not yet available.

References

1. Munro MG. Practical aspects of the two FIGO systems for management of abnormal uterine bleeding in the reproductive years. Best Pract Res Clin Obstet Gynaecol. 2017 Apr 1; 40:3-22. https://pubmed.ncbi.nlm.nih.gov/27836285/

2. Ely JW, Kennedy CM, Clark EC, Bowdler NC. Abnormal uterine bleeding: a management algorithm. J Am Board Fam Med. 2006 Nov 1;19(6):590-602.

3. Sarbhai V, Singla T. Histo-pathological study of endometrium by Pipelle sampling device versus Hysteroscopy guided biopsy in women with Abnormal Uterine Bleeding. Int J Clin Obstet Gynecol. 2019;3(6):92-5. https://www.gynaecologyjournal.com/archives/2019/vol3issue6/b/3-5-54

4. Dimitriu G, Abdelazim IA, Svetlana S, Zhurabekova G, Alrbeihat RS, Taso OA. Saline infusion sonography compared to hysteroscopy for uterine cavity evaluation in abnormal uterine bleeding. J Obstet Gynecol Investig. 2018;1(1):35–40. https://doi.org/10.5114/jogi.2018.77765/

5. Kuhn TM, Dhanani S, Ahmad S. An overview of endometrial cancer with novel therapeutic strategies. Curr Oncol. 2023 Aug 27;30(9):7904-19.

6. Committee on Practice Bulletins—Gynecology. Practice bulletin no. 128: diagnosis of abnormal uterine bleeding in reproductive-aged women. Obstet Gynecol. 2012 Jul;120(1):197-206. doi: 10.1097/AOG.0b013e318262e320/

7. Terzic MM, Aimagambetova G, Terzic S, Norton M, Bapayeva G, Garzon S. Current role of Pipelle endometrial sampling in early diagnosis of endometrial cancer. Transl Cancer Res. 2020 Dec;9(12):7716.

8. Kotdawala P, Kotdawala S, Nagar N. Evaluation of endometrium in peri-menopausal abnormal uterine bleeding. J Midlife Health. 2013 Jan 1;4(1):16-21.

9. Inal ZO, Inal HA, Kucukosmanoglu I, Kucukkendirci H. Assessment of endometrial sampling and histopathological results: analysis of 4,247 cases. Eurasian J Med. 2017 Feb;49(1):44. https://pubmed.ncbi.nlm.nih.gov/28416932/

10. Narice BF, Delaney B, Dickson JM. Endometrial sampling in low-risk patients with abnormal uterine bleeding: a systematic review and meta-synthesis. BMC Fam Pract. 2018 Dec; 19:1-3.

11. Ilavarasi CR, Jyothi GS, Alva NK. Study of the efficacy of pipelle biopsy technique to diagnose endometrial diseases in abnormal uterine bleeding. J Midlife Health. 2019 Apr 1;10(2):75-80.

12. Clark TJ, Mann CH, Shah N, Khan KS, Song F, Gupta JK. Accuracy of outpatient endometrial biopsy in the diagnosis of endometrial cancer: a systematic quantitative review. Int J Obst Gynecol. 2002 Mar 1;109(3):313-21. https://www.ncbi.nlm.nih.gov/books/nbk69498/

13. Kolhe S. Management of abnormal uterine bleeding–focus on ambulatory hysteroscopy. Int J Women's Health. 2018 Mar 22:127-36. https://www.tandfonline.com/action/journalinformationjournalcode=djwh20/

14. Liu H, Wang FL, Zhao YM, Yao YQ, Li YL. Comparison of Pipelle sampler with conventional dilatation and curettage (D&C) for Chinese endometrial biopsy. J Obstet Gynaecol. 2015 Jul 4;35(5):508-11.

15. Sanam M, Majid MM. Comparison the diagnostic value of dilatation and curettage versus endometrial biopsy by pipelle-a clinical trial. Asian Pac J Cancer Prev. 2015;16(12):4971-5.

16. Abdelazim IA, Aboelezz A, AbdulKareem AF. Pipelle endometrial sampling versus conventional dilatation & curettage in patients with abnormal uterine bleeding. J Turk Ger Gynecol Assoc. 2013;14(1):1.

17. Aimagambetova G, Kaiyrlykyzy A, Bapayeva G, Ukybassova T, Kenbayeva K, Ibrayimov B, et al. Validation of Pipelle endometrial biopsy in patients with abnormal uterine bleeding in Kazakhstani healthcare setting. Clin Exp Obstet Gynecol . https://www.imrpress.com/journal/ceog/48/3/10.31083/j.ceog.2021.03.2510/htm/

18. Tanko NM, Linkov F, Bapayeva G, Ukybassova T, Kaiyrlykyzy A, Aimagambetova G, et al. Pipelle endometrial biopsy for abnormal uterine bleeding in daily clinical practice: why the approach to patients should be personalized J Pers Med. 2021 Sep 28;11(10):970.

19. Kaur H, Gupta R, Patel E, Mukherjee P. Pipelle endometrial sampling vs dilatation and curettage in abnormal uterine bleeding. Indian J Obstet Gynecol Res. 2020 Dec 28;7(4):470–5.

20. Piatek S, Warzecha D, Kisielewski F, Szymusik I, Panek G, Wielgos M. Pipelle biopsy and dilatation and curettage in clinical practice: are factors affecting their effectiveness the same J Obstet Gynaecol Res. 2019 Mar;45(3):645-51.

21. Balaram MS, Shinde RR, Babu CS, Mubasher HM, Shinde RV. Role of pipelle versus dilatation and curettage in tissue diagnosis abnormal uterine bleeding. Int J Res Med Sci. 2020 Aug 26;8(9):3223.

22. Aue-Aungkul A, Kleebkaow P, Kietpeerakool C. Incidence and risk factors for insufficient endometrial tissue from endometrial sampling. Int J Women's Health. 2018 Aug 15:453-7.

23. Dijkhuizen FP, Mol BW, Brölmann HA, Heintz AP. The accuracy of endometrial sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia: a meta?analysis. Cancer. 2000 Oct 15;89(8):1765-72.

24. Rezk M, Sayyed T, Dawood R. The Effectiveness and Acceptability of Pipelle Endometrial Sampling versus Classical Dilatation and Curettage: A Three-Year Observational Study. Gynecol Obstet Invest. 2016;81(6):537-542. doi: 10.1159/000444711. Epub 2016 Mar 1.