Evaluation of Diagnostic Efficacy of Pipelle Endometrial Sampling in Abnormal Uterine Bleeding EC01-EC04
Dr. Abilash Sasidharannair Chandrakumari,
Associate Professor, Department of Pathology, Shri Sathya Sai Medical College and Research Institute,
Ammapettai, Nellikuppam-603108, Tamil Nadu, India.
Introduction: Abnormal Uterine Bleeding (AUB) is a major clinical problem among women in peri and postmenopausal age groups which needs complete scrutiny. Various methods are in vogue for the assessment of endometrium. Histopathological interpretation of endometrial tissue is the gold standard investigation. Studies have raised concern about diagnostic accuracy and adequacy of pipelle endometrial sample.
Aim: To compare the efficacy of pipelle endometrial sampling method with conventional Dilatation (D) and Curettage (C) in diagnosis of AUB.
Materials and Methods: This comparative cross-sectional study was carried out at DM Wayanad Institute of Medical Science, Kerala, India (January 2016 to June 2017). Endometrial samples collected from 210 patients with AUB initially by pipelle method followed by D and C formed the material for this study. Slides were prepared after routine histopathological processing and sectioning. Staining was done using Haematoxylin and Eosin (H&E) stains and the slides were subjected to thorough and independent microscopic examination for comparative analysis. Data analysis was performed using IBM SPSS Software version 21.0.
Results: Histopathological examination of endometrial samplings by pipelle method revealed endometrial carcinoma in seven cases, atypical endometrial hyperplasia in seven cases, endometrial hyperplasia in 85 cases and disordered proliferative endometrium in 30 cases. These were correlated with histopathological findings of conventional D and C sampling method which showed pipelle sampling method had sensitivity and specificity in endometrial carcinoma (80% and 100% respectively), atypical endometrial hyperplasia (100% and 99.5% respectively), endometrial hyperplasia (100% and 93.98% respectively) and disordered proliferative endometrium (81.1% and 100% respectively). There was significant positive correlation (p<0.01) between the two techniques. Endometrial sampling by pipelle method had a high sensitivity and negative predictive value in diagnosing abnormal endometrium.
Conclusion: Endometrial sampling by pipelle method is a safer and simpler alternative for diagnosis of endometrial lesions in patients with AUB. It has a fair degree of diagnostic accuracy almost comparable to that of curettage material. The diagnostic accuracy is high if interpreted by an experienced pathologist.