A Comparison of Pipelle Endometrial Biopsy with Dilatation and Curettage for Evaluation of Endometrial Pathology in Abnormal Uterine Bleeding

Author(s): Sunitha Mary Mathew1

BACKGROUND Histopathological assessment of endometrium is recommended in cases of AUB to rule out premalignant conditions and malignancy. Endometrial sampling can be done by Pipelle biopsy in outpatient units as well as by conventional Dilatation and Curettage in an operation theatre setup. Our study aims to compare the efficacy of office endometrial biopsy with D and C in terms of its sample adequacy and diagnostic accuracy METHODS This prospective study was conducted in a tertiary care centre over a period of 2 year follow up. 150 women presenting with abnormal uterine bleeding were included. A detailed history along with clinical examination findings and ultrasound report showing pelvic pathology and endometrial thickness were entered in the proforma. They were then randomly allotted into 2 groups, group A (n=75) had D and C under anaesthesia and group B (n=75) underwent Pipelle endometrial sampling. Histopathology reports are collected and sample adequacy and histopathology pattern were analysed. Patients are subsequently followed up for a period up to two years. Those who underwent subsequent hysterectomy are analysed for the endometrial pathology in hysterectomy specimen which is used as gold standard to compare endometrial pathology. RESULTS Sample accuracy for D and C is 93% and for Pipelle biopsy it was 92%. Inadequate specimens by both methods were mostly focal lesions. Diagnostic accuracy for atypical hyperplasia and adenocarcinoma by D and C is 97.6% and by Pipelle biopsy is 95.7%. CONCLUSIONS Thus, focal lesions can be missed by Pipelle endometrial biopsy as well as by D and C. 33.3% of atypical hyperplasia diagnosed by both D and C and Pipelle biopsy had coexisting adenocarcinoma in hysterectomy specimen. Pipelle biopsy is a cost effective method for endometrial sampling when compared with D and C.