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 <0.001which is statistically very highly significant. In this study, comparing Pipelle with D&C, the Pipelle device had 100% sensitivity, 97.4 specificity, PPV 71.4%, NPV 100%, 97.5% accurate for proliferative endometrium. The sensitivity, specificity, PPV, NPV, Accuracy rate were 100% in endometrial CA and hormone progesterone effect. The sensitivity is 80% in simple hyperplasia without atypia and 57.1% in disordered proliferative endometrium and in endometrial polyp the sensitivity was 42.9%. The calculated P value is <0.001 which is statistically significant. No adverse effects were noted in both Pipelle and D&C procedures.
Conclusion: Endometrial sampling using Pipelle device is an easy and safe method of getting tissue diagnosis, which can be done as an outpatient procedure. Pipelle is cost effective and has better patient compliance in addition to the added advantage of no anesthesia or other procedure complications like perforation compared to D&C.