OUTPATIENT ENDOMETRIAL BIOPSY WITH PIPELLE Vs DIAGNOSTIC DILATATION AND CURETTAGE

Authors

  • Raazia Rauf
  • Asma Shaheen
  • Shamsunisa Sadia
  • Faressa Waqar
  • Shamsa Zafar
  • Saadia Sultana
  • Shumaila Waseem

Abstract

Background: Pipelle is a silastic curette which does not require a tenaculum or straightening of the cervical fundus axis because of its flexibility and does not require general anaesthesia. whereas Dilatation and curettage (D&C) requires hospitalization and general anaesthesia along with the problem of postoperative pain. The objective of the study was to assess the effectiveness of Pipelle sampling in terms of adequate specimen collection and patients' knowledge and perception about Pipelle and compare it D&C. Methods: In this randomized control trial, 203 women presenting with abnormal uterine bleeding were enrolled. The patients were randomly assigned to one of the two procedures. In group A 102 patients were subjected to Pipelle endometrial sampling and in group B 101 patients were enrolled for D&C. Frequencies of adequacy of histopathology reports and cost effectiveness of both groups were compared. Patient's knowledge, perception, pain and acceptability of the procedure of both groups were also assessed and compared. Results: The mean age of the patients was 46.3±4.45 years. Tissue obtained for histopathology was 100% adequate when the procedure was D&C while it was 98% in Pipelle group. In group-A 92% patients experienced no discomfort, with only 2% experiencing severe pain and 6% mild pain. On the other hand in group-B, 45% patients experienced moderate and 5% experienced severe pain up to 9 on visual analogue scale (VAS) postoperatively and requiring post-operative analgesia. The acceptability for the Pipelle suction curette was 98% and for the D&C group was 34%. Regarding previous knowledge of procedure none of patients (100%) knew about Pipelle procedure but 98% patients were aware of D&C procedure. Pipelle was eight times more cost effective as compared to D&C. Conclusions: The results of obtained by endometrial sample by Pipelle and D&C are compareable. Pipelle significantly produced less pain than D&C.

Keywords: Pipelle, suction curette, dilatation and curettage, pre-menopause, visual analogue scale

References

Spence CP, Whitehead MI. Endometrial assessment revisited. Br J Obstet Gynaecol 1999;106:623-32.

Gorman TO, Hollingworth T. Postmenopausal bleeding. In: Dunlop W, Ledger WL, editors. Recent Advances in Obstetrics and Gynaecology. 24th ed. UK: Royal Society of Medicine Press Ltd; 2008.p. 245-58.

Behnamfar F, Khamehchian T, Mazoochi T, Fahiminejad T. Diagnostic value of endometrial sampling with Pipelle suction curettage for identifying endometrial lesions in patients with abnormal uterine bleeding. J Res Med Sci 2004;3:123-5

Berek JS, Hacker NF, editors. Practical Gynacologic Oncology. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2000.

Fakhar S, Saeed G, Khan AH, Alam AY. Validity of Pipelle endometrial sampling in patients with abnormal uterine bleeding. Ann Saudi Med 2008;28:188-91.

Seamark CJ. Endometrial sampling in general practice. Br J Gen Pract 1998;48:1597-8.

Check JH, Chase JS, Nowroozi K, Wu CH, Chern R. Clinical evaluation of Pipelle endometrial suction curette for timed endometrial biopsies. J of Reproductive Medicine 1989;34:218-20.

Rock JA, Howard W. Jones HW 3rd, editors. Te Linde's Operative Gynaecology. 9th ed. Philadelphia, Pa : Lippincott Williams & Wilkins; 2003.

Guido RS, Stovall DW. Endometrial sampling procedure up to date (online serial). In: Wathan MA. Up to date; 2008.

Choudry A, Javaid M. Clinical usefulness of Pipelle endometrial sampling. Pak Armed Forces Med J 2005;55:122-5.

Bakour SH, Khan KS, Gupta JK. Transvaginal Ultrasonography and Endometrial histology in peri and post-menopausal women on hormonal replacement therapy (letter). Br J Obstet Gynaecol 2000;107:295.

Dijkhuizen FP, Mol BW, Brolmann HA, Heintz AP. The Accuracy of Endometrial Sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia: a meta-analysis. Cancer 2000;89:1765-72.

Clark TJ, Mann CH, Shah N, Khan KS, Song F, Gupta JK. Accuracy of outpatient endometrial biopsy in the diagnosis of endometrial carcinoma: a systemic quantitative review. Br J Obstet Gynecol 2002;109:313-21.

Machado F, Moreno J, Carazo M, Leon J, Fiol G, Serna R. Accuracy of Endometrial biopsy with the Cornier Pipelle for diagnosis of endometrial carcinoma and Atypical hyperplasia. Eur J Gynaecol Oncol 2003;24:279-81.

Clark TJ, Mann CH, Shah N, Khan KS, Song F, Gupta JK. Accuracy of outpatient endometrial biopsy in the diagnosis of endometrial hyperplasia. Acta Obstet Gynecol Scand 2001;80:784-93.

Schneider J, Centena MM, Austin J. Use of Cornier pipelle as the only mean of pre surgical histologic diagnosis in endometrial carcinoma: agreement between initial and final histology. Eur J Gynaecol Oncol 2000;21:74-5.

Critchley HO, Warner P, Lee AJ, Brechin S, Guise J, Graham B. Evaluation of Abnormal uterine bleeding .comparison of three outpatient procedure with in cohorts defined by age and menopausal status. Health Technol Assess 2004;8(34):iii-iv, 1-139

Downloads

Published

2014-06-01

How to Cite

Rauf, R., Shaheen, A., Sadia, S., Waqar, F., Zafar, S., Sultana, S., & Waseem, S. (2014). OUTPATIENT ENDOMETRIAL BIOPSY WITH PIPELLE Vs DIAGNOSTIC DILATATION AND CURETTAGE. Journal of Ayub Medical College Abbottabad, 26(2), 145–148. Retrieved from https://jamc.ayubmed.edu.pk/index.php/jamc/article/view/1538

Issue

Vol. 26 No. 2 (2014): JOURNAL OF AYUB MEDICAL COLLEGE, ABBOTTABAD

Section

ORIGINAL ARTICLE

License

Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License  CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.

USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.

AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.