Alka Murlidhar Patankar1 , Sushma Suresh Nitnaware 2
BACKGROUND Abnormal Uterine Bleeding (AUB) is a common presenting complaint in peri- and post-menopausal women. In these cases, dilatation and curettage (D&C) is the gold standard for assessing Endometrial abnormalities. However, D&C is Gold Standard, requires anaesthesia and hospitalization, and is frequently associated with complications. Thus, a non-invasive, outpatient procedure such as Pipelle biopsy is preferred. We wanted to compare histopathological findings of Pipelle endometrial biopsy with that of D&C, in cases of AUB. METHODS This was a prospective, observational, and comparative study performed over a period of 18 months. This study involved 125 cases of AUB and transabdominal ultrasonography was performed. Endometrial samples were obtained in each patient, initially by OPD based Pipelle biopsy followed by operation theatre-based D&C method. Each sample was then subjected to histopathological examination (HPE) for thorough and independent microscopic examination for comparative analysis. Finally, sample adequacy, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of both the methods were estimated and compared. RESULTS The mean age of the patients was 48.68 ± 6.62 years. Majority of the women were multiparous (98.4%), had heavy uterine bleeding (65.6%) as the presenting complaint, and had ultrasonographically normal uterus (47.2%). The sample adequacy rate was 96.8% from Pipelle biopsy and 96% with D&C method. The most common findings on HPE were proliferative and secretory endometrium, and simple hyperplasia with / without atypia. The sensitivity, specificity, NPV, PPV, and accuracy of Pipelle biopsy to diagnose endometrial adenocarcinoma was 100%. CONCLUSIONS Endometrial biopsy with Pipelle is easy, safe, painless, and OPD based procedure for obtaining adequate sample for HPE. It has high sensitivity and specificity for diagnosing endometrial pathologies and endometrial carcinoma.
