European Journal of Cardiovascular Medicine

Introduction: Abnormal uterine bleeding is a routinely encountered gynecological problem, pointing out the magnitude of the disease. It is a major problem accounting for 33% of outpatient gynecological referrals1 and one of the leading indications of hysterectomy. This proportion rises to 70% in the perimenopausal and postmenopausal years. Several methods are utilized for assessing the endometrium, with histopathological interpretation of endometrial tissue being considered the gold standard investigation. However, studies have raised concerns regarding the diagnostic accuracy and adequacy of pipelle endometrial samples. Aim: To assess the diagnostic value of the pipelle endometrial sampling method against the conventional Dilatation and Curettage (D&C) procedure in diagnosing Abnormal Uterine Bleeding (AUB). Materials and Methods: A cross-sectional observational study was done at a teritiary hospital of Bangalore between January 2019 to January 2021. 70 cases of abnormal uterine bleeding attending the outpatient clinic in the department of Obstetrics and Gynecology were included in the study. The endometrial sample was obtained with Pipelle device followed by conventional D & C and sent for histopathology assessment. 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. Result: Pipelle had a high sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for diagnosing proliferative phase, disordered proliferative endometrium. It showed a sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of 100% in diagnosing secretory endometrium, hyperplasia, hyperplasia with atypia, endometritis, irregular ripening and endometrial carcinoma. The histopathology results obtained by D & C and pipelle sampling were comparable. No opinion could be inferred in 5 cases in pipelle group and 3 cases in D&C group due to inadequate sample. Conclusion: Pipelle is a simple, safe and yet very efficient tool for endometrial assessment. It is very convenient and less painful to the patients and a cost-effective sampling procedure. Endometrial tissue obtained by pipelle has shown high sensitivity and specificity in patients with abnormal uterine bleeding even for hyperplasia and malignancy. Thus, pipelle can be considered as a first line investigation for getting adequate endometrial sample in patients with abnormal uterine bleeding.