A Comparative Evaluation of the Three Different Methods of Endometrial Sampling in the Diagnosis of Perimenopausal Bleeding

Abstract

Background: The aim of the study was to compare the efficacy of three different methods of endometrial sampling (endometrial cytology using nasogastric tube no. 10, endometrial aspiration biopsy using pipelle, and traditional dilatation and curettage) in diagnosis of perimenopausal bleeding. Methods: This study was conducted on patients with perimenopausal bleeding in the Department of Obstetrics and Gynaecology at R.L. Jalappa Hospital and Research Centre, Tamaka, Kolar, from January 2012 to June 2013. A total of 100 women with perimenopausal bleeding were evaluated using the three different methods of endometrial sampling. After detailed history, examination and relevant investigations, each patient was subjected firstly to endometrial aspiration cytology using nasogastric tube, followed by pipelle aspiration biopsy and lastly traditional dilatation and curettage. Samples collected were sent for cytohistopathological assessment and the results were compared with dilatation and curettage method of sampling. Results: Data were analyzed using Chi-squared test. There were 91 women with perimenopausal bleeding and nine women had post-menopausal bleeding. Endometrial aspiration cytology could detect benign endometrial pathologies in 44% and premalignant lesions in 19%. Pipelle biopsy detected benign pathologies in 49% and premalignant pathology in 45%. Dilatation and curettage detected benign pathology in 50% and premalignant lesions in 44%. About 37% of endometrial samples by aspiration cytology were found to be inadequate in comparison to 4% of endometrial samples by both pipelle biopsy and dilatation and curettage methods. The sensitivity, specificity and diagnostic accuracy of endometrial aspiration cytology were 29.09%, 87.04% and 59% (P = 0.095) respectively. Pipelle biopsy had 100% sensitivity and 98.15% specificity with diagnostic accuracy of 99% (P < 0.001). Conclusion: Pipelle biopsy and dilatation and curettage showed almost equal success rate in the diagnosis of endometrial pathologies. Pipelle biopsy preserves stromal architecture better and takes shorter time compared to dilatation and curettage. Hence, it can be used as an initial screening procedure. J Clin Gynecol Obstet. 2014;3(4):133-137 doi: http://dx.doi.org/10.14740/jcgo271w