OC109: Ultrasound examination of the endometrium before and after Pipelle® endometrial sampling: a preliminary prospective series

Abstract

To evaluate if—and to what extent—Pipelle endometrial sampling influences the ultrasound examination of the endometrium. Prospective descriptive study on 43 consecutive women in whom a Pipelle endometrial biopsy was indicated because of abnormal uterine bleeding. All patients underwent first a transvaginal ultrasound evaluation of the uterus. The endometrial thickness (ET) was measured and the endometrial sonographic aspect was recorded. Thereafter a Pipelle endometrial biopsy was taken. Finally the ultrasound examination was repeated. The patients' characteristics, the sampling procedure and histology, and the sonographical findings before and after Pipelle biopsy were compared. Forty-three women of whom 18 postmenopausal entered the study. Mean age was 58.8 years (SD 9.3) for the menopausal women, and 40.6 years (SD 8.4) for the others. The Pipelle sampler was introduced 2.4 (SD 1.6) times in average (range 1–7). On histology endometrial cancer was diagnosed in 2 patients, atypical hyperplasia in 1, and simple endometrial hyperplasia in 2. The average ET before Pipelle sampling was 8.7 mm (SD 7.2) versus 8.5 mm (SD 7.9) after biopsy. In 14% of patients ET fell under the 5 mm threshold after Pipelle. After Pipelle sampling, the endometrium was less clearly delineated in 5 cases and the 3-layer type of the endometrium was lost in 5 women (12%). In 42% of patients echogenic endometrial spots appeared after Pipelle (in one case spots disappeared after sampling). In 9% the intracavity fluid disappeared after sampling, whereas in 21% of patients some fluid was seen in the uterine cavity after biopsy. Overall ET measurements were slightly affected by Pipelle sampling and the quality of the ultrasound features tends to be altered by biopsy. Performing the ultrasound examination before proceeding with endometrial sampling may therefore improve diagnostic accuracy of ultrasound.