Pipelle Endometrial Biopsy for Abnormal Uterine Bleeding in Daily Clinical Practice: Why the Approach to Patients Should Be Personalized?

Abstract

Background: Abnormal uterine bleeding (AUB) is a common gynecologic condition, and proper management is based on histological evaluation of adequate endometrial sample obtained by biopsy. Aims of this study were to evaluate factors influencing the reliability and success rate of Pipelle endometrial sampling for histopathological diagnosis. Methods: One hundred and eighty patients with AUB underwent endometrial sampling using both Pipelle and dilatation and curettage (D & C) procedure at the Clinical Academic Department of Women’s Health, University Medical Center between January 2019 and April 2021. We analyzed the effects of age, menopausal status, ethnicity, body mass index (BMI), provider experience, and procedure indication on success and reliability of each procedure. Findings: Pipelle sampling was successful in 144 (80.56%) women, while D & C was successful in 164 (91.11%) of women. Fisher’s exact test analysis showed that age, menopausal status and biopsy indication were factors affecting the success rate of both methods, while ethnicity, BMI and physician’s experience had no influence. Overall concordance in histopathological results between Pipelle and D & C was 91.72%. Interpretation: Pipelle sampling was found reliable for detection of endometrial carcinoma and endometrial hyperplasia, while its reliability was low in cases of endometrial polyps. Funding Information: This study was supported by the Nazarbayev University Grant Number 110119FD4540, 2019-2021. Declaration of Interests: None declared. Ethics Approval Statement: The study protocol was approved by the Institutional Research Ethics Committee of the Nazarbayev University (NU IREC) and the University Medical Center (February 25, 2019, number: 109/11122018). Each study participant gave written informed consent.