Pipelle Endometrial Sampling Research Articles

Pipelle Endometrial Sampling With a Full Bladder Compared With Standard Care: A Randomized Controlled Trial.

To compare insertion failure rates for Pipelle endometrial sampling with a full bladder compared with the standard process (not taking into account bladder status) without cervical manipulation. A single-masked randomized trial was conducted in a single tertiary care center from July 2021 to January 2022. Two hundred fourteen participants aged 18 years or older who were scheduled for outpatient Pipelle endometrial sampling were randomized: 107 each to having a full bladder (by oral water intake) or standard process (without delayed sampling and bladder status not taken into account). Women with known cervical stenosis, gynecologic malignancy, uterine anomalies, leiomyoma distorting the uterine cavity, acute cervicitis, urge bladder dysfunction, intense anxiety, need for anesthesia or analgesic before the procedure, positive pregnancy test, or previous failed office endometrial sampling were excluded. The primary outcome was the insertion failure rate of endometrial sampling at first attempt. Secondary outcomes were pain during procedure, satisfaction score, analgesia use, procedure duration, and need for cervical manipulation. Factoring in a baseline insertion failure rate of 30.0%, relative risk of 0.45, α of 0.05, 80.0% power, and a dropout rate of 10.0%, we needed 107 participants in each arm. The insertion failure rate was significantly lower in the full bladder group compared with standard process: 25 of 107 (23.4%) compared with 45 of 107 (42.1%) (relative risk 0.56, 95% CI, 0.37-0.84; number needed to treat to benefit 6.0, 95% CI, 3.20-15.70). Pain score (median) during the procedure (interquartile range) was 4 (3-6) compared with 5 (3-8) ( P =.004); patient satisfaction score was 8 (7-9) compared with 7 (4-8) ( P <.001); and mean±SD procedure duration was 3.0±2.4 compared with 4.7±2.9 minutes ( P <.001) for the full bladder and standard process arm, respectively. Other secondary outcomes of cervical laceration, analgesia use, and adequacy of endometrial tissue for histopathologic assessment were not significantly different between groups. Pipelle endometrial sampling with a full bladder reduces the initial insertion failure rate, procedure-related pain, and duration of sampling and increases patient satisfaction compared with the standard process. ISRCTN, ISRCTN33938192.

Pipelle Endometrial Sampling Versus Fractional Curettage for evaluating patient of Postmenopausal Bleeding: A Comparative Study

Pipelle Endometrial Sampling Versus Fractional Curettage for evaluating patient of Postmenopausal Bleeding: A Comparative Study

Effect of endometrial injury on pregnancy outcomes in infertile women undergoing intrauterine insemination.

One of the most common treatments for infertility is intrauterine insemination (II). The objective of this study was to determine the effect of endometrial injury on pregnancy outcomes in unexplained infertility in women undergoing II. In this randomized clinical trial, 122 women with unexplained infertility who were referred to Shariati Hospital from 2018 to 2020 were enrolled. They underwent ovulation induction using letrozole and gonadotropins. On day 9 of stimulation, they were randomly assigned to two similar groups of the same size. The first group underwent endometrial local injury by pipelle endometrial sampling, and the second group (control group) received no intervention. Only 1 II cycle was performed for each patient. Patients with negative pregnancy outcomes were followed up for 3 months. Endometrial thickness, dominant follicle count, chemical and clinical pregnancy rate, miscarriage rate, and spontaneous pregnancy rate after the II cycle were compared between the two groups. Endometrial thickness, dominant follicle count, chemical and clinical pregnancy rate, and miscarriage rate in the same II cycle were not different between the two groups (p>0.05). However, the spontaneous pregnancy rate after the II cycle was significantly higher in the endometrial injury group (p=0.02). Endometrial injury increases pregnancy rates in later cycles but not in the same II cycle.

Accuracy of Pipelle Endometrial Samplingin comparison to D&amp;C in women with abnormal uterine bleeding: A comparative analysis of all samples vsonly adequate samples by Pipelle

Background: The Pipelle endometrial sample biopsy (PESB) is considered the most convenient, non - invasive method for endometrial sampling. The abnormal uterine bleeding has many causes and consequences in women. The exact causes are described by histology of sample through D&amp;C. The accuracy of PESB is under observation in different settings and a lot of work is further required. Aim: To see the accuracy of PESBin comparison to D&amp;C for morphological findings among women with abnormal uterine bleeding. Study design: Cross--sectional analytical study. Place and duration of study: Gyne OPD &amp; Histopathology Departments, Shaikh Zayed Hospital, Lahore during 1st May 2019 to 8th December 2019. Methodology: Two hundred and thirty five adult women with AUB recommended for D&amp;C and with Pipelle endometrial sample were included. Those with endometrial thickness less than 4mm, having fibroids, with pelvic inflammatory disease, or clotting factor disorders were excluded. Pipelle endometrial sample was taken in GyneOPD and were examined at Histopathology Department. Data were managed through SPSS-20. Results: 80.0% had adequate Pipelle samples and Pipelle inadequate as negative were considered for comparison the accuracy of Pipelle for proliferative endometrium and secretory endometrium were lower (90.6% vs 100.0%) and (93.6% vs 100.0%) as compared to only 188 adequate samples considered; by considering D&amp;C as gold standard. Accuracies for Hyperplasia, and chronic endomitritis were little higher for all cases and for carcinoma the accuracy was 100.0% in either case. Conclusion: Pipelle endometrial sampling can be considered an effective method for endometrial sampling with an accuracy of more than 90.0% for each of the endometrial morphology. Keywords: Abnormal uterine bleeding, Pipelle endometrial biopsy, Diagnostic accuracy

Validity of Pipelle Endometrial Sampling in Patients with Abnormal Uterine Bleeding: an Analytical Cross-Sectional Study

Objective: The study's objectives were to evaluate the validity of the pipelle device in obtaining a suitable &amp; representative endometrial sample by contrasting the histopathological outcomes of pipelle sampling with those from dilatation and curettage (D&amp;C). Study design: An analytical cross-sectional study Place and Duration: This study was conducted at Liaquat University of Medical and Health Sciences Jamshoro from June 2021 to June 2022 Methodology: The study comprised 100 patients withabnormal uterine bleeding (AUB) who visited the obstetrics and gynecology department's outpatient clinic. Before a formal D&amp;C, endometrial samples were taken from 100 patients using a pipelle device. The sample marked as sample A was obtained by inserting the Pipelle without conducting cervical dilatation and rotating it inside the uterus. The patients were then brought into the operating room for D&amp;C, and the sample that was taken following D&amp;C was designated as sample B Results: Pipelle sampling exhibited a 97% sensitivity,and a 100% specificity when compared to D&amp;C sampling for obtaining an endometrial sample. With the exception of an endometrial polyp, which could not be detected by the pipelle sample, the Histopathology report’s diagnosis using the sample acquired from the pipelle showed very high sensitivity, specificity, positive predictive value, and negative predictive value. Conclusion: Pipelle endometrial biopsy is a risk-free method of obtaining an appropriate endometrial sample for histopathology. In terms of detecting endometrial abnormalities and endometrial cancer, it has high sensitivity and excellent specificity. An accurate diagnosis of endometrial cancer can be made using a Pipelle endometrial biopsy. Keywords: sampling, endometrial, abnormal uterine bleeding

ASSESSMENT OF ENDOMETRIUM USING TRANSVAGINAL SONOGRAPHIC ENDOMETRIAL THICKNESS AND ENDOMETRIAL BIOPSY IN PERIMENOPAUSAL ABNORMAL UTERINE BLEEDING

Background: Abnormal uterine bleeding (AUB) is a major gynecological problem in perimenopausal and postmenopausal age group.Aim:This study is intended to investigate the association between endometrial thickness in transvaginal sonography (TVS), the results of endometrial biopsy in perimenopausal women with AUB and to evaluate the combined use in diagnosis of endometrial lesions. Materials And Method: A retrospective study of 250 perimenopausal women with AUB were enrolled. Data was analyzed using SPSS V 22.0. Results: 160 samples were identified to be benign lesions, 85 were with Hyperplasia and 5 were Malignant. The mean endometrial thickness in subgroup benign were 6.57± 3.06 mm and Malignancy were 17.97±2.79mm. The sensitivity of endometrial biopsy to identify Hyperplasia with or without Atypia was 93.5% and carcinoma was 100%.Conclusion: The study infers that as the endometrial thickness rises the chances of getting abnormal endometrial histological finding increases. A cut-off point of 10.50mm for endometrial thickness using transvaginal ultrasound can predict the results of Pipelle endometrial sampling well

When Less Is More – Pipelle Endometrial Sampling for Quantification of Uterine Natural Killer Cells in Patients With Recurrent Implantation Failure or Habitual Abortion

Despite recent advancements in reproductive medicine, recurrent implantation failure and habitual abortion remain ongoing issues. One of the most important aspects of successful implantation is the intricate immune response and regulation necessary for the acceptance of the hemiallogenic embryo. The most numerous immune cells in the decidua are uterine natural killer cells (uNK). Studies suggest that changes in the uNK count and physiology may be responsible for the aforementioned pathological conditions. Thus, testing for uNK may provide valuable insights into their pathogenesis. The study compared Pipelle endometrial sampling with conventional curettage to find out whether the less invasive Pipelle method is a viable alternative of tissue collection. Tissue samples from 14 patients obtained by both methods were examined. The average size of tissue samples obtained with Pipelle was 17 mm2, samples obtained with curettage had on average 34 mm2. Using immunohistochemical visualization of CD56 (NK cells) and granzyme B antigens (serine protease-expressing activation state of NK cells), it was found that the average total count of CD56 / mm2 was for Pipelle 115 and 120 for curettage, respectively. The study also proved a correlation between granzyme B positivity and identification of NK cells clusters. The results indicated that Pipelle endometrial sampling seems a suitable method of tissue harvesting for the purpose of uNK cells examination. Pipelle endometrial sampling is safe, cost-effective and can be performed on an outpatient basis without the need of anesthesia or analgesia. Several issues remain yet to be solved: how to standardize the subsequent uNK testing, how to interpret the results and finally yet importantly, how to use this knowledge in personalized treatment protocols.

Uterine Natural Killer Cells in the Context of Implantation: Immunohistochemical Analysis of Endometrial Samples from Women with Habitual Abortion and Recurrent Implantation Failure

Infertility affects approximately 48 million couples globally. Despite the enormous progress of the methods of reproductive medicine that has been made since the first test-tube baby was born in 1978, the implantation rate of day-3 embryos is only around 15-20 % and 30 % of day-5 embryos. Numerous strategies aim to improve implantation rates and prevent repeated implantation failure, however there is no specific general recommendation leading to satisfying results. One of the many risk factors relevant in this regard is the uterine immunological make-up, mainly the uterine Natural Killer (uNK) cells. They orchestrate the overall immune response during implantation by influencing trophoblast invasion and vascular remodeling and throughout pregnancy, uNK cells are also the main immune cells at the maternal-foetal interface. Previously, uNK count has been correlated with various fertility issues including idiopathic reccurent miscarriage. The present study used endometrial samples collected from 256 patients with recurrent implantation failure (RIF), habitual abortion (HA) and idiopathic sterility. Samples were collected between day 19 and 21 of the menstrual cycle mainly by Pipelle endometrial sampling. The samples were fixed in formalin for 24 hours and further processed for immunohistochemistry using anti-CD56 to visualize this antigen marker of uNK cells. Immunohistochemical counting was performed to assess the low, normal, or elevated count of uNK cells. According to the one-way ANOVA test, the age of our patients did not have any influence on the count of uNK cells. With Spearman correlation analysis, we found statistically significant correlation (p-value 0.05) of -0.133 between prior miscarriage and lower uNK cell count. Using the same analysis we found statistically significant correlation (correlation 0.233 with p-value 0.01) between number of uNK cells and activation status. Patients with higher uNK cells were more frequenty diagnosed with endometriosis (p-value 0.05, correlation 0.130). Patients with an immunological factor of sterility (defined by a clinical immunologist) had a lower chance of gravidity (-0.203 with p-value 0.01). Based on our results, we can confirm that there is a correlation between RIF, HA, idiopathic sterility, endometriosis, and immunological factor of sterility (uNK cell count). The true predictive value with regard to fertility outcomes needs to be addressed in future research.

Pipelle Endometrial Sampling and Morphological Findings in Women with Abnormal Uterine Bleeding

Background: The abnormal uterine bleeding has many causes and consequences in women. The exact causes are described by histology of sample through D&amp;C. Pipple biopsy samples is considered one of the least invasive, OPD setting technique, comparable to D&amp;C. Objective: To see the adequacy of Pipelle endometrial sampling and morphological findings among women with abnormal uterine bleeding. Study Design: Cross-sectional descriptive study Place and Duration of Study: Department of Gynaecology &amp; Histopathology, Shaikh Zayed Hospital Lahore from 1st May to 31st December 2021. Methodology: Two hundred and thirty seven adult women with AUB recommended for D&amp;C were included. Those with endometrial thickness less than 4mm, having fibroids, with pelvic inflammatory disease, or clotting factor disorders were excluded. Pipelle endometrial sample was taken in Gyne OPD and were examined at Histopathology Department. Results: 80.0% were sampled adequately through Pipelle. Secondary endometrium was most common in 39.9% followed by proliferative endometrium in 36.2% and chronic endometritis 12.2%. There were 6 cases with carcinoma, 4 (2.1%) with adenocarcinoma and 2(1.1%) squamous cell carcinoma. Conclusion: Pipelle Endometrial sampling can be considered an effective methods for endometrial sampling. Keywords: Abnormal uterine bleeding, Pipelle endometrial biopsy, Sample adequacy, Endometrial pathology

Immunologically active cells and infertility ‐ Quantification of uterine Natural Killer cells in endometrial samples from patients with recurrent implantation failure

BackgroundDespite enormous advancements of reproductive medicine, recurrent implantation failure and habitual abortion remain an ongoing issue. One of the most important aspects of successful implantation is the intricate immune regulation necessary for the acceptance of the hemiallogenic embryo. The most numerous immune cells in the decidua are uterine Natural Killer (uNK) cells. Studies suggest that changes in the uNK cells count and physiology may be responsible for the aforementioned conditions. Thus, the uNK cells testing may provide valuable insights into their pathogenesis.MethodsWe compared Pipelle endometrial sampling with conventional curettage to find out whether the less invasive Pipelle method is a viable alternative of tissue collection.ResultsWe examined tissue samples from 9 patients obtained by both methods. The average size of tissue samples obtained with pipelle was 10,27 mm2, samples obtained with curettage had on average 18,74 mm2. Using immunohistochemical visualization of CD56 (NK cells) and granzyme B antigens (serine protease‐expressing activation state of NK cells), we found out that the average total count of CD56 / mm2 was for pipelle 90,13 and 84,04 for curettage. We also proved a correlation between granzyme B positivity and identification of NK cells clusters. The results showed that Pipelle endometrial sampling is a suitable method of tissue harvesting for the purpose of uNK cells examination. Discussion: Pipelle endometrial sampling is safe, cost‐effective and can be performed on an outpatient basis without the need of anaesthesia or analgesia. Several issues remain to be solved: how to standardize the subsequent uNK cells testing, how to interpret the results and finally yet importantly, how to use this knowledge in personalized treatment protocols.

Pipelle Endometrial Sampling Versus Conventional Dilatation &amp; Curettage in Patients With Abnormal Uterine Bleeding

Aim: To assess the efficacy of endometrial sampling using Pipelle compared with Conventional dilatation &amp; curettage in women with bleeding from the uterus that is heavier/longer than usual or that occurs at an irregular time. Place and duration of study: Department of Obs &amp; Gynae, Aviceena Medical College/Hospital from June 2020 to June 2021. Methodology: This comparative study was carried out in 57 women with abnormal uterine bleeding. Endometrial sampling was done by Pipelle without cervical dilatation followed by dilatation &amp; curettage. Histopathology results were compared. Histopathological evaluation of the samples obtained by Dilatation &amp; curettage was considered gold standard. Results: All endometrial tissue samples (100%) collected by dilatation &amp; curettage while 98% obtained by the Pipelle sampler were acceptable for histopathology. Histopathological investigation of 57 samples acquired through dilatation &amp; curettage confirmed proliferative and Secretory changes, Endometrial Hyperplasia, Endometritis in 15,13, 19, and 4 subjects while Endometrial Polyps and Malignant change in 2 and 4 specimens respectively. Conclusion: Pipelle endometrial sampling is an efficient outpatient procedure thus avoiding hazards of general anesthesia with a great precision for evaluating benign and malignant endometrial pathology. Keywords: Abnormal Uterine Bleeding , Endometrial biopsy, Dilatation &amp; curettage, Pipelle sampler

A Randomized Comparative Study to Compare Karman's Cannula and Pipelle Biopsy for Evaluation of Abnormal Uterine Bleeding.

Objectives:This study aimed to compare the diagnostic accuracy, inadequate sampling, pain during the procedure (Visual Analog Scale [VAS] score), and ease of insertion of the Karman's cannula and Pipelle biopsy for patients with abnormal uterine bleeding (AUB).Methods:This prospective observational randomized comparative study included women of age more than 40 years with complaints of AUB. Two hundred and fifty women were randomly divided into two groups: (1) Group A (n = 125) who underwent endometrial aspiration using Karman's cannula and (2) Group B (n = 125) who underwent Pipelle endometrial sampling. Both the groups were followed by conventional dilation and curettage (D and C) which was considered the gold standard. Sensitivity, specificity, positive predictive value, and negative predictive value for differentiating benign and malignant conditions of endometrium were calculated.Results:Group B had a sensitivity of 89.29% followed by Group A (86.36%); on the other hand, Group A had a specificity of 96.08% followed by Group B (95.74%) (P > 0.05). Inadequacy was comparable among the two groups with 1 inadequate in Group A and 3 inadequate in Group B. Mean VAS score was significantly lesser in Group A than Group B (4.5 ± 2 vs. 5.8 ± 2.1, P < 0.0001). Ease of insertion was similar in Groups A and B (P = 0.345).Conclusion:Both procedures were equivalent in diagnostic accuracy, inadequacy, and ease of insertion. However, the use of Karman cannula resulted in less pain and is a much cheaper option in comparison to Pipelle. Overall, either procedure can be performed on an outpatient basis without cervical dilation and anesthesia and thus may be routinely used for women presenting with AUB.

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

Background. Abnormal uterine bleeding (AUB) is a common gynecologic condition, and proper management is based on the histological evaluation of an adequate endometrial sample obtained via biopsy. The 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) procedures 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 the success and reliability of each procedure. Results. Pipelle sampling was successful in 144 (80.56%) women, while D&C was successful in 164 (91.11%) women. Analysis using Fisher’s exact test showed that age, menopausal status, and biopsy indication were factors affecting the success rate of both methods, while ethnicity, BMI, and physician experience had no influence. Overall concordance in the histopathological results between Pipelle and D&C was 91.72%. Conclusion. Pipelle sampling was found to be reliable for the detection of endometrial carcinoma and endometrial hyperplasia, while its reliability was low in cases of endometrial polyps. The endometrial sampling approach should be personalized in daily clinical practice for women with AUB, and Pipelle sampling is not suitable for all patients. If an endometrial polyp is suspected, the physician should consider other diagnostic tools, bearing in mind all of the factors influencing endometrial sampling success and reliability rates.

Pipelle endometrial sampling success rates in Kazakhstani settings: results from a prospective cohort analysis

The aim of this study was to evaluate the feasibility of Pipelle endometrial sampling and to explore factors influencing Pipelle success rate in the clinical settings of Kazakhstan. This prospective analysis included 87 patients who had undergone Pipelle biopsy due to medical indications for endometrial sampling. We analysed physician and patient-related factors potentially influencing the success rate of this method. Pipelle endometrial biopsy overall success rate was 82.76%. The indications for the procedure and patients’ age were key factors influencing Pipelle sampling success (p < .001). The success rate was the highest in the group with abnormal uterine bleeding as a biopsy indication in the reproductive age group (93.19%; p < .001). Pipelle biopsy was found to be an acceptable option for endometrial sampling in our clinical setting; at the same time, physicians should consider the potential influencing factors on its success rate like indications for the procedure, BMI and patients’ age as well as their menopausal status. In order to provide precise future directions, there is a need to study a larger number of patients. IMPACT STATEMENT What is already known on this subject? Compared to dilation and curettage sampling conducted in the operation room, Pipelle endometrial sampling is relatively inexpensive, associated with less morbidity, safe, accurate, and can be performed in an office setting. What do the results of this study add? This is the first prospective data analysis about Pipelle endometrial sampling in Kazakhstani population. What are the implications of these findings for clinical practice and/or further research? Enabling the timely diagnosis of current endometrial pathology, Pipelle endometrial sampling approach may have an important impact on healthcare safety and efficiency, and improve overall treatment outcomes and the quality of life of Kazakhstani population if used consistently.

Efficacy of pipelle endometrial sampling in diagnosing endometrial pathologies in postmenopausal women with asymptomatic thick endometrium in comparison to fractional curettage

Objective: To evaluate the efficacy of pipelle endometrial sampling (PES) in diagnosing endometrial pathologies in patients with asymptomatic thick endometrium compared to fractional curettage (FC). Methods: A prospective, comparative, observational study was conducted, involving 100 postmenopausal women with asymptomatic thickened endometrium. Demographic characteristics, clinical features, and transvaginal ultrasound measurements were recorded. PES was performed as an outpatient procedure, followed by confirmatory FC under general anesthesia. Histopathological examination was conducted for both PES and FC samples. Diagnostic accuracy, pain scores, and association with endometrial hyperplasia and carcinoma were assessed. Results: The mean age of the participants was 56.7±2.8 years, with a mean body mass index of 29.6±3.6 kg/m2. The mean endometrial thickness was 14.3±2.9 mm. PES yielded 73 (73%) adequate samples, while FC yielded 87 (87%) adequate samples. Pain scores were significantly lower for PES compared to FC (3.23±1.23 vs. 6.48±1.54, respectively, p &lt; 0.001). PES demonstrated a sensitivity rate of 81.25% and a specificity rate of 100% for endometrial hyperplasia, and a sensitivity rate of 60% and specificity rate of 100% for endometrial carcinoma. Conclusions: Pipelle endometrial sampling is an effective and well-tolerated method for diagnosing endometrial pathologies in postmenopausal women with asymptomatic thickened endometrium.

The Lipiodol Uterine Bathing Effect to Improve Fertility May Include Uterine Natural Killer Cell Up-regulation in the Endometrium

BACKGROUND: Lipiodol has a dramatic short term fertility enhancing effect for women with endometriosis. Microarray studies have shown transcriptomic regulation of molecular markers of endometrial inflammation, most notably a consistent down-regulation of endometrial osteopontin. We further explored the endometrial bathing effect of lipiodol on leukocyte expression in endometrium. METHODS: A cohort of four women, nested within a randomised trial of twelve women assessing the lipiodol uterine bathing effect, was studied as an ‘own control’ group, with their mid-luteal endometrium assessed before and after endometrial lipiodol exposure. Pipelle endometrial sampling allowed endometrial assessment by immunochemistry. Endometrial tissue samples were assessed by immunochemistry for total CD45+ leukocytes, CD68+ macrophages, CD3+ T-cells and CD56+ uterine natural killer cells. RESULTS: There was a statistically significant increase in the mean density of uterine natural killer cells in the endometrium of women post-lipiodol. No other significant differences were found in the mean densities of all leukocytes, macrophages or T cells in the endometrium of women post-lipiodol. CONCLUSIONS: These preliminary data further support the concept of a uterine bathing effect of lipiodol. Whether the increase in the mean density of uterine natural killer cells in the endometrium might contribute to an improvement in endometrial receptivity to embryo implantation merits further investigation.

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

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.

Assessing the Efficacy of Pipelle Sampling as Outpatient Diagnostic Test in a Tertiary Care Hospital-Rawalpindi, 2020

ABSTRACT&#x0D; Objective:&#x0D; To assess the effectiveness and enlist clinical factors, which may affect effectiveness of Pipelle sampling in diagnosing endometrial pathology in patients with abnormal uterine bleeding and Post-menopausal Bleeding.&#x0D; Study Design:&#x0D; ‘Analytical Cross-Sectional’ study.&#x0D; Place and duration:&#x0D; Gynecology Department at Combined Military Hospital Rawalpindi, in collaboration with Histo-Pathology Department, of six months duration i.e. from 1st December 2019 to 31st May 2020.&#x0D; Patients and methods:&#x0D; 100 female patients of outpatient department with presenting complaints of either abnormal or post-menopausal bleeding were included in the study in the specified time frame. After informed written consent, Pipelle endometrial sampling was done on outpatient basis, and by consecutive sampling technique using lottery method, sample was sent for histopathological evaluation. Evaluated factors studied were: indications for the procedure, age, parity, age of menarche.&#x0D; Results:&#x0D; Of the total patients evaluated, 91% (n=100) were non-malignant, while 4% (n=100) were malignant. Inadequate tissue was obtained in 5% samples. Most common histopathological findings among reproductive age group were Proliferative and Secretory phase endometrium 64% (n=100). While in Post-menopausal age group 4% (n=100) were Endometrial carcinoma on histopathology. Inadequate tissue samples 5% (n=100) were noted among the Post-menopausal group. 6% samples showed endometrial hyperplasia. Pipelle Endometrial Sampling had sensitivity and specificity, in diagnosing the endometrial pathologies is summarized in Table 3.&#x0D; Conclusion:&#x0D; Pipelle Endometrial Sampling is an effective, safe, simple and acceptable procedure for diagnosing endometrial pathology. It is cost effective requiring no anesthesia with high sensitivity and specificity for detecting endometrial pathology.&#x0D;

Pipelle Endometrial vs Hysteroscopic Endometrial Sampling in Abnormal Uterine Bleeding

Background: For Endometrial biopsy Pipelle sampling can be done as an office procedure. In this study Pipelle is being studied in terms of specificity and sensitivity for diagnosis and for replacing other methods of sampling. Methods: 60 patients underwent pipelle endometrial sampling on OPD basis followed by hysteroscopic evaluation and endometrial sampling in the same menstrual cycle . Histopathology report of both the pipelle and hysteroscopic endometrial samples were compared and statistical analysis done. Results: In subjects with proliferative Endometrium in Hysteroscopy 93.9% were diagnosed by pipelle sample, In Secretory Endometrium in Hysteroscopy, 83.3% were diagnosed by pipelle sample, Out of 33 subjects with Disordered Endometrium in Hysteroscopy, 100% were diagnosed by pipelle sample. In the sample Hyperplasia in hysteroscopy, 100% were diagnosed by pipelle sample. In samples without simple Hyperplasia in Hysteroscopy, 98.3% were negative in pipelle sample and 1.7% were positive in pipelle sample (False Positive). In Adenomatous Polyp in Hysteroscopy 20% were diagnosed by pipelle sample and 80% were negative (False Negative). In Cystoglandular Hyperplasia in Hysteroscopy, 100% diagnosed by pipelle sample. Conclusion: Pipelle is 100% sensitive in diagnosing premalignant changes in the endometrium. Hence pipelle, a cost effective non-invasive procedure, can be used as a first line method to diagnose endometrial pathology in abnormal uterine bleeding.

Pipelle endometrial sampling vs dilatation and curettage in abnormal uterine bleeding

Aim to ascertain if aspiration endometrial sampling can replace conventional dilatation and curettage for histopathological evaluation in abnormal uterine bleeding. The present study was a prospective, observational, comparative study conducted at Tata Main Hospital from 1st November 2015 to 31st October 2016. Sample size was calculated as 200. Data was analyzed using SPSS 22 version software. Sensitivity, pecificity, NPV, PPV and accuracy of histopathological diagnosis of pipelle will be computed taking DNC as the standard.The global sensitivity of pipelle endometrial biopsy is 90.72%, specificity is 100%, NPV is 25%, 100% is PPV.The accuracy for histopathological diagnosis is good if sample is adequate, hence it can be used as a first line method for endometrial sampling. Additional diagnostic methods need to be applied if sample obtained is inadequate for histological examination or if insertion fails.