Pipelle Endometrial Sampling Research Articles

Current role of Pipelle endometrial sampling in early diagnosis of endometrial cancer.

Endometrial cancer is the most common gynecologic cancer in developed countries. The most prevalent, however not pathognomonic symptom of the disease is abnormal uterine bleeding. The diagnosis of endometrial cancer is based on the histologic results of endometrial sampling. Endometrial biopsy could be obtained using different modalities: hysteroscopy-directed endometrial biopsy, uterine curettage or office endometrial biopsy. Outpatient endometrial biopsy using different devices for the evaluation of abnormal uterine bleeding is gaining popularity. The most popular office-based device for endometrial sampling procedure is the Pipelle device. Currently, Pipelle endometrial sampling is widely used to diagnose endometrial cancer in women with abnormal uterine bleeding and/or postmenopausal bleeding. The method became very useful due to easiness and simplicity of the procedure, availability of a device, as well as high sensitivity in detecting endometrial cancer. Many studies compared the validity and accuracy of Pipelle biopsy with dilation and curettage in the detection of various endometrial pathologies. Published results state that Pipelle biopsy and uterine curettage are almost equally reliable in the evaluation of endometrial pathologies. Moreover, Pipelle biopsy appears more beneficial as it does not require hospital admission and anaesthesia. However, it is proven the Pipelle technique has a limited capacity to identify endometrial polyps, and some authors, based on their study, claim that dilation and curettage is a more reliable method in terms of correlation with the final histological results. In addition, there are many factors affecting the efficiency of the endometrial biopsy. Failure to get samples that are adequate for histological examination is one of the problems associated with Pipelle sampling. The above mentioned contradictory conclusions by different researchers and lack of guidance to avoid inadequate sampling present the demand for further studies on the comparison of Pipelle biopsy and uterine curettage efficiency and accuracy.

Diagnostic Values of Pipelle and Standard Curettage Compared to Hysterectomy Pathology in Postmenopausal Bleeding: A Comparative Study.

Background:Postmenopausal bleeding might occur due to many benign and malignant underlying diseases. Differentiating between these diseases poses a great importance. This study was designed to compare the diagnostic value of pipelle endometrial sampling and curettage in patients with postmenopausal bleeding. Further, the results were compared with hysterectomy if performed.Materials and Methods:Eighty-seven patients with postmenopausal bleeding were included. Pipelle sampling endometrial biopsy was performed for patients in office, and then, patients were transferred to the operation room for dilatation and curettage. Pathology results of pipelle sampling were compared with curettage method. If hysterectomy was performed due to any reason, it was compared as well.Results:The pipelle sampling biopsy diagnosed 94.1% of malignant tumors, and curettage sampling biopsy diagnosed 100% of malignant tumors. The sensitivity and specificity of pipelle compared to curettage were 94.12% and 100%, respectively, for the diagnosis of malignant tumors. Based on the Kappa test, the agreement between pipelle and curettage sampling biopsy was statistically significant (P < 0.001).Conclusion:The endometrial sampling with pipelle is safe and cost-effective in patients referred with postmenopausal bleeding. This might avoid the need for general anesthesia for the detection of endometrial hyperplasia and endometrial malignancy.

Insulin-like growth factor-II mRNA-binding protein 3 immunocytochemical expression in direct endometrial brushings: Possible diagnostic help in endometrial cytology.

This study evaluated the immunocytochemical (ICC) expression of IMP3 in direct endometrial brushings processed as liquid-based cytology (LBC) samples of endometrioid adenocarcinoma (EAC), serous carcinoma (ESC) and surface papillary syncytial change (SPSC) with endometrial glandular and stromal breakdown (EGBD) to exploit its possible differential diagnostic aid. In total, 333 samples of LBC samples were obtained from selected outpatients in parallel with Pipelle endometrial sampling. They consisted of 97 EAC (83 grade 1: EAC-1, 14 EAC-3), 35 ESC and 201 benign endometrial samples (51 proliferative, 42 secretory, 38 atrophic, 70 SPSC with EGBD). ICC expression of insulin-like growth factor-II mRNA-binding protein 3 (IMP3) was manually performed on Papanicolaou-stained LBC samples. The ESC samples showed positive staining cells in 100%, EAC-3 in 28.5%, and EAC-1 in 2.4% cases. All the benign endometrium samples were negative. Only ESC cases showed strong immunoreactivity (≥3+) in more than 50% of tumour cells with an average frequency of 80%. IMP3 is a helpful immunomarker to distinguish ESC from EAC and SPSC in endometrial cytology.

Study of the Efficacy of Pipelle Biopsy Technique to Diagnose Endometrial Diseases in Abnormal Uterine Bleeding.

Background:Pipelle biopsy is ideal for obtaining endometrial sample in outpatient department. It samples only 4% of the endometrial surface and has sensitivity up to 97%. A positive biopsy can avoid inconvenience to a patient, but a nonspecific finding should be interpreted with caution. Thus, the objectives of this study were to analyze the efficacy of pipelle biopsy by adequacy of the sample obtained and also to establish the reliability by comparing the histopathology report obtained by pipelle biopsy with that of the hysterectomy specimen.Materials and Methods:A prospective study conducted at a tertiary care hospital on 104 women with abnormal uterine bleeding (AUB). They were scheduled for pipelle endometrial sampling before hysterectomy. The sensitivity, specificity, negative and positive predictive values, and accuracy of pipelle biopsy in diagnosing various endometrial pathologies were analyzed. The validity of pipelle biopsy was studied for endometrial hyperplasia and carcinoma and their statistical significance was tested.Results:The overall concordance rate was 63.8%. The sensitivity, specificity, positive and negative predictive values, and accuracy of pipelle biopsy for endometrial hyperplasia was 64.2%, 88.8%, 94.1%, 85.5%, and 47.3% and for endometrial carcinoma was 75%, 100%, 100%, 97.9%, and 98%, respectively. The P value for endometrial hyperplasia and carcinoma was 0.001 (statistically significant).Conclusion:Pipelle biopsy is valuable in diagnosing endometrial pathology of AUB cases. It has very high sensitivity and specificity for endometrial malignancies. A hysteroscopic dilatation and curettage is required for definitive diagnosis in cases of polyps and focal endometrial lesions.

Cost-effectiveness analysis of biopsy strategies for endometrial cancer diagnosis in women with postmenopausal bleeding: Pipelle sampling curette versus dilatation & curettage

BackgroundEndometrial sampling is widely used for accurate diagnosis of endometrial cancer (EC), which is the most common gynecologic cancer in US women. The objective of this study was to explore the cost-effectiveness of two endometrial sampling procedures for diagnosing EC: (1) Pipelle endometrial sampling (Pipelle), and (2) dilatation & curettage (D&C), while accounting for sampling procedure failure rates and diagnostic accuracy in women with postmenopausal bleeding (PMB). MethodThe decision analytic model was built to compare the cost-effectiveness of Pipelle and D&C strategies in a hypothetical cohort of PMB women. The analysis was performed from the perspective of a public healthcare payer (Medicare, US). We used 2017 Medicare reimbursement data for cost estimation. The effectiveness of these two diagnostic strategies was measured by analyzing the remaining life expectancy after EC diagnosis and subsequent treatment. ResultsThe base case analysis suggested that Pipelle was not only equally effective (32.11 vs. 32.11 years of life), but also less costly ($1897.80 vs. $2999.11) based on Medicare reimbursement when compared to D&C. In one-way sensitivity analyses and Monte Carlo probabilistic sensitivity analysis, the Pipelle remained the more cost-effective sampling strategy even after accounting for sampling failure rate associated with each sampling strategy. ConclusionThe Pipelle is the more cost-effective sampling strategy compared to D&C for EC diagnosis in women with PMB. From the cost-effectiveness perspective, the higher sampling failure rate of Pipelle should not be regarded as a limitation in its clinical application.

Relationship between adnexal mass and endometrial thickness in postmenopausal period

Endometrial cancer is the most common gynecological cancer. Increased postmenopausal endometrial thickness may be an indicator of endometrial cancer. Transvaginal ultrasound (TV-USG) is the primary imaging method for evaluating endometrial thickness in the postmenopausal period. The aim was to employ transvaginal ultrasonography in the evaluation of adnexal masses synchronously seen in postmenopausal women with increased endometrial thickness. The work was designed as a retrospective study. The medical records of 155 patients evaluated for increased postmenopausal endometrial thickness were examined. Ultrasonography had been performed on the women in the study for routine follow-up, postmenopausal hemorrhage, pelvic pain, pelvic mass on examination and family history of gynecological cancer. All patients had undergone endometrial evaluation with fractional dilatation and curettage (D & C) or pipelle endometrial sampling. Histopathological diagnosis was based on endometrial sampling results. Adnexal mass was present simultaneously in 17.4% (n = 27) of the women included in the study, while 82.6% (n = 128) had no gynecological pathology other than increased endometrial thickness. The endometrial thickness in the women with postmenopausal adnexal masses was greater than in those without adnexal mass (11.7 mm vs. 7.8 mm, p = 0.009). Non-atypical and atypical endometrial hyperplasia was more frequent in the group with postmenopausal adnexal mass (11.1% vs. 2.8%, 11.1% vs. 3.79, p = 0.03, p = 0.04, respectively). Final histopathological evaluation of patients operated on for adnexal masses revealed tubo-ovarian abscess in 1.9% (n = 1), benign ovarian tumor in 25.9% (n = 7) and malignant ovarian tumor in 11.1% (n = 3) of the patients. In postmenopausal women, adnexal masses can be seen simultaneously with increased endometrial thickness. In this regard, transvaginal ultrasound offers important opportunities for evaluation of both the endometrium and adnexa. Pre-surgery transvaginal ultrasound as well as multivariate serum markers may be used in evaluation models.

Evaluation of Diagnostic Efficacy of Pipelle Endometrial Sampling in Abnormal Uterine Bleeding

Evaluation of Diagnostic Efficacy of Pipelle Endometrial Sampling in Abnormal Uterine Bleeding

Diagnostic accuracy of endometrial biopsy in relation to the amount of tissue

AimsFor the diagnostic workup of postmenopausal bleeding, histological examination of the endometrium is frequently performed. Failure of endometrial sampling due to insufficient material is often reported but objective criteria for...

Effect of Cervical Lidocaine Gel for Pain Relief in Pipelle Endometrial Sampling.

To evaluate the efficacy of cervical lidocaine gel in reducing patient discomfort during Pipelle endometrial sampling. From September 2012 to January 2013, 137 patients were evaluated with Pipelle endometrial biopsy. For group 1 (77 women), 2% lidocaine gel was applied to the cervical canal 3 min before endometrial sampling. For group 2 (60 women), a placebo gel was applied. The pain experienced by the patients during biopsy was evaluated using a 100 mm visual analog scale. The pain score was significantly lower during suction curettage (T3) in the group 1 than in the group 2. There was no significant difference between the groups in terms of pain score in other stages of the procedure (2.6±1.3 and 4.5±1.4; p=0.03). Cervical 2% lidocaine gel is simple and effective for decreasing pain associated with Pipelle endometrial biopsy.

Diagnostic value of pipelle endometrial sampling in comparison with dilatation and curettage among patients with abnormal uterine bleeding

Diagnostic value of pipelle endometrial sampling in comparison with dilatation and curettage among patients with abnormal uterine bleeding

Positive predictive value of endometrial polyps in Pipelle aspiration sampling: a histopathological study of 195 cases

ObjectiveTo estimate the positive predictive value of Pipelle endometrial sampling in detecting the presence of an underlying endometrial polyp. The secondary objective is to examine the histologic features that can predict the presence of endometrial polyps. Study designThis is a retrospective case review study. 195 women who had undergone diagnostic hysteroscopy and/or polypectomy were identified in a University teaching hospital. All patients had a prior polyp diagnosis in the Pipelle endometrial sample. The histology of these samples were compared and analyzed with subsequent DH findings and final hysteroscopic biopsies. Slides were reviewed by 2 gynaecological pathologists. Results162 women were premenopausal (mean age 46.1, SD=4.6) and 33 were postmenopausal (mean age 57.2, SD=8.1). The commonest indication for a Pipelle endometrial sampling was abnormal uterine bleeding. Presence of polyp was confirmed by DH in 56.3% (111/195) cases. Of these, 81.1% (90/111) were confirmed histologically. The positive predictive value of detection of polyps in Pipelle endometrial samples for premenopausal and postmenopausal women was 53.7% and 72.7%, respectively (p=.05). The most reliable histologic features that can predict the presence of an underlying polyp was fibrous stroma (p=.01) and focal glandular clustering (p=.03). The prevalence of endometrial hyperplasia and carcinoma in women who was confirmed to have polyp was 11.7% (13/111). ConclusionThe positive predictive value of Pipelle endometrial samples in detecting endometrial polyps was 56.3%. It was higher in the postmenopausal women (72.7%) compared to premenopausal women (53.7%). The prevalence of endometrial hyperplasia and carcinoma in women who was confirmed to have polyp was consistent with the rate reported in the literature. Using ultrasonography as an adjunct maybe helpful in diagnosing endometrial polyps.

The Effectiveness and Acceptability of Pipelle Endometrial Sampling versus Classical Dilatation and Curettage: A Three-Year Observational Study

Objective: To assess the effectiveness and acceptability of Pipelle endometrial sampling in comparison to dilatation and curettage (D&C). Methods: This was a prospective observational study including a total of 538 patients with abnormal uterine bleeding who were allocated to be treated using 2 sampling techniques: Pipelle sampler (n = 270) and D&C (n = 268). The primary outcome was the adequacy of both methods and concordance rate with hysterectomy specimens. The secondary outcome included drawbacks and patients' acceptability. Results: There was no significant difference between the 2 methods regarding adequacy and concordance rate with hysterectomy (p > 0.05). There was a statistically significant difference between the 2 groups regarding the requirement of analgesia and overall discomfort (p < 0.001), which was higher in the Pipelle group. No significant statistical difference was recognized between the study groups regarding the occurrence of cervical lacerations, fever or the rate of inadequate intrauterine sampling (p > 0.05). In addition, no significant statistical difference between both procedures was recognized concerning the overall satisfaction rate and the advisability of the procedure to other women (p > 0.05). Conclusion: Under the conditions of this study, Pipelle endometrial sampling is comparable to D&C biopsy in terms of adequacy and concordance rate with hysterectomy except that more pain and a higher overall discomfort rate were associated with it.

Endometrial histology in severely obese bariatric surgery candidates: an exploratory analysis

BackgroundEndometrial pathology risk has been linked to obesity; however, little is known of its prevalence in severely obese women not seeking care for endometrial pathology associated symptoms. This pilot study was designed to explore the frequency and risk factors associated with endometrial pathology in cancer-free, severely obese, bariatric surgery candidates using the Pipelle endometrial sampling technique (SureFlex Preferred Curette, Bioteque America, Inc, New Taipei City, Taiwan). MethodsTwenty-nine severely obese bariatric surgery candidates with intact uteruses and no history of endometrial cancer or endometrial ablation were included in this subanalysis from a larger cohort of 47. Endometrial samples were obtained using a Pipelle endometrial suction curette at a single time point before surgery. Logistic regression was used to assess the relationship between body mass index and endometrial pathology when adjusting for age and race. ResultsOf the 29 successful biopsies, 8 (27.6%) were classified as abnormal endometrium: 1 was classified as complex atypical hyperplasia, 1 was classified as hyperplasia without atypia, 4 samples were identified with endometrial polyps, and 2 samples were identified with metaplasia. None presented with cancer. Increasing body mass index was significantly associated with higher risk of abnormal endometrium (OR = 1.19, 95% CI [1.03–1.36], P = .01). ConclusionsThe findings in this sample suggest that obesity may be associated with increased risk of having undiagnosed endometrial pathology. More thorough examination of relationships between levels of obesity and endometrial pathology are needed to better characterize high cancer risk groups who may benefit from introducing new screening measures.

The Performance of Pipelle Endometrial Sampling After Endometrial Ablation

The Performance of Pipelle Endometrial Sampling After Endometrial Ablation

Pipelle endometrial sampling in the evaluation of abnormal first trimester pregnancies.

To evaluate the utility of pipelle endometrial sampling as a diagnostic tool in the evaluation of abnormal first trimester gestations. Thirty-one women with abnormal first trimester pregnancies defined as gestations with abnormally rising or falling quantitative human chorionic gonadotropin (β-hCG) levels and ultrasound findings consistent with a nonviable or ectopic pregnancy were prospectively evaluated. Endometrial pipelle sampling was performed on each patient in a standardized fashion immediately before curettage and evaluated as a fixed, permanent specimen to assess for the presence of either chorionic villi, trophoblastic or fetal tissue. The sensitivity, specificity, positive predictive value, and negative predictive value for endometrial biopsy were 70.1%, 100%, 100%, and 33.3%, respectively. For curettage, the sensitivity, specificity, positive predictive value, and negative predictive value were 88.9%, 100%, 100%, and 57.1%, respectively. Curettage's overall sensitivity is superior to endometrial biopsy in detecting the presence of intrauterine products of conception in early abnormal pregnancies. However, in some clinical situations where the diagnosis of ectopic pregnancy is in question, particularly if the β-hCG is ≤ 2,000 mIU/mL, endometrial pipelle biopsy could be a useful tool in the evaluation algorithm.

Pipelle endometrial sampling versus conventional dilatation &amp; curettage in patients with abnormal uterine bleeding

This study was designed to compare the diagnostic accuracy of Pipelle endometrial sampling with conventional dilatation & curettage in patients with abnormal uterine bleeding. One hundred and forty patients with abnormal uterine bleeding were included in this comparative study; where endometrial sampling was carried out before cervical dilatation by Pipelle device followed by conventional dilatation & curettage (D&C). The histopathology report of the Pipelle sample was compared with that of the dilatation & curettage sample and the dilatation & curettage reports were considered as the gold standard. 100% of the samples obtained by conventional D&C, while 97.9% of the samples obtained by the Pipelle device were adequate for histopathological examination. The histolopathological examination of 140 samples obtained by conventional D&C revealed proliferative endometrium in 37 specimens, secretory endometrium in 33 specimens, endometrial hyperplasia in 49 specimens (45 without atypia & 4 with atypia), endometritis in 8 specimens, endometrial polyps in 3 specimens and malignant endometrium in 10 specimens. In this study; the Pipelle device had 100% sensitivity, 100% specificity and 100% accuracy for diagnosing endometrial hyperplasia, endometrial carcinoma, proliferative and secretory endometrium. Also, it had 88.9% sensitivity, and 99.2% negative predictive value (NPV) and 99.3% accuracy for diagnosing endometritis and it had 60% sensitivity, 89.6% NPV and 98.6% accuracy for diagnosing endometrial polyps. The endometrial sampling using Pipelle is a safe, accurate, cost effective outpatient procedure, which avoids general anesthesia and has a high sensitivity and specificity for detection of endometrial hyperplasia and endometrial malignancy.

Pipelle endometrial sampling versus conventional dilatation &amp; curettage in patients with abnormal uterine bleeding

To compare the diagnostic accuracy of Pipelle endometrial sampling with conventional dilatation & curettage in patients with abnormal uterine bleeding. One hundred and forty patients with abnormal uterine bleeding were included in this comparative study; endometrial sampling was done before cervical dilatation by Pipelle device followed by conventional dilatation & curettage (D&C). The histopathology report of the Pipelle sample was compared with that of the D&C sample and the D&C report was considered as the gold standard. 100% of the samples obtained by conventional D&C, while 97.9% of the samples obtained by Pipelle device were adequate for histopathological examination. The histolopathological examination of one hundred and forty (140) samples obtained by conventional D&C revealed proliferative endometrium in 37 specimens, secretory endometrium in 33 specimens, endometrial hyperplasia in 49 specimens (45 without atypia & 4 with atypia), endometritis in 8 specimens, endometrial polyps in 3 specimens and malignant endometrium in 10 specimens. In this study; the Pipelle device had 100% sensitivity, 100% specificity and 100% accuracy for diagnosing endometrial hyperplasia, endometrial carcinoma, proliferative and secretory endometrium, also, it had 88.9% sensitivity, 99.2% NPV and 99.3% accuracy for diagnosing endometritis and it had 60% sensitivity, 89.6% NPV and 98.6% accuracy for diagnosing endometrial polyps. The endometrial sampling using Pipelle is safe, accurate, cost effective outpatient procedure, avoids general anesthesia with high sensitivity and specificity for detection of endometrial hyperplasia and endometrial malignancy.

LNG-IUS treatment of non-atypical endometrial hyperplasia: Can Pipelle endometrial sampling be an accurate method of follow-up evaluation?

See accompanying article on page 128. Endometrial hyperplasia (EH) is a common disease affecting women of all ages [1]. It is clinically important because it can cause abnormal uterine bleeding, and can precede, or occur concurrently, with endometrial carcinoma. There are many progestin therapy regimens available for treatment of EH. The main progestational agents are oral progestogens such as norethisterone acetate, megestrol acetate, and medroxyprogesterone 17-acetate. More recently, the levonorgestrel-releasing intrauterine system (LNG-IUS; Mirena, Bayer Schering Pharma Oy, Turku, Finland) also has been used successfully to treat EH [2,3]. Several observational studies have shown higher regression rates for LNG-IUS than for the oral progestogens [4-6]. However, systematic examination of the literature indicates that the quality of the published data, derived from small sample sizes and short-term follow-up, is relatively poor [5]. In this issue of the Journal of Gynecologic Oncology, Abu Hashim et al. [6] reports a prospective randomized controlled trial (RCT) that compared the efficacy of LNG-IUS with norethisterone acetate (NET) for treatment of non-atypical EH in perimenopausal women. As noted above, there are many reports on the best way to treat this condition, but only observational studies are available to inform clinical practice. Therefore, many gynecologists consider an RCT on the use of oral progestogens versus LNG-IUS in the management of EH to be required [7]. In this sense, the present study carries clinical significance. The authors of the present report found a significantly higher regression rate in the LNG-IUS group than in the NET group at the 3rd-, 6th- and 12th-month follow-up visits (67.8% vs. 47.5%; 79.7% vs. 60.7%; 88.1 vs. 55.7%). These findings match those of a recent meta-analysis of 190 observational studies including 1,001 women. This analysis showed that a significantly higher regression rate was achieved with LNG-IUS than with oral progestins in treatment of non-atypical complex EH (92% vs. 66%). The authors also reported that the LNG-IUS regression time ranged from 3 to 12 months (median, 3 months), a significant proportion of the patients (67.8%) having achieved regression by the 3rd month. This success rate accords with data reported by Lee et al.[8] for a prospective observational study of 12 Korean women diagnosed with EH and treated with LNG-IUS. In that study, complete regression of EH was achieved in all cases (100%, 12/12), most of the patients (66%, 8/12) having attained it within three months. In light of these results, the authors concluded that LNG-IUS is superior to high-dose oral NET therapy for non-atypical EH and should therefore be considered a valuable treatment option in such cases. Whereas these results are certainly encouraging, there is yet an important concern with respect to the accuracy of the follow-up evaluation method employed by the authors. Specifically, Pipelle endometrial sampling was utilized. But can Pipelle endometrial sampling be an accurate method for follow-up evaluation? The authors note that a recent trial reported almost equal EH-diagnostic success rates between Pipelle biopsy and dilatation & curettage (DC however, these results were obtained for cases where the LNG-IUS was not in the uterus and where there were no progestin effects on the endometrium. According to the reported literature, in cases of EH treatment using LNG-IUS, the endometrial response has been evaluated by endometrial aspiration biopsy while the LNG-IUS is in the uterus or by D&C after LNG-IUS removal [2-6,8]. Nevertheless, there has been no report comparing the accuracy of these methods. In our recent study comparing the diagnostic accuracy of endometrial aspiration biopsy with the LNG-IUS in the uterus with that of DC in fact, it might not be reliable for follow-up evaluation where patients have been treated with LNG-IUS for EH. To confirm our findings, a Korean prospective multicenter study is currently underway [11], and will provide more reliable data on this issue. The study of Abu Hashim et al. [6] is meaningful for being the first RCT to date that has evaluated the efficacy of LNG-IUS for treatment of non-atypical EH. However, the accuracy and reliability of any such results on the effectiveness of hormonal treatment depend on a precise follow-up method of endometrial evaluation. Therefore, until which method is confirmed to be more accurate, differences between the results for oral progestogens and LNG-IUS in the treatment of non-atypical EH, even if they appear to be significant, should be interpreted with caution.

Cervical cancer in a patient with uterus didelphys and obstructive hemivagina, ipsilateral renal anomaly (OHVIRA) syndrome

We report a rare case of cervical adenocarcinoma diagnosed and treated in a woman with uterine didelphys, obstructive hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome. A 49-year-old multiparous woman applied to our institution with menorrhagia and intermenstrual bleeding since 6 months. On pelvic examination, a grossly normal cervix was noted. A 7-cm firm mass was palpated in the left pelvic region extending to the vaginal level. Also, a 4-cm fluctuant mass was palpated on the left vaginal wall. On pelvic ultrasound, a 40-mm cystic mass with internal echoes resembling an endometrioma was visualized adjacent to the left superior vaginal wall. Upper abdominal ultrasound revealed left unilateral renal dysplasia, which was further confirmed by magnetic resonance imaging (MRI) (Fig. 1). Laboratory, pap-smear and endocervical curettage (ECC) results were normal. Endometrial biopsy taken with a pipelle endometrial sampling cannula was reported as endometrioid adenocarcinoma. Laparotomy was performed and peritoneal washings were obtained for cytology. Upon exploration, uterine didelphys (UD) with normal adnexa on both sides were discovered (Fig. 2). After complete resection of the uterus with bilateral tubes and ovaries, a blind vaginal stump on the left side was visualized. A brown-colored fluid was drained from the left vaginal lumen. There was a small opening between the left and right vaginal lumens. The operation was completed with bilateral pelvic-paraaortic lymph node dissection (LND) and omentectomy. Final pathology was reported as UD with a 10 9 8 mm well-differentiated primary endometrioid adenocarcinoma of the right cervix. Endometrial tissues on both uteruses were free of any tumoral involvement. Retroperitoneal lymph nodes, omentum and peritoneal cytology were negative for any tumoral spread. The patient was informed about the pathology results. Further treatment options including surgical treatment or chemoradiation were discussed. The patient preferred surgical treatment. Radical parametrectomy and proximal vaginectomy were performed. Postoperative follow-up period was uneventful. On pathological examination, bilateral parametria and vaginal tissues were free of tumor. The patient was consulted to the radiation oncology department of an affiliated hospital. Regular follow-up without adjuvant treatment was recommended, and she was discharged from the hospital. Short-term (15 months) follow-up visits were normal without any treatment related complications or signs of recurrence. Obstructive hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome (Herlyn–Werner–Wunderlich syndrome) is a rare type of congenital Mullerian anomaly (CMA), which is frequently associated with UD [1, 2]. This syndrome results from lateral fusion defect of the Mullerian ducts with asymmetric vaginal obstruction. The classical urinary manifestation of OHVIRA syndrome is ipsilateral renal agenesis. However, as in our case, dysplastic or duplicated kidneys have also been reported [3]. Women with CMA are generally diagnosed in adolescence or reproductive period. Symptoms and clinical findings vary greatly, depending on the present anomaly. The woman presented here did not report any symptoms M. Kaba T. Gungor E. Baser (&) B. Ozdal Department of Gynecologic Oncology, Zekai Tahir Burak Women’s Health Education and Research Hospital, Talatpasa Bulvari, Samanpazari, Altindag, Ankara, Turkey e-mail: eralpbaser@gmail.com

Comparison of the success of histopathological diagnosis with dilatation-curettage and Pipelle endometrial sampling

The aim of this study is to compare collection of sufficient material and diagnostic accuracy of Pipelle biopsy with curettage and hysterectomy. A total of 82 cases with indications for endometrial biopsy for any reason and in which endometrial biopsy was performed with dilatation and curettage (D&C) and Pipelle aspiration biopsy, and 66 cases in which an indication for hysterectomy was established for any reason were included in the study. Histopathological findings were examined in the following six groups: normal; endometrial polyps; hyperplasia without atypia; hyperplasia with atypia; atrophy; and insufficient material. Descriptive statistical methods and McNemar's test were used. When the histopathological compatibility between Pipelle and D&C was considered (n = 82), a diagnosis that was different from that obtained by D&C was obtained in 22 of the 63 cases (34%), in whom normal endometrial histology was found with a Pipelle biopsy specimen. It was observed that only 1 of 13 cases of endometrial polyps was diagnosed with Pipelle biopsy. Insufficient material was obtained in six cases (7%) with Pipelle biopsies and three cases (4%) with D&C. While Pipelle biopsies and D&C have a nearly equal level of success in widespread endometrial lesions, Pipelle biopsies provide limited diagnostic accuracy in cases with focal pathologies.