Diagnostic Efficacy of Endometrial Sampling by Pipelle Biopsy Technique in Peri and Postmenopausal Women with Abnormal Uterine Bleeding

Aim: Current study is conducted to determine the diagnostic efficacy of pipelle as a tool for endometrial biopsy and to establish the reliability of pipelle curette so that the number of traditional Dilatation and Curettage done under short general anesthesia can be reduced to minimum. Method: In this study we assessed 100 consecutive peri and postmenopausal patients attending Obstetrics and Gynecology department with complaints of abnormal uterine bleeding. These patients are subjected to transvaginal ultrasonography and pipelle endometrial sampling. Results: Indication for the procedure were heavy menstrual bleeding 21 (42%), intermenstrual bleeding 11 (22%), irregular periods 10 (20%) and others 8(16%) in premenopausal women with AUB and postmenopausal bleeding in 50 out of 50 postmenopausal women means 100%. In postmenopausal group, 6% of the patients were nulliparous who had hyperplasia and hyperplasia with atypia. Majority of postmenopausal patients have period of menopause in the range of 6-10 years (37.5%). In postmenopausal group 74% of the patient had associated medical problem. In premenopausal women 44 patients (88%) had endometrial thickness more than 10mm and in 6 patients (12%) had endometrial thickness less than or equal to 10mm. Among 50 postmenopausal women the ET was more than 4mm in 40 patients (80%) and in 10 patients (20%) ET was less than or equal to 4mm. In those who had 4mm. In the present study difficulty encountered during pipelle sampling while passing the cannula through the cervical os is comparatively less 2% in premenopausal women than postmenopausal women 8%. Post procedure complaint or discomfort in lower abdomen or slight vaginal spotting which was about nil in premenopausal women and 4% in postmenopausal women. Adequacy of the pipelle sampling using the pipelle curette has shown to obtain adequate specimen in 87-100% of patient. In the present study, it was 96% and 88% in premenopause and in postmenopausal women with AUB respectively. In the present study, since no complication occurred and no serious pathology was missed, pipelle sampling combined with endometrial thickness increases the sensitivity and specificity both, therefore we suggest that pipelle sampling combined with sonographic measurement of endometrial thickness is an acceptable, less invasive alternative to hysteroscopy and D & C as a first line investigation in the evaluation and management of abnormal peri and postmenopausal uterine bleeding. Conclusion: Evaluation of the target population i.e., peri and postmenopausal women with AUB by using office based pipelle endometrial biopsy and transvaginal ultrasonography, and to detect prevalence of atypical hyperplasia -endometrial carcinoma at the earliest in a cost effective way. In developing countries like India evaluation of AUB in peri and postmenopausal women can be done with minimal infrastructure setup even where operation theatre facilities are not available in remote areas by doing Ultrasonography and office endometrial biopsy which is cost effective safe OPD procedure, less time consuming, non-invasive, less discomfort to the patient and early diagnosis of atypical hyperplasia and endometrial carcinoma.