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9 - The comparison between pipelle biopsy and dilatation curettage for endometrial sampling
Almila Bal Yıldız, Oya Aygün Mutlu, Canan Eren, Sabri Kartal, Alparslan Baksu, Necmettin Yıldız, Sibel Özsoy, Nimet Göker
OBJECTIVE: We compared pipelle biopsy with dilatation and curettage in parameters such as sensitivity, specifisity, accuracy, predictibility and patient tolerability.
STUDY DESIGN: 45 patients scheduled for histerectomy and 36 patients with diagnosis of abnormal uterine bleeding scheduled for endometrial sampling were admitted. Pipelle biopsy followed by dilatation and curettage were applied to ech patient. Histerectomy was applied to 10 of the 36 patients with abnormal uterine bleeding and 45 patients with previous indications for histerectomy.
RESULTS: The pain felt during dilatation amd curettage (D&C) was more in comparison to pipelle biopsy (p<0.005). The accuracy, sensitivity and specifisity of pipelle biopsy was 63.6%, 75% and 97%, respectively. These parameters were found as 78.1%, 100% and 97.4% for D&C. Insufficient tissue was obtained in 25% of patients with pipelle biopsy and in 16% ofpatiens with D&C. Insufficient tissue specimens were mostly obtained from postmenoposal patients. In assesment of atrophic endometrium the sensitivities of of pipelle biopsy and D&C wer 12.5%, 25% respectively. The sensitivity of pipelle biopsy in assesment of endometrial polip was 0 % whereas sensitivity of D&C was 100%. The sensitivities in the assesment of adenocarcinoma and simple endometrial hyperplasia for both methods were 100%.
CONCLUSION: In premenoposal and postmenoposal patients with uterine bleeding, if there is a suspicion of submucozal myoma or endometrial polip in ultrasonography histerescopy guided endometrial biopsy should be done. If there is no such suspicion pipelle is as accurate as dilatation and curettage in assesment of endometrial patologies and more tolerable. In postmenoposal patients with endometrial thickness below 4 mm, measured by ultrasonography, histeroscopy guided biopsy can be preferred to pipelle biopsy and D&C due to their high rate of insufficient tissue sampling.
Keywords: Endometrium, pipelle biopsy, D&C.
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