OUTPATIENT ENDOMETRIAL SAMPLING VERSUS DILATATION AND CURETTAGEIN ABNORMAL UTERINE BLEEDING

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Dr. Sahana SM
Dr. Nandita Maitra
Dr. Vishakha Ahuja

Abstract

Background: AUB is a major gynaecological condition. It requires Histopathological assessment of endometrium to differentiate benign from malignant pathologies. Endometrial tissue for histopathological analysis can be obtained by outpatient endometrial sampling devices and by conventional dilatation and curettage technique done under anesthesia. This study was conducted to compare the efficacy of outpatient endometrial sampling device(Pipelle) with D & C with respect to sample adequacy and diagnostic accuracy.



Objective: To compare validity and diagnostic accuracy of outpatient endometrial sampling with dilatation and curettage (D&C) in terms of sampling adequacy, histopathology and failure rate.



Materials and methods: This prospective observational study was performed on 80 patients older than 35 years who presented with abnormal uterine bleeding (AUB). An endometrial sample by Pipelle like device was taken without anaesthesia or dilatation. Under sedation, dilatation and curettage was performed. Both samples were sent for histopathological analysis. The value of two methods in the diagnosis of various endometrial pathologies were compared. Data analysis was performed using Chi-Square, Fisher exact test and McNemar's test. The results were considered statistically significant at p value less than 0.05.



Results: Adequate samples were obtained in 62 patients (77.5%) and 18 patients had inadequate samples (22.5%). There was agreement between result of outpatient endometrial sample and D&C sample (p value-0.26). Two methods were agreed upon 100% sensitivity and 100% specificity for detection of secretory endometrium, complex hyperplasia without atypia, endometritis and endometrial carcinoma. Pain scores were lower in outpatient sampling technique (median = 3, SD ñ 1.05) than with D&C (median=7, ñ 1.05). This observation was statistically significant (p value < 0.0001, CI 99%).



Conclusion: Outpatient endometrial sampling using Pipelle like device is an easy, less painful and convenient method. It has high specificity in detecting endometrial hyperplasia and carcinoma. This sampling technique can be used as an effective screening procedure in the outpatient department.



Keywords: Endometrial pathology; Diagnostic accuracy; Histopathology; Pipelle device; Sample adequacy

Published Jan 10, 2022

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