Comparison the Diagnostic Value of Dilatation and Curettage Versus Endometrial Biopsy by Pipelle - a Clinical Trial


Background: Several methods have been presented for the evaluation of the endometrium in patients withabnormal uterine bleeding, which include minimal invasive and invasive approaches such as diagnostic curettageor endometrial biopsy by Pipelle. Many studies have been performed in order to compare two methods; diagnosticcurettage and outpatient endometrial biopsy. This investigation compared sampling adequacy, endometrialhistopathology, failure rates, duration and costs between diagnostic curettage in a hospital and endometrialbiopsy. Materials and
Methods: This single blind clinical trial was performed on 130 patients older than 35years who was referred to Amir training hospital in 2013 for elective diagnostic curettage because of abnormaluterine bleeding. For all patients eligible for the study, an endometrial sample by Pipelle was taken withoutanesthesia or dilatation. Then under general anesthesia diagnostic curettage was performed by sharp curette.Sampling duration was calculated and both samples were sent to the same pathologist. The diagnostic values oftwo methods in the diagnosis of normal endometrium, endometrial hyperplasia and carcinoma were compared.The costs of these two methods were also compared. Data analysis was performed by SPSS (version 16.0) software.Chi-Square, Fisher, and Pearson tests were used and were considered statistically significant at P values lessthan 0.05.
Results: Two methods were agreed upon 88% of sampling adequacy and 94% of pathological results.Specificity of 100% and sensitivity of 90% for detection of proliferative endometrium, secretory endometrium,simple hyperplasia without atypia and 100% for cancer were recorded. Pipelle diagnostic accuracy in comparisonwith curettage, have been reported over 97%, so the failure rate in this study was below 5%. Sensitivity of Pipellefor detection of atrophic endometrium was reported below 50%. Duration and cost was lower in Pipelle versuscurettage.
Conclusions: It is concluded that due to high agreement and cohesion coefficient between curettageand Pipelle on the issue of sampling adequacy, histopathology finding (except atrophic endometrium), low failurerate, duration of sampling and cost, Pipelle can be introduced as a suitable alternative of diagnostic curettage.