A Comparative Evaluation of the Three Different Methods of Endometrial Sampling in the Diagnosis of Perimenopausal Bleeding: A Cross Sectional Study

Abstract

Background: Abnormal uterine bleeding (AUB) is a common cause for a woman of all ages to consult their gynaecologists. One-third of patients attending the Gynaecology OPD present with complaints of AUB. The present study was proposed to obtain the endometrial sampling by three different techniques: 1.endometrial cytology using the nasogastric tube 2. endometrial aspiration biopsy using the pipelle,  3.conventional dilatation and curettage and to evaluate the effectiveness of this three different process in obtaining satisfactory samples for endometrial evaluation by pathologists. The study of available literature shows that all the three different processes of endometrial sampling have not been evaluated to each other. Subjects and Methods: A total of 200 patients with the indication of perimenstrual bleeding were estimated. Each woman was subjected to the three different methods of endometrial sampling (endometrial aspiration cytology using the nasogastric tube, pipelle aspiration biopsy and dilatation and curettage). Results: Endometrial aspiration cytology was able to diagnose benign pathology in 44% cases and premalignant pathologies in 19% cases. Endometrial aspiration cytology was failed to detect pathology in 37% cases. It was failed to detect any malignancy. Pipelle biopsy showed benign pathologies in 49% cases, premalignant pathology in 45% cases and carcinoma in 2% cases. Endometrial sample was found to be inadequate in 4% cases. On the other hand, dilatation and curettage diagnosed benign pathologies in 50% cases, premalignant pathologies in 44% cases and  carcinoma in 2% cases.  Inadequate sample was found in 4% cases. Conclusion: Results of the present study suggest that accuracy for endometrial diagnosis of pipelle biopsy was equal to dilatation and curettage method of endometrial sampling. Pipelle biopsy has very high accuracy of 99% in detecting premalignant and malignant pathologies of endometrium. However, pipelle biopsy and dilatation and curettage method are equally effective in diagnosing endometrial pathologies. Comparing to dilatation and curettage method pipelle biopsy of endometrium takes shorter time and preserves stromal architecture better. We emphasise that pipelle biopsy should be used for the endometrial diagnosis in perimenopausal bleeding as it is less painful as well as rapid along with that it is cost effective.