Published: 2020-08-26

Role of pipelle versus dilatation and curettage in tissue diagnosis abnormal uterine bleeding

Markad Swapnil Balaram, Roopa R. Shinde, C. Suresh Babu, Hamid Mubashar Mohamed Mubasher, Ranoji Vijaysing Shinde


Background: Menstrual irregularities and abnormal heavy menstruation account for up to 26-35% of women attending Gynecological outpatient Department. Abnormal Uterine Bleeding (AUB), it is more common at extremes of age endometrial hyperplasia occurs in 5-10% of patients with post-menopausal bleeding out of which atypical hyperplasia has 26-32 % risk of having malignancy in future. Therefore, endometrial sampling for histopathology is important in the assessment of abnormal uterine bleeding is mandatory. Our study was conductive to know the effectiveness of pipelle type devices, versus Dilatation and curettage in obtaining quality endometrial tissue for histopathological examination.

Methods: The study was undertaken in Department of obstetrics and gynaecology along with department of Pathology at Rajarshi Chhatrapati Shahu Maharaj, government medical college, Kolhapur after getting approval from the Hospital Committee on Clinical Research and Ethical Committee of the institution, during the period from October 2016 to March 2017 (six months). Total number of subjects included in study is Hundred after taking into consideration of inclusion and exclusion criteria.

Results: The ease of doing procedure was much easier as compared to D&C and the Tissue sample obtained for histopathological examination were as par D&C. It was concluded that histopathology report was available in 92 of the 100 pipelle samples and 93 of 100 D&C samples. It was also, observed that increased endometrial thickness was not always associated with adequate tissue diagnosis.

Conclusions: Pipelle is simple, affordable, patient friendly can be easily performed with minimal training, which can be performed in Outpatient Gynaecological Department. The diagnostic value and positive predictive value of Pipelle is at par with conventional D&C. So, pipelle can be recommended for all perimenopausal patients with AUB to rule out various, premalignant and malignant conditions of the endometrium.


Endometrial quality tissue, Histopathology, Pipelle, Transabdominal Ultrasound

Full Text:



Shaw W. Textbook of gynaecology. British Med J. 1948;1(4562):1138.

Seltzer VL, Benjamin F, Deutsch S. Perimenopausal bleeding patterns and pathologic findings. J American Medical Women's Association. 1990;45(4):132-4.

Dijkhuizen FP, Mol BW, Brölmann HA, Heintz AP. The accuracy of endometrial sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia. Cancer. 2000;89(8):1765-72.

Seamark CJ. Endometrial sampling in general practice. Br J Gen Pract. 1998;48(434):1597-8.

Ben-Baruch G, Seidman DS, Schiff E, Moran O, Menczer J. Outpatient endometrial sampling with the Pipelle curette. Gynecologic and obstetric investigation. 1994;37(4):260-2.

Williams AR, Brechin S, Porter AJ, Warner P, Critchley HO. Factors affecting adequacy of Pipelle and Tao Brush endometrial sampling. BJOG: An Intern J Obst Gynaecol. 2008;115(8):1028-36.

Bakour SH, Khan KS, Gupta JK. Controlled analysis of factors associated with insufficient sample on outpatient endometrial biopsy. BJOG: An Intern J Obst Gynaecol. 2000;107(10):1312-4.

Ben-Baruch G, Seidman DS, Schiff E, Moran O, Menczer J. Outpatient endometrial sampling with the Pipelle curette. Gynecologic Obstetric Investigation. 1994;37(4):260-2.

Fakhar S, Saeed G, Khan A, Alam A. Validity of pipelle endometrial sampling in patients with abnormal uterine bleeding. Annals of Saudi Medicine. 2008;28(3):188.

Huang GS, Gebb JS, Einstein MH, Shahabi S, Novetsky AP, Goldberg GL. Accuracy of preoperative endometrial sampling for the detection of high-grade endometrial tumors. American J Obst Gynecol. 2007;196(3):243-e1.

Behnamfar F, Khamehchian TA, Mazoochi T, Fahiminejad T. Diagnostic value of endometrial sampling with Pipelle suction curettage for identifying endometrial lesions in patients with abnormal uterine bleeding. J Res Med Sci. 2004;9(3):123-5.

Choudry A, Javaid M. Clinical usefulness of Pipelle endometrialsampling. Pak Armed Forces Med J. 2005;55:122-5.

Timmermans A, Gerritse MB, Opmeer BC, Jansen FW, Mol BW, Veersema S. Diagnostic accuracy of endometrial thickness to exclude polyps in women with postmenopausal bleeding. J Clin Ultrasound. 2008;36(5):286-90.

Gordon SJ, Westgate J. The incidence and management of failed Pipelle sampling in a general outpatient clinic. Australian and New Zealand J Obst Gynaecol. 1999;39(1):115-8.

Van den Bosch T, Vandendael A, Wranz PA, Lombard CJ. Endopap®-versus Pipelle®-sampling in the diagnosis of postmenopausal endometrial disease. European J Obst Gynecol Reproductive Biology. 1996;64(1):91-4.

Yasmin F, Farrukh R, Kamal F. Efficacy of pipelle as a tool for endometrial biopsy. Biomedica. 2007;23:116-9.

Machado F, Moreno J, Carazo M, Leon J, Fiol G, Serna R. Accuracy of endometrial biopsy with the Cornier pipelle for diagnosis of endometrial cancer and atypical hyperplasia. European J Gynaecol Oncol. 2002;24(3-4):279-81.

Gimpelson RJ. The accuracy of endometrial pipelle sampling with and without sonographic measurement of endometrial thickness. Obst Gynecol. 1994;83(3):480.

Antoni J, Folch E, Costa J, Foradada CM, Cayuela E, Combalia N, Rue M. Comparison of cytospat and pipelle endometrial biopsy instruments. European J Obst Gynecol Reproductive Biol. 1997;72(1):57-61.

Stovall TG, Ling FW, Morgan PL. A prospective, randomized comparison of the Pipelle endometrial sampling device with the Novak curette. American J Obst Gynecol. 1991;165(4):1287-90.