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PIPPELE
PIPPELE
DECENA, MD
Frequency
Regularity
Heaviness (volume or amount) Duration
Diagnostic curettage
most common method utilized relatively blind procedure usually done under in-patient settings
Pipelle cannula
utilized in an out-patient setting
obviating the need for admission and possible anesthetic risks and complications
To determine the accuracy of pipelle cannula in diagnosing endometrial pathology among women with abnormal uterine bleeding
To compare the histopathological result of endometrial tissues collected using pipelle cannula with diagnostic curettage. To determine the threshold of endometrial thickness wherein the histopathologic results for both pipelle and diagnostic curettage would be reproducible.
To determine the degree of pain and degree of comfort/discomfort of patients undergoing pipelle curettage.
Diagnostic curettage requires patient to be admitted and be sedated intravenously in order to perform the procedure.
In the absence of significant difference on the
result, pipelle cannula biopsy of endometrial tissue will be recommended as an office procedure in this institution.
during sedation
thereby focusing more on other patients who needed more attention and care
Patient selection
Prospective Non-Randomized Study Patients screened: Inclusion and Exclusion Criteria Baseline Labs: CBC with platelet count, UA, pregnancy test, UTZ
Consent for procedure obtained Pipelle endometrial sampling questionnaires Endometrial Diagnostic curettage under IV sedation sampling
Table 1. Comparing the histopathologic results of endometrial tissues collected using pipelle cannula as to diagnostic curettage
Histopathologic Results Placental tissues Normal Polyp Diagnostic Curettage 3 25 53 Pipelle Cannula 5 27 40
Simple Hyperplasia
Simple Hyperplasia with atypia Complex Hyperplasia Complex Hyperplasia with atypia Carcinoma
30
1 1 4 3
33
2 3 6 4
Total
120
120
Table 1.1 Comparing the histopathologic results of endometrial tissues collected using pipelle cannula and diagnostic curettage as to category
Histopathological results
Diagnostic Curettage
Pipelle
28 85 7
120
32 78 10
120
Prospective study N = 133 postmenopausal women Chief complaint: vaginal bleeding Endorette: a brand of pipelle cannula
have similar diagnostic properties among women
Epstein, E et al. Comparison of Endorette and Dilatation and Curettage for Sampling of the Endometrium in Women with Postmenopausal Bleeding. Acta Obstetricia e tGynecologica Scandinavica. 2001:80:959-964.
Table 2. Comparison of histopathological results of pipelle and Diagnostic Curettage in relation with endometrial thickness
Endometrial thickness Polyp and Hyperplasia Pipelle D&C Pre-malignant and Malignant Pipelle D&C
0.6 to 1
16
13
29
31
1.1 to 2.0
10
11
31
32
18
22
Total
32
28
78
85
10
p value 0.9370
p value 0.7647
P value 0.1428
Table 3.1 Description of the pain during the procedure, from inserting the speculum, grasping the anterior fornix using the tenaculum up to insertion of the pipelle cannula
OB score
Absence of pain
Mild pain
Moderate pain
Severe pain
Weighted Mean
Description
0 2
5 2
8 3
10 1
3.21 2.26
G2P0 and up
15
35
32
2.35
Mild pain
Total
17
42
43
18
2.61
Moderate pain
Table 3.2 Description of pain during collection of endometrial tissues using pipelle cannula
Absence of pain 0 2
Mild pain 6 4
Moderate pain 11 2
Severe pain 6 0
Worst pain 0 0
Description
17
46
19
2.17
Mild pain
19
56
32
13
2.39
Moderate pain
Table 3.3 Comfortability of patients during the procedure, from inserting the speculum, grasping the anterior fornix using the tenaculum up to insertion of the pipelle cannula
OB score G0P0
Yes 15
No 8
Description Affirmative
G1P0/G1P1
1.125
Affirmative
G2P0 and up
80
1.10
Affirmative
Total
102
18
1.19
Affirmative
Table 3.4 Comfortability of patients during the collection of endometrial tissues using the pipelle cannula
OB score G0P0
Yes 16
No 7
Description Affirmative
G1P0/G1P1
1.125
Affirmative
G2P0 and up
81
1.09
Affirmative
Total
104
16
1.17
Affirmative
Yes
18 7 82 107
No
5 1 7 13
Weighted Mean
1.21 1.125 1.07 1.14
Description
Affirmative Affirmative Affirmative Affirmative
Author
Study
IN THIS STUDY
Bakkum-Gamez et al. Behnamfar, MD et al. Fakhar S, et al.
100 % of the endometrial tissue samples obtained using the pipelle were adequate for histopathological diagnosis.
Current Issues in the Management of Endometrial Cancer. Mayo Clinic Proceedings: Symposium on Solid Tumors, Mayo Foundation for Medical Education and Research. January 2008;83 (1) 99-100. Diagnostic Value Endometrial Sampling with Pipelle Suction Curettage for Identifying Endometrial Lesion Among Women with Abnormal Uterine Bleeding. Journal of Research in Medicine:2004:3:123-125. Validity of Pipelle Endometrial Sampling in Patients with Abnormal Uterine Bleeding. Annual Saudi Medicine 2008; 28:188-91.
Epstein, E et al.
Comparison of Endorette and Dilatation and Curettage for Sampling of the Endometrium in Women with Postmenopausal Bleeding. Acta Obstetricia e tGynecologica Scandinavica. 2001:80:959-964.
Feasibility and yield of Endometrial Biopsy using Suction curette device for evaluation of abnormal pre and postmenopausal bleeding. Journal of Obstetrics and Gynecology of India. 2008;58(4):322-326. Is Pipelle biopsy really adequate for diagnosing endometrial disease? Med Sci Monit 2004; 10(6): 271-4
Efficacy of Pipelle as a tool for endometrial biopsy. Biomedica Vol. 23 (Jul-Dec 2007)
N = 8/120 (6.67%)
Result: Benign endometrial gland and
to cause a concern
normal1 as failure to obtain an endometrial specimen from a device correctly positioned within the uterine cavity is considered to be an assurance that no significant intrauterine pathology is present.2
1Epstein,
2001 2004
2Tanniverdi,
Patient Green-MC-048
Pipelle Consistent with well differentiated endometriod adenocarcinoma Consistent with well differentiated endometriod adenocarcinoma
D&C Consistent with well differentiated endometriod adenocarcinoma Simple hyperplasia with focal complex hyperplasia with atypia
TAHBSO Consistent with well diffentiated endometriod adenocarcinoma WHO Grarde 2 Consistent with an endometriod adenocarcinoma WHO Grade 2
White-JG-052
White-GMC-054
Orange-AV-074
Endometrial thickness is not a significant factor in using pipelle contrary to the findings of Epstein (2001)
Patient discomfort during pipelle curettage was noted more on nulligravid patients.
Good rapport with the patient and thorough explanation of the procedure give a sense of security and assurance to the patient and may lessen their anxiety.
The endometrial tissue sample obtained using pipelle is sufficient and adequate for histology. The histopathological result of endometrial tissue sample obtained using pipelle cannula is comparable to that of diagnostic curettage
A thorough explanation to guarantee that pipelle curettage is a generally safe, and tolerable procedure is recommended to give each patient a sense of security and assurance so as to lessen their anxiety.