DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20212164

Comparison of adequacy of endometrial biopsy using endosampler and hysteroscope guided sampling

Vijay Zutshi, Asmita Saran, Charanjeet Ahluwalia

Abstract


Background: The objective of the study was to compare the tissue adequacy of endometrial biopsy obtained using hysteroscope guided biopsy and endosampler for histopathology.

Methods: This was a cross sectional study in the Department of Obstetrics and Gynaecology and Pathology, Medical College Hospital, New Delhi, India. Ninety patients fulfilling the inclusion criteria were subjected to office hysteroscope guided biopsy followed by endometrial aspiration biopsy using endosampler in the same sitting. Labelling of samples was done as ‘A’ and ‘B’ and sent for histopathological examination in 10% formalin. Pathologist was blinded to the type of biopsy taken and samples were evaluated for tissue adequacy. The presence of even one intact endometrial gland with stroma was labelled as adequate endometrial biopsy sample by the pathologist.

Results: The endometrial biopsy samples obtained by both methods were adequate in 35 patients (38.89%). On the other hand, there were 18 patients (20%) who had inadequate sampling results by both methods. Out of the remaining 37 patients, in 13 (14.44%) patient’s endometrial biopsy was adequate by hysteroscope guided biopsy and in 24 (26.67%) patients it was adequate using endometrial aspiration   Individually, hysteroscope guided biopsies were found to have adequate results in 48 patients out of 90 (53.33%) while endosampler aspiration provided adequate biopsy results in 59 patients out of 90 (65.56%) after excluding the number of patients having inadequate reports. The difference between tissue adequacy of both devices was not statistically significant (p=0.129). A significant correlation was found between age (p<0.001), endometrial thickness on ultrasound (p<0.0001) and tissue adequacy by both methods.

Conclusions: Endometrial biopsy obtained by hysteroscope guided method and endometrial aspiration was comparable in terms of tissue adequacy.


Keywords


Hysteroscope, Endosampler

Full Text:

PDF

References


Seamark CJ. The demise of the D&C. J R Soc Med. 1998;91(2):76-9.

Stovall TG, Ling FW, Morgan PL. A prospective, randomized comparison of the Pipelle endometrial sampling device with the Novak curette. Am J Obstet Gynecol. 1991;165(5):1287-90.

Larson DM, Krawisz BR, Johnson KK, Broste SK. Comparison of the Z-sampler and Novak endometrial biopsy instruments for in-office diagnosis of endometrial cancer. Gynecol Oncol. 1994;54(1):64-7.

Rodriguez GC, Yaqub N, King ME. A comparison of the Pipelle device and the Vabra aspirator as measured by endometrial denudation in hysterectomy specimens: the Pipelle device samples significantly less of the endometrial surface than the Vabra aspirator. Am J Obstet Gynecol. 1993;168(1):55-9.

Naim NM, Mahdy ZA, Ahmad S, Razi ZR. The Vabra aspirator versus the Pipelle device for outpatient endometrial sampling. Aust N Z J Obstet Gynaecol. 2007;47(2):132-6.

Gungorduk K, Asicioglu O, Ertas IE, Ozdemir IA, Ulker MM, Yildirim G, et al. Comparison of the histopathological diagnoses of preoperative dilatation and curettage and Pipelle biopsy. Eur J Gynaecol Oncol. 2014;35(5):539-43.

Abdelazim IA, Aboelezz A, Abdulkareem AF. Pipelle endometrial sampling versus conventional dilatation & curettage in patients with abnormal uterine bleeding. J Turk Ger Gynecol Assoc. 2013;14(1):1-5.

Kazandi M, Okmen F, Ergenoglu AM, Yeniel AO, Zeybek B, Zekioglu O, et al. Comparison of the success of histopathological diagnosis with dilatation-curettage and Pipelle endometrial sampling. J Obstet Gynaecol. 2012;32(8):790-4.

Elsandabesee D, Greenwood P. The performance of Pipelle endometrial sampling in a dedicated postmenopausal bleeding clinic. J Obstet Gynaecol. 2005;25(1):32-4.

Du J, Li Y, Lv S, Wang Q, Sun C, Dong X, et al. Endometrial sampling devices for early diagnosis of endometrial lesions. J Cancer Res Clin Oncol. 2016;142(12):2515-22.

Soeters R, Whittaker J, Dehaeck K. Endometrial sampling: a comparison between the Pipelle endometrium sampler and the Endosampler. South Africa J Gynaecol Oncol. 2011;3(1):34-8.

Ejzenberg D, Simoes MJ, Pinheiro W, Soares JM Júnior, Serafini PC, Baracat EC. Blind aspiration biopsy versus a guided hysteroscopic technique for investigation of the endometrium in infertile women. Histol Histopathol. 2016;31(9):981-6.

Garuti G, Cellani F, Colonnelli M, Garzia D, Gonfiantini C, Luerti M. Hysteroscopically targeted biopsies compared with blind samplings in endometrial assessment of menopausal women taking tamoxifen for breast cancer. J Am Assoc Gynecol Laparosc. 2004;11(1):62-7.

Bettocchi S, Venere R, Pansini N, Pansini MV, Pellegrino A, Santamato S, Ceci O. Endometrial biopsies using small-diameter hysteroscopes and 5F instruments: how can we obtain enough material for a correct histologic diagnosis? J Am Assoc Gynecol Laparosc. 2002;9(3):290-2.

Arumaikannu J, Priyadarsene P, Rani U. Accuracy of pipelle aspiration versus office hysteroscope in diagnosing endometrial pathology in perimenopausal women with abnormal uterine bleeding. Indian J of Res. 2016;5(12).

Kandil D, Yang X, Stockl T, Liu Y. Clinical outcomes of patients with insufficient sample from endometrial biopsy or curettage. Int J Gynecol Pathol. 2014;33(5):500-6.

Trimble CL, Method M, Leitao M, Lu K, Ioffe O, Hampton M, et al. Management of endometrial precancers. Obstet Gynecol. 2012;120(5):1160-75.

Litta P, Merlin F, Saccardi C, Pozzan C, Sacco G, Fracas M, et al. Role of hysteroscopy with endometrial biopsy to rule out endometrial cancer in postmenopausal women with abnormal uterine bleeding. Maturitas. 2005;50(2):117-23.

Trimble CL, Kauderer J, Zaino R, Silverberg S, Lim PC, Burke JJ, et al. Concurrent endometrial carcinoma in women with a biopsy diagnosis of atypical endometrial hyperplasia: a Gynecologic Oncology Group study. Cancer. 2006;106(4):812-9.

Sivakumar S, Vaishnavi V. Comparartive study of endometrial sampling using Pipelle with hysteroscope guided biopsy. J of Evidence Based Med and Healthcare. 2017;4(53):3236-40.

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

Aue AA, Kleebkaow P, Kietpeerakool C. Incidence and risk factors for insufficient endometrial tissue from endometrial sampling. Int J Womens Health. 2018;10:453-7.

Visser NC, Breijer MC, Herman MC, Bekkers RL, Veersema S, Opmeer BC, et al. Factors attributing to the failure of endometrial sampling in women with postmenopausal bleeding. Acta Obstet Gynecol Scand. 2013;92(10):1216-22.

Breijer MC, Visser NC, Hanegem N, Wurff AA, Opmeer BC, Doorn HC, et al. A Structured Assessment to Decrease the Amount of Inconclusive Endometrial Biopsies in Women with Postmenopausal Bleeding. Int J Surg Oncol. 2016;3039261.

Xie B, Qian C, Yang B, Ning C, Yao X, Du Y, et al. Risk Factors for Unsuccessful Office-Based Endometrial Biopsy: A Comparative Study of Office-Based Endometrial Biopsy (Pipelle) and Diagnostic Dilation and Curettage. J Minim Invasive Gynecol. 2018;25(4):724-9.