PIPPELE ppt

ROMMEL A. DECENA, MD

Most commonly encountered condition in gynecology.

Encompasses any significant deviation Frequency Regularity Heaviness (volume or amount) Duration

In almost all cases, an endometrial involvement or etiology must be ruled out.

Diagnostic curettage most common method utilized relatively blind procedure usually done under in-patient settings requiring intravenous sedation or regional

anesthesia

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.

The potential benefits for the patients less medical cost increase man-hours avoiding complications that may arise from

anesthesia during sedation

The potential benefits for the hospital decrease work load for medical and nursing

staff and thereby focusing more on other patients who needed more attention and care

frequency and cross tabulation paired t-test weighted mean F-test

RESULTS AND DISCUSSION

Histopathologic Results Diagnostic Curettage

Pipelle Cannula

Placental tissues 3 5

Normal 25 27

Polyp 53 40

Simple Hyperplasia 30 33

Simple Hyperplasia with atypia

1 2

Complex Hyperplasia 1 3

Complex Hyperplasia with atypia

4 6

Carcinoma 3 4

Total 120 120

Table 1. Comparing the histopathologic results of endometrial tissues collected using pipelle cannula

as to diagnostic curettage

Histopathological results DiagnosticCurettage

Pipelle

Normal 28 32

Polyp and Hyperplasia 85 78

Pre-malignant and Malignant

7 10

Total 120 120

Table 1.1 Comparing the histopathologic results of endometrial tissues collected using pipelle cannula and diagnostic curettage

as to category

Prospective study N = 133 postmenopausal women Chief complaint: vaginal bleeding Endorette®: a brand of pipelle

cannula have similar diagnostic properties among

women with endometrium of <7 mm Diagnostic Curettage is superior to

Endorette® in women with endometrium of > 7 mm

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.

Endometrial thickness Normal

Polyp and Hyperplasia

Pre-malignant and Malignant

Pipelle D & C Pipelle D&C Pipelle D&C

0.6 to 1 16 13 29 31 1 2

1.1 to 2.0 10 11 31 32 5 3

1.6 and thicker 6 4 18 22 4 2

Total 32 28 78 85 10 7

p value 0.9370 p value 0.7647 P value 0.1428

Table 2. Comparison of histopathological results of pipelle and Diagnostic Curettage in relation with

endometrial thickness

OB score

Absence of pain

Mild pain

Moderate pain

Severe pain

Very severe

pain

WeightedMean

Description

G0P0 0 5 8 10 0 3.21 Moderate pain

G1P0 and G1P1

2 2 3 1 0 2.26 Mild pain

G2P0 and up

15 35 32 7 0 2.35 Mild pain

Total 17 42 43 18 0 2.61 Moderate pain

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

Table 3.2 Description of pain during collection of endometrial tissues using pipelle cannula

OB score

Absence of pain

Mild pain

Moderate pain

Severe pain

Worst pain

WeightedMean

Description

G0P0 0 6 11 6 0 3.0 Moderate pain

G1P0 and G1P1

2 4 2 0 0 2.0 Mild pain

G2P0 and up

17 46 19 7 0 2.17 Mild pain

Total 19 56 32 13 0 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 Yes No Weighted Mean Description

G0P0 15 8 1.35 Affirmative

G1P0/G1P1 7 1 1.125 Affirmative

G2P0 and up 80 9 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











Table 3.5 Recommendation of patients regarding the pipelle cannula

Author Study

IN THIS STUDY

100 % of the endometrial tissue samples obtained using the pipelle were adequate for histopathological diagnosis.

Bakkum-Gamez et al. 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.

Behnamfar, MD et al. 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.

Fakhar S, et al. 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.

Bharti, Bharani, Satish PR.

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.

Tanvriverdi HA, et al Is Pipelle biopsy really adequate for diagnosing endometrial disease? Med Sci Monit 2004; 10(6): 271-4

Yasmin F et alEfficacy of Pipelle as a tool for endometrial biopsy. Biomedica Vol. 23 (Jul-Dec 2007)

N = 8/120 (6.67%) Result: Benign endometrial gland and stroma

Comment by the pathologist: ▪ “Evaluation is limited by scant endometrial tissues in the submitted specimen”

Insufficient sample generally is not believed to cause a concern▪ “normal”1

▪ 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

2Tanniverdi, 2004

Patient Pipelle D & C TAHBSO

Green-MC-048 Consistent with well differentiated endometriod adenocarcinoma

Consistent with well differentiated endometriod adenocarcinoma

Consistent with well diffentiated endometriod adenocarcinoma WHO Grarde 2

White-JG-052 Consistent with well differentiated endometriod adenocarcinoma

Simple hyperplasia with focal complex hyperplasia with atypia

Consistent with an endometriod adenocarcinoma WHO Grade 2

White-GMC-054 Consistent with moderately to poorly differentiatedendometriod adenocarcinoma

Moderately differentiated endometriod adenocarcinoma

Moderately differentiated endometriod adenocarcinoma, WHO Grade 2

Orange-AV-074 Consider Malignant Mixed Mullerian Tumor

Malignant Mixed Mullerian Tumor

Malignant Mixed Mullerian Tumor

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.

Endometrial biopsy using pipelle cannula safe cost-effective office procedure an alternative to a more invasive

procedure

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

Endometrial thickness is not a significant factor for using pipelle

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.

Documents

PIPPELE ppt