Journal of Emergency Health Care
Formerly known as: International Journal of Medical Investigation
Volume 7, Issue 1 (3-2018)
J Emerg Health Care 2018, 7(1): 56-67 |
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Gelini Moghaddam T, Hedayatifar F, Nouri B. Comparing The Pipelle With Dilatation And Curettage (D&C) In Diagnostic Power Of Sampling For Evaluating The Patients With Abnormal Uterine Bleeding. J Emerg Health Care 2018; 7 (1) :56-67
URL: http://intjmi.com/article-1-303-en.html
URL: http://intjmi.com/article-1-303-en.html
Department of Obstetrics & Gynecology, Mazandaran University of Medical Science, Sari, Iran.
Abstract: (7891 Views)
Introduction: Abnormal uterine bleeding is a common and serious problem in the women of late reproductive age, and an indication for biopsy. Common diagnostic methods in Iran including the endometrial biopsy with dilatation and curettage (D&C) are the gold standard for diagnosis. The aim of this study is to compare the diagnostic power, complications, and duration of endometrial biopsy caused by two diagnostic methods of endometrial sampling of pipelle with dilatation and curettage (D&C) in patients with AUB. Methods: This single blinded- parallel randomized clinical trial was performed at the Iranian Center for Clinical Trials (IRCT). The research population is the patients referring to the specialized clinic of Mostafavian and Baghban 1 in Sari with complaints of AUB from October 2016 to September 2018. The patient selection was available for study. The patients were divided in simple random method into two groups of D&C and pipelle alternatively. The samples were sent to pathology after sampling, and when sampling is done, the patient was examined for complications such as uterine bleeding or vasovagal shock symptoms for the cervical stimulation, then, the results were compared with D&C, and also it was compared with the sample histopathologically. Findings: A number of 70 patients were included, while many of which were excluded, and finally 50 patients were completed the study. First, the biopsy with pipelle and then biopsy with D&C were performed on all the patients. The mean age of subjects was 47.5 years old. The highest number of patients (28%) was in the 40-45 group. The mean thickness of the endometrium in patients was 11.5 mm. In the pipelle group, 34% of the cases of insufficient samples were obtained, while using the biopsy, only 4% of the insufficient samples are obtained. A total of 23 samples from 50 patients undergoing pathologic diagnosis were obtained from two similar sampling methods. In the pipelle group, the insufficient sample with 34% proliferative, and then the secretion and proliferative samples were the second and third (prophylactic and secretion pathology are considered as normal tissues that was calculated 56% in this study) in the diagnosis, and accommodation of the pipelle and D&C samples in proliferative has allocated the highest percentage of 9%, and the lowest accommodation was in the in atrophy and polyps and hyperplasia. The average duration of the procedure in the pipelle group was significantly lower than D&C. The pain was significantly higher in pipelle group than D&C (P <0.05). Conclusion: Pipelle is a cheap, fast, outpatient method with low side effects without the use of anesthesia and operating room facilities for diagnosis of hyperplasia and cancer with lower susceptibility to D&C. In the D&C with acceptable susceptibility and specificity, the pain was lower, number of insufficient samples was lower, and diagnosis of polyps was higher.
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