Which is the best technique for endometrial sampling? Aspiration (pipelle) versus dilatation and curettage (D&C)

Purpose To compare diagnostic accuracy and adequacy of pipelle endometrial biopsy with dilatation and curettage. Methods From October 2007 to November 2009, 673 patients were evaluated with pipelle endometrium biopsy, D&C and hysterectomy in the Department of Obstetrics and Gynecology, Istanbul University Cerrahpasa Medical Faculty. 478 patients underwent pipelle and D&C, 212 patients underwent pipelle and hysterectomy and 161 patients underwent D&C and hysterectomy. Uterine findings were grouped under five headings: normal, hyperplasia, focal lesion, atypia, and atrophy. Histologic sections from pipelle biopsy or D&C specimens were compared with each other and hysterectomy specimens. Chi-square, Mc.Nemar, and Fisher-exact tests were used as appropriate. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each method used in the study. Results We compared the histological results of pipelle biopsy and D&C. Statistically outcomes of pipelle and D&C were concordant with each other. Concordance rate was 67 % between pipelle and hysterectomy and 70 % between D&C and hysterectomy. Sensitivity of pipelle biopsy in detection of hyperplasia and aytpia was 67 and 75 %, respectively. Sensitivity of D&C for detecting hyperplasia and atypia was 62 and 83 %. NPV of pipelle biopsy and D&C was 99 % for malignancy. Conclusions Pipelle biopsy and D&C showed almost equal success rate in the diagnosis of endometrial pathologies. Neither pipelle nor D&C is adequate method for focal endometrial pathologies. Both biopsy methods are not perfect, but pipelle biopsy is a cheaper and easy technique compared with D&C, and ultrasonographic findings of endometrium should be considered prior to endometrial biopsy.