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Risk Factors for Unsuccessful Office-Based Endometrial Biopsy: A Comparative Study of Office-Based Endometrial Biopsy
Bingying Xie1, Cuifeng Qian1, Bingyi Yang1
1Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
Study Objective:
To determine the risk factors for Pipelle diagnostic failure, which might help healthcare providers choose the appropriate protocol for endometrial evaluation individually.
Design:
A single-center prospective study (Canadian Task Force classification II).
Setting:
The Obstetrics and Gynecology Hospital of Fudan University.
Patients:
Patients (n = 466) with an indication for endometrial biopsy.
Interventions:
All patients received Pipelle and then diagnostic dilation and curettage. The samples were sent for histopathologic diagnosis separately.
Measurements And Main Results:
The Pipelle procedure failed in 10 of 466 patients (2.146%). The general sample inadequacy and histopathologic diagnosis inconsistency of Pipelle was 5.921% (27/456) and 14.254% (65/456), respectively. Upon multivariate analysis, history of cervical operation(s) (odds ratio [OR], 26.510; 95% coefficient interval [CI], 2.932-239.784; p = .004), prior intrauterine procedure(s) (OR, .096; 95% CI, .017-.554; p = .009), and pinpoint cervical os (OR, 5.939; 95% CI, 1.134-31.108; p = .035) were significantly associated with Pipelle procedure failure. Meanwhile, uterine volume < 43 cm3 (OR, 8.229; 95% CI, 1.902-35.601; p = .005) and uneven endometrium detected by ultrasound (OR, .176; 95% CI, .042-.734; p = .017) had significant correlation with sample inadequacy. Pipelle detected all endometrial cancer cases, whereas only 50.000% (7/14) of endometrial hyperplasia with atypia, 26.471% (9/34) of polyps, and 18.182% (2/11) of polyps with endometrial hyperplasia without atypia cases were detected by Pipelle.
Conclusion:
Although Pipelle is the first-line method for endometrial biopsy, it might fail in women with risk factors identified in this study. More considerations should be taken when choosing Pipelle.
