Pipelle Endometrial Biopsy for Abnormal Uterine Bleeding in Daily Clinical Practice: Why the Approach to Patients Should Be Personalized?

Background. Abnormal uterine bleeding (AUB) is a common gynecologic condition, and proper management is based on the histological evaluation of an adequate endometrial sample obtained via biopsy. The aims of this study were to evaluate factors influencing the reliability and success rate of Pipelle endometrial sampling for histopathological diagnosis. Methods. One hundred and eighty patients with AUB underwent endometrial sampling using both Pipelle and dilatation and curettage (D&C) procedures at the Clinical Academic Department of Women’s Health, University Medical Center between January 2019 and April 2021. We analyzed the effects of age, menopausal status, ethnicity, body mass index (BMI), provider experience, and procedure indication on the success and reliability of each procedure. Results. Pipelle sampling was successful in 144 (80.56%) women, while D&C was successful in 164 (91.11%) women. Analysis using Fisher’s exact test showed that age, menopausal status, and biopsy indication were factors affecting the success rate of both methods, while ethnicity, BMI, and physician experience had no influence. Overall concordance in the histopathological results between Pipelle and D&C was 91.72%. Conclusion. Pipelle sampling was found to be reliable for the detection of endometrial carcinoma and endometrial hyperplasia, while its reliability was low in cases of endometrial polyps. The endometrial sampling approach should be personalized in daily clinical practice for women with AUB, and Pipelle sampling is not suitable for all patients. If an endometrial polyp is suspected, the physician should consider other diagnostic tools, bearing in mind all of the factors influencing endometrial sampling success and reliability rates.