Related to this topic: Equipment | Books | Your Experience | Other resources | Glossaries
Print options: Printer friendly version of this leaflet (html)     Other options:  AddThis Social Bookmark Button (what's this?)

PatientPlus articles are written for doctors and so the language can be technical. However, some people find that they add depth to the articles found in the other sections of this website which are written for non-medical people.

Pipelle Endometrial Sampling (Procedure)

To make a diagnosis of, or exclude, malignancy and premalignancy, it is necessary to obtain an endometrial biopsy for histological examination. The Cornier pipelle is a disposable polypropylene sheath with an inner plunger and is used for blind endometrial biopsy. It does not require a general anaesthetic.

Indications for use

Endometrial biopsy should be considered in the following women:

  • All women aged >40 years with abnormal bleeding.
  • Younger women with risk factors, including for endometrial cancer:
    • Nulliparity. Pregnancy protects from endometrial carcinoma by interrupting the continued stimulation of the endometrium by oestrogen.
    • Family history of endometrial or colonic cancer.
    • A history of abnormal smears.
    • Obesity.
    • Polycystic ovary syndrome.
    • Tamoxifen therapy.
    • Unopposed oestrogen therapy.
  • Younger women in whom abnormal bleeding does not resolve with medical treatment

It also has a role in screening for hereditary non-polyposis colorectal carcinoma; it is prudent to screen for gynaecological tumours in mutation positive families, irrespective of family history, as 40% of female gene carriers develop endometrial carcinomas.1

Procedure

The patient should have the procedure fully explained to her. A chaperone should be offered. A clean modesty blanket should be available. The use of oral non-steroidal anti-inflammatories e.g. mefenamic acid 500mg, prior to the procedure can reduce the post-procedure symptoms of pain and cramp.

  • Bimanual examination asseses the size and position of the uterus.
  • The cervix is visualised using a vaginal speculum, and cleaned.
  • Recent research has looked at transcervical instillation of 5mls 2% lignocaine. This was shown to significantly reduce pain during endometrial sampling.2
  • A tenaculum applied to the anterior lip of the cervix is used to provide gentle traction whilst a sound is inserted though the cervical os. This reduces the risk of uterine perforation.The tenaculum should be used to straighten the uterocervical canal, thereby preventing the pipelle from passing through the thin walled posterior vaginal wall.
  • Dilators may be required if there is difficulty in passing the sound.
  • When the position and size of the uterine cavity have been assessed, the pipelle is inserted through the cervical os and advanced until gentle resistance is felt.
  • The inner piston of the device is then withdrawn to create a suction and the endometrial sample is obtained by moving the pipelle up and down within the uterine cavity by approximately 2-3cm but not beyond the cervical os. As the cannula is rotated during removal, a strip of endometrium is peeled off and sucked into the syringe.
  • This procedure should be repeated at least four times, and the device rotated 360 degrees to ensure adequate coverage of the area.
  • The pipelle is then withdrawn from the cervical os and the endometrial sample expelled into a solution of formalin for transport to the laboratory.

Pipelle endometrial sampling can also be combined with hysteroscopy.

Complications

These include:

  • Prolonged bleeding
  • Infection
  • Uterine perforation
  • Post procedure pain and cramps

Bacteraemia can occur after endometrial sampling, and antibiotic prophylaxis must be given to patients at risk of endocarditis.3

Contraindications

These include:

Comments
  • Pipelle endometrial biopsy is a cost effective and safe procedure that is well tolerated by patients.
  • There is less pain and a lower risk of perforation with the pipelle than with the Novak curette.4
  • In addition, the pipelle is more portable than the Novak curette and the Vabra aspirator, both of which require external suction.
  • The detection rates for endometrial carcinoma using the Pipelle device were found by one metanalysis to be 99.6% in postmenopausal and 91% in premenopausal women.5
  • In post-menopausal women the combined use of pipelle sampling and ultrasound has a high detection rate for endometrial carcinoma.6 7
  • The pipelle is however, poor at detecting endometrial pathologies such as polyps and submucosal myomas.6
  • Pipelle aspirates provide accurate endometrial sampling in pre-menopausal patients with abnormal uterine bleeding.8
  • However, sampling error is greater with the pipelle and the device samples only 4% of the endometrium compared with 42% with the vabra aspirator.9


Document References
  1. Cole TRP. Sleightholme HV. The Role of Clinical genetics In Management. ABC of Colorectal Cancer. BMJ.; October 2000
  2. Hui SK, Lee L, Ong C, et al; Intrauterine lignocaine as an anaesthetic during endometrial sampling: a randomised double-blind controlled trial.; BJOG. 2006 Jan;113(1):53-7. [abstract]
  3. Livengood CH 3rd, Land MR, Addison WA; Endometrial biopsy, bacteremia, and endocarditis risk. Obstet Gynecol. 1985 May;65(5):678-81. [abstract]
  4. Hill GA, Herbert CM 3rd, Parker RA, et al; Comparison of late luteal phase endometrial biopsies using the Novak curette or PIPELLE endometrial suction curette. Obstet Gynecol. 1989 Mar;73(3 Pt 1):443-5. [abstract]
  5. Dijkhuizen FP, Mol BW, Brolmann HA, et al; The accuracy of endometrial sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia: a meta-analysis.; Cancer. 2000 Oct 15;89(8):1765-72. [abstract]
  6. Van den Bosch T, Vandendael A, Van Schoubroeck D, et al; Combining vaginal ultrasonography and office endometrial sampling in the diagnosis of endometrial disease in postmenopausal women. Obstet Gynecol. 1995 Mar;85(3):349-52. [abstract]
  7. Stovall TG, Photopulos GJ, Poston WM, et al; Pipelle endometrial sampling in patients with known endometrial carcinoma. Obstet Gynecol. 1991 Jun;77(6):954-6. [abstract]
  8. Goldchmit R, Katz Z, Blickstein I, et al; The accuracy of endometrial Pipelle sampling with and without sonographic measurement of endometrial thickness. Obstet Gynecol. 1993 Nov;82(5):727-30. [abstract]
  9. Rodriguez GC, Yaqub N, King ME; A comparison of the Pipelle device and the Vabra aspirator as measured by endometrial denudation in hysterectomy specimens: the Pipelle device samples significantly less of the endometrial surface than the Vabra aspirator. Am J Obstet Gynecol. 1993 Jan;168(1 Pt 1):55-9. [abstract]

Internet and Further Reading Acknowledgements EMIS is grateful to Dr Hayley Willacy for writing this article. The final copy has passed scrutiny by the independent Mentor GP reviewing team. ©EMIS 2007.
DocID: 2614
Document Version: 20
DocRef: bgp24699
Last Updated: 18 Jan 2007
Review Date: 17 Jan 2009
Patient UK Current Health News










Disclaimer: Patient UK has no control of the content of the above links. Inclusion does not imply endorsement by Patient UK.

Advertise on this site



PS - Health and Poverty

Perhaps the biggest cause of ill health in the world is poverty. Help to Make Poverty History. For example, why not lend some of your money to disadvantaged communities to enable them to trade their way out of poverty through schemes such as Shared Interest.

See also MAKEPOVERTYHISTORY North East for details and links to campaigns against poverty.

^ Top of Page