Accuracy of endometrial biopsy by Pipelle: A systematic review and meta-analysis

Abstract

Abstract Background Abnormal uterine bleeding is the most common complaint in women attending to physicians, especially in the peri-menopausal and post-menopausal period which is reported to account for 70% of all gynecological consultations. The main aim of investigations for abnormal uterine bleeding is to rule out intrauterine pathology, particularly endometrial cancer or atypical hyperplasia.The study was aimed to conduct a systematic review and meta-analysis to evaluate the diagnostic accuracy of endometrial biopsy with Pipelle in women with abnormal uterine bleeding compared to D&C (reference standard) and sufficiency of the obtained endometrial tissue of two techniques. Methods Literature for studies published between 1965 and 2019 comparing the results of Pipelle with findings by D&C was searched. The QUADAS 2 tool was performed to evaluate the risk and applicability of each study. The diagnostic accuracy of Pipelle was evaluated through calculation of sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio with pooled proportion. Results A total of 8 studies and 1675 patients were included in this meta-analysis. The pooled sensitivity of endometrial sampling by Pipelle was 70.9% (95%CI: 58.1%-81.1%) in endometrial tumor, 97.2% (95%CI: 95.5%-98.3%) in endometrial benign disease, and 94.4% (95%CI 92.7%-95.8%) in normal endometrium. The pooled specificity of Pipelle was 99.6% (95%CI: 99.0%-99.9%) in endometrial tumor, 74.7% (95% 56.4%-87.1%) in endometrial benign disease, and 90.0% (95%CI 75.5%-96.3%) in normal endometrium. The positive likelihood ratio by Pipelle in the diagnosis of endometrial tumor, benign disease and normal endometrium was 191.06 (95%CI 70.81-515.48), 28.86 (95%CI 15.10-55.19) and 9.573 (95%CI 4.28-21.40), while the negative likelihood ratio by Pipelle was 0.337 (95%CI 0.236-0.482), 0.241 (95%CI 0.131-0.444) and 0.07 (95%CI 0.04-0.11), respectively. The highest DOR 851.68 was achieved in the result of endometrial tumor. Conclusions Pipelle can be introduced as a suitable alternative of diagnostic curettage. When an adequate specimen is obtained, a positive test result is more accurate for ruling in disease than a negative test result for ruling it out. Legal entity responsible for the study The authors. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.