Histological sampling with pipelle or similar instrumentMedical editor Gunnar B. Kristensen MD
Oslo University Hospital
Cancer is always suspected when a woman has postmenopausal bleeding, even if benign conditions are most common. When postmenopausal bleeding occurs, ultrasound is always performed as well as endometrial sampling for histological evaluation. The tissue sample can be taken with either a pipelle or equivalent instrument, or by fractionated abrasion. The endometrial sampling can be done as an outpatient procedure without anesthesia, however, fractionated abrasion requires anesthesia.
A meta-analysis (10) has shown a 97–99% sensitivity and 98–100% specificity of pipelle or vabra methods in diagnosing endometrial cancer. The amount of material obtained by pipelle is sometimes minimal to determine the histological type and grade. In such cases, we choose to do fractionated abrasion under general anesthesia.
- To obtain a representative endometrial sample for histological evaluation.
- Broad-spectrum antiseptic such as chlorhexidine 0.5 mg/ml
- Specimen container with formalin
- Inform the patient about the sampling procedure.
- Sampling may cause some discomfort, but little pain.
- The sampling is done at an outpatient clinic without general anesthesia.
- The patient lies in a gynecological position during the sampling.
- The vagina and cervix are washed with broad-spectrum antiseptic (chlorhexidine) 0.5 mg/ml).
- The gynecologist inserts the pipelle into the cervical canal and up into the uterine cavity until it reaches the top of the uterine cavity.
- Vacuum is created by aspiration and maintaining this.
- Scrape the material from the uterine wall all the way around by moving the pipelle back and forth under rotation.
- Remove the pipelle.
- Empty the pipelle of collected material and put it into a specimen container with formalin.
A follow-up meeting with the gynecologist will take place when the result is available.