How representative are Pipelle endometrial biopsies? A retrospective analysis of 324 biopsies followed by transcervical resection of the endometrium or hysterectomy

Objective To evaluate the diagnostic accuracy of Pipelle endometrial biopsies before surgical treatment of uterine bleeding disorders. Design Retrospective analysis. Setting County Hospital unit specializing in operative hysteroscopy. Interventions Routine outpatient endometrium biopsies were taken from 628 patients because of uterine bleeding disorders. Of these patients, 249 underwent transcervical resection of the endometrium (TCRE) and 75 had a hysterectomy within 6 months. Results Comparing the two subgroups ‘malignant’ and ‘benign’, the positive predictive value for endometrial malignancy was 100% (95% CI, 73.5–100). Insufficient tissue was obtained in five cases (1.5%); in three there were submucous fibroids, in one sampling took place after TCRE, and one patient had atrophic endometrium. Conclusion Adequate preoperative histological assessment of the endometrium is feasible with Pipelle biopsies, and they are highly accurate in detecting endometrial malignancy.