日常临床实践中用于异常子宫出血的 Pipelle 子宫内膜活检：为何对患者的诊疗方法应个性化？

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

作者信息

Tanko Naanlep M, Linkov Faina, Bapayeva Gauri, Ukybassova Talshyn, Kaiyrlykyzy Aiym, Aimagambetova Gulzhanat, Kenbayeva Kamila, Ibrayimov Bakytkali, Lyasova Alla, Terzic Milan

机构信息

Clinical Academic Department of Laboratory Medicine, Pathology and Genetics, University Medical Center, Republican Diagnostic Center, 2 Syganaq Street, Nur-Sultan 010000, Kazakhstan.

Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Zhanybek-Kerey khans Street, 5/1, Nur-Sultan 010000, Kazakhstan.

出版信息

J Pers Med. 2021 Sep 28;11(10):970. doi: 10.3390/jpm11100970.

DOI:10.3390/jpm11100970

PMID:34683110

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8539706/

Abstract

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.

摘要

背景

异常子宫出血（AUB）是一种常见的妇科疾病，恰当的管理基于对通过活检获取的足够子宫内膜样本进行组织学评估。本研究的目的是评估影响 Pipelle 子宫内膜取样用于组织病理学诊断的可靠性和成功率的因素。

方法

2019 年 1 月至 2021 年 4 月期间，180 例 AUB 患者在大学医学中心妇女健康临床学术部同时接受了 Pipelle 子宫内膜取样和刮宫术（D&C）。我们分析了年龄、绝经状态、种族、体重指数（BMI）、医疗人员经验和手术指征对每种手术的成功率和可靠性的影响。

结果

144 例（80.56%）女性 Pipelle 取样成功，而 164 例（91.11%）女性 D&C 成功。使用 Fisher 精确检验分析表明，年龄、绝经状态和活检指征是影响两种方法成功率的因素，而种族、BMI 和医生经验没有影响。Pipelle 和 D&C 组织病理学结果的总体一致性为 91.72%。

结论

发现 Pipelle 取样对于检测子宫内膜癌和子宫内膜增生是可靠的，而在子宫内膜息肉病例中其可靠性较低。在日常临床实践中，对于 AUB 女性，子宫内膜取样方法应个性化，Pipelle 取样并不适用于所有患者。如果怀疑有子宫内膜息肉，医生应考虑其他诊断工具，同时牢记所有影响子宫内膜取样成功率和可靠性的因素。