Research Article| Volume 203, P12-15, August 2016

Positive predictive value of endometrial polyps in Pipelle aspiration sampling: a histopathological study of 195 cases



      To estimate the positive predictive value of Pipelle endometrial sampling in detecting the presence of an underlying endometrial polyp. The secondary objective is to examine the histologic features that can predict the presence of endometrial polyps.

      Study design

      This is a retrospective case review study. 195 women who had undergone diagnostic hysteroscopy and/or polypectomy were identified in a University teaching hospital. All patients had a prior polyp diagnosis in the Pipelle endometrial sample. The histology of these samples were compared and analyzed with subsequent DH findings and final hysteroscopic biopsies. Slides were reviewed by 2 gynaecological pathologists.


      162 women were premenopausal (mean age 46.1, SD = 4.6) and 33 were postmenopausal (mean age 57.2, SD = 8.1). The commonest indication for a Pipelle endometrial sampling was abnormal uterine bleeding. Presence of polyp was confirmed by DH in 56.3% (111/195) cases. Of these, 81.1% (90/111) were confirmed histologically. The positive predictive value of detection of polyps in Pipelle endometrial samples for premenopausal and postmenopausal women was 53.7% and 72.7%, respectively (p = .05). The most reliable histologic features that can predict the presence of an underlying polyp was fibrous stroma (p = .01) and focal glandular clustering (p = .03). The prevalence of endometrial hyperplasia and carcinoma in women who was confirmed to have polyp was 11.7% (13/111).


      The positive predictive value of Pipelle endometrial samples in detecting endometrial polyps was 56.3%. It was higher in the postmenopausal women (72.7%) compared to premenopausal women (53.7%). The prevalence of endometrial hyperplasia and carcinoma in women who was confirmed to have polyp was consistent with the rate reported in the literature. Using ultrasonography as an adjunct maybe helpful in diagnosing endometrial polyps.


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        • Ngu S.F.
        • Cheung V.Y.
        • Pun T.C.
        Randomized study of vaginoscopy and H Pipelle vs. traditional hysteroscopy and standard Pipelle.
        J Minim Invasive Gynecol. 2012; 19: 206-211
        • Dealberti D.
        • Riboni F.
        • Prigione S.
        • et al.
        New mini-resectoscope: analysis of preliminary quality results in outpatient hysteroscopic polypectomy.
        Arch Gynecol Obstet. 2013; 288: 349-353
        • Salim S.
        • Won H.
        • Nesbitt-Hawes E.
        • Campbell N.
        • Abbott J.
        Diagnosis and management of endometrial polyps: a critical review of the literature.
        J Minim Invasive Gynecol. 2011; 18: 569-581
        • Kazandi M.
        • Okmen F.
        • Ergenoglu A.M.
        • et al.
        Comparison of the success of histopathological diagnosis with dilatation-curettage and Pipelle endometrial sampling.
        J Obstet Gynaecol. 2012; 32: 790-794
        • McCluggage W.G.
        My approach to the interpretation of endometrial biopsies and curettings.
        J Clin Pathol. 2006; 59: 801-812
        • Elpek G.
        • Uner M.
        • Elpek G.O.
        • Sedele M.
        • Karaveli S.
        The diagnostic accuracy of the Pipelle endometrial sampler in the presence of endometrial polyps.
        J Obstet Gynaecol. 1998; 18: 274-275
        • Liu H.
        • Wang F.L.
        • Zhao Y.M.
        • Yao Y.Q.
        • Li Y.L.
        Comparison of Pipelle sampler with conventional dilatation and curettage (D&C) for Chinese endometrial biopsy.
        J Obstet Gynaecol. 2014; December (31): 1-4
        • Demirkiran F.
        • Yavuz E.
        • Erenel H.
        • Bese T.
        • Arvas M.
        • Sanioglu C.
        Which is the best technique for endometrial sampling? Aspiration (pipelle) versus dilatation and curettage (D&C).
        Arch Gynecol Obstet. 2012; 286: 1277-1282
        • Epstein E.
        • Ramirez A.
        • Skoog L.
        • Valentin L.
        Dilatation and curettage fails to detect most focal lesions in the uterine cavity in women with postmenopausal bleeding.
        Acta Obstet Gynecol Scand. 2001; 80: 1131-1136
        • Gambadauro P.
        • Martinez-Maestre M.A.
        • Schneider J.
        • Torrejon R.
        Malignant and premalignant changes in the endometrium of women with an ultrasound diagnosis of endometrial polyp.
        J Obstet Gynaecol. 2014; 34: 611-615
      1. AAGL practice report: practice guidelines for the diagnosis and management of endometrial polyps.
        J Minim Invasive Gynecol. 2012; 19: 3-10
        • Ricciardi E.
        • Vecchione A.
        • Marci R.
        • et al.
        Clinical factors and malignancy in endometrial polyps. Analysis of 1027 cases.
        Eur J Obstet Gynecol Reprod Biol. 2014; 183: 121-124
        • Costa-Paiva L.
        • Godoy Jr., C.E.
        • Antunes Jr., A.
        • Caseiro J.D.
        • Arthuso M.
        • Pinto-Neto A.M.
        Risk of malignancy in endometrial polyps in premenopausal and postmenopausal women according to clinicopathologic characteristics.
        Menopause. 2011; 18: 1278-1282
        • Lee S.C.
        • Kaunitz A.M.
        • Sanchez-Ramos L.
        • Rhatigan R.M.
        The oncogenic potential of endometrial polyps: a systematic review and meta-analysis.
        Obstet Gynecol. 2010; 116: 1197-1205
        • Lieng M.
        • Istre O.
        • Sandvik L.
        • Qvigstad E.
        Prevalence, 1-year regression rate, and clinical significance of asymptomatic endometrial polyps: cross-sectional study.
        J Minim Invasive Gynecol. 2009; 16: 465-471