The main method of endometrial sampling in Kazakhstan remains D&C, which requires hospitalization, anesthesia, antibiotic use, and is more invasive. Taking into account that Kazakhstan has a higher rate of mortality due to EC than in western countries, and despite EMB reported to be a preferred modality for diagnosing gynecological pathologies in the Western world, EMB is not widely utilized in the clinical practice as a diagnostic tool in Kazakhstan. This study has been designed to improve our understanding of acceptability and factors influencing successful use of EMB by investigating the relationship between severe pain, anxiety, and the rate of Pipelle failure. suggest the strong links between anxiety before a Pipelle biopsy and patients' experiences of extreme pain during the procedure. The Pipelle procedure has shown better or equal tolerability by patients compared to other office-based devices, however, although most women tolerate it well, some do experience significant discomfort, which may affect the efficacy of the procedure. The role of psychological factors such as anxiety and pain sensitivity in obtaining adequate samples, have rarely been investigated as an increased risk of biopsy failure. For example, level of anxiety affects the tolerability of the office hysteroscopy. This is supported by a substantial body of evidence that links elevated state anxiety to an increase in pain intensity and decrease in pain tolerance. Many invasive diagnostic procedures have been reported in the literature to induce discomfort in patients by causing anxiety. Thus, it is important to establish factors that may have an impact the ability to collect an adequate endometrial sample. ĭespite the documented benefits there are risks for failure associated with Pipelle procedure, one of the main being the failure to obtain satisfactory samples for histological examination. Compared to D&C sampling conducted in the operation room, EMB is relatively inexpensive, associated with less morbidity, safe, accurate, and can be performed in an office setting. EMB has been reported to be an equivalent and sometimes even superior tool for detecting EC compared to other endometrial sampling techniques with diagnostic accuracy comparable to dilatation and curettage (D&C) sampling for some types of endometrial pathology, including endometrial hyperplasia, hyperplasia with atypia, and EC. Use of a Pipelle suction curette (flexible plastic curette used for minimally invasive tissue collection) has emerged as the most common method for endometrial tissue sampling, often indicated for evaluation of abnormal uterine bleeding, which is responsible for ~ 70% of all peri- and post-menopausal gynecological visits. Office vacuum aspiration (Pipelle) for endometrial biopsy (EMB) sampling plays an important role in early cancer diagnosis, preoperative assessment, and treatment planning for endometrial pathologies. Due to increasing obesity rates and little access to preventive services, EC mortality in Kazakhstan is higher than in comparison to the US and other developed countries. ConclusionĪnxiety during procedure performance was significantly associated with severe pain during the procedure but did not represent a key element for the success of Pipelle biopsy.Įndometrial cancer (EC) is the most common gynecologic malignancy in the developed world. We found no differences in Pipelle biopsy success rates in relationship to baseline, during and postprocedural pain and anxiety scores. Pain level was higher among patients sampled by the junior OB/GYN specialist ( p < 0.0001). Women who experienced severe pain during procedure tend to be more anxious during procedure ( p = 0.0001) and have higher number of sampling attempts ( p = 0.0040). Resultsģ.8%, 15.19% and 4.43% of women reported severe pain and 39.24%, 34.18% and 14.56% of women reported severe anxiety prior, during and after procedure, respectively. Women were asked to fill survey on pain, anxiety before, during and after the procedure. Study included 158 women with median age of 42 who underwent Pipelle endometrial biopsy at Clinical Academic Department of Women’s Health of the University Medical Center (UMC), Nur-Sultan City, Kazakhstan with an abnormal uterine bleeding from June 2019 to April 2021. The study's objective was to explore whether there is relationship between severe pain, anxiety, and the rate of Pipelle failure. The role of psychological factors such as anxiety and pain sensitivity in obtaining adequate samples is not well known. One of the reported disadvantages of sampling with Pipelle curette is failure to collect enough tissue for histological analysis. Pipelle endometrial biopsy is vital for the early diagnostics of endometrial pathology and is performed in outpatient setting in minimally invasive manner.
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