A comparative study to evaluate endometrial aspiration using Karman’s cannula versus dilatation and curettage in cases of abnormal uterine bleeding

Abstract

Background: Abnormal uterine bleeding (AUB) is defined as any variation from the normal menstrual cycle such as changes in regularity, frequency, duration of flow or amount of flow. Objective of this study was to compare the adequacy and diagnostic accuracy of endometrial aspiration using Karman’s cannula versus dilatation and curettage in women with abnormal uterine bleeding.Methods: This prospective study was conducted on 250 women with AUB in age group of more than 40 years. In all patients, endometrial aspiration was done with manual vacuum aspiration (MVA) syringe attached to 4 mm Karman's cannula without anesthesia. The sample was collected in a bottle containing formalin and was labelled as sample A. After that, intracervical local anesthesia (1% Xylocaine) was given and cervix was dilated and scrapping of endometrial lining with sharp curette was done. The sample was also collected in a bottle containing formalin and was labelled as sample B. Both the samples A and B were sent for histopathology. The histopathology report of aspiration was compared with that of dilatation and curettage sample.Results: Endometrial aspiration biopsy had sensitivity of 92.3%, specificity of 100%, positive predictive value of 100% and negative predictive value of 99.56% for diagnosis of endometrial pathology while considering D and C gold standard. The sample adequacy of endometrial aspiration was 98.8% as compared to dilatation and curettage (98%).Conclusions: Present study showed that endometrial aspiration biopsy is an alternate to traditional dilatation and curettage in diagnosing endometrial pathologies in women with abnormal uterine bleeding.

A Randomized Comparative Study to Compare Karman's Cannula and Pipelle Biopsy for Evaluation of Abnormal Uterine Bleeding

“…Among other studies which compared Karman with others, Tomar et al . [ 1 ] reported that Karman cannula had a sensitivity of 92.3%, specificity of 100%, PPV of 100%, and NPV of 99.56% for diagnosis of endometrial pathology, which was slightly higher than that of our study.…”

“…In the present study, one case (0.97%) was inadequate in the Karman cannula group and three cases (2.4%) in the Pipelle group. Among other studies on Karman, the inadequacy rate has been reported to range from 2% to 24%,[ 1 5 10 19 20 21 22 ] and for Pipelle, it has been reported in the range of 2% to 28.8%. [ 13 23 24 25 26 27 ] Since we frequently use Karman cannula, the inadequacy was lower in that group.…”

“…Abnormal uterine bleeding (AUB) is an increasing health problem in the reproductive age group affecting nearly 9%–14% of women[ 1 ] with a significant impact on their quality of life. [ 2 ] AUB may be a part of disturbance in the menstrual cycle or sudden nonmenstrual bleeding, both of which require medical investigation in the form of endometrial sampling primarily to differentiate benign causes like hyperplasia from malignant causes like carcinoma.…”

“…As both of them are effective and minimally invasive methods of endometrial aspiration, each of these methods has been studied individually in comparison with D and C, with results being in favor of their clinical use. [ 1 3 5 8 9 10 11 ] However, till date, there has been no head-to-head trial comparing both of them.…”

Correlation between Manual Vacuum Aspiration and Endometrial Cell Sampler in Abnormal Uterine Bleeding

“…16,17 Previous studies found similar tissue adequacy and similar histopathologic finding between MVA and uterine curettage. [18][19][20][21] Moreover, MVA was reported to have 86.4-96% sensitivity and 100% specificity for diagnosing endometrial pathology. [19][20][21][22][23] MVA has, therefore, been proposed as an alternative technique for obtaining an endometrial biopsy in women with AUB.…”