The assessment of Pipelle for endometrial sampling in Kazakhstani settings

Faculty Development Competitive Research Grant Program 2019-2021

Office vacuum aspiration (Pipelle) for endometrial biopsy (EMB) sampling has emerged as the preferred modality for diagnosing gynecological pathologies, including detection of endometrial cancer (EC), the most prevalent gynecologic malignancy in women all over the world. Abnormal uterine bleeding, the most common indication for endometrial biopsy, is responsible for ~70% of all peri- and postmenopausal gynecological visits. Compared to tissue sampling by classic dilatation and curettage (D&C), which is typically performed in an operating room under anesthesia, EMB is less expensive, has lower risks, and is very effective for detecting EC. Despite the documented advantages of EMB, it has not yet achieved its full potential to minimize the use of D&C for tissue collection. Moreover, in Kazakhstan EMB is not present in everyday clinical practice as a diagnostic tool, taking into account the fact that Kazakhstan has higher rate of mortality due to EC than in western countries. The main method of endometrial biopsy remains D&C, which requires hospitalization, anesthesia, antibiotic use, and is more invasive. For patients who do not have urgent indications for D&C, introducing Pipelle biopsy in the office settings would be a gentle, informative and economically beneficial method of diagnosing the state of the endometrium.
The overall goal of this project is to fill important gaps in the current understanding of Pipelle endometrial biopsy (EMB) acceptance and success in Kazakhstani settings by comprehensively and rigorously exploring underlying factors relevant to attempting and conducting successful EMB.
The results of this study will improve our understanding of acceptability and successful use of EMB, thus, enabling the timely diagnosis of current endometrial pathology will have important impact on healthcare safety and efficiency, improve overall treatment outcomes and the quality of life of Kazakhstani population. Findings will provide key evidence needed to guide future research aimed at the development and testing of new intervention strategies for increasing the use of EMB rather than D&C sampling for endometrial cancer diagnoses.