Volume 03 Issue 04-2023
1
International Journal of Medical Sciences And Clinical Research
(ISSN
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VOLUME
03
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AGES
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01-12
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6.
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1121105677
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ABSTRACT
Evaluation of the effectiveness and diagnostic accuracy of the Pipelle device in the early stages of endometrial
sampling, precancerous diseases, including endometrial hyperplasia, atypical hyperplasia, endometrial polyps, and
various histological types of endometrial cancer, compared to the traditional curette.
KEYWORDS
Curettage, Pipelle, biopsy, adenocarcinoma, atypical.
INTRODUCTION
Uterine cancer is one of the most common cancers
among women in all countries of the world, making up
7.1% and increasing from 1 to 2% every year. Republican
Specialized Scientific and Practical Oncology and
Research Article
COMPARATIVE CONCLUSIONS OF DIAGNOSIS IN UTERINE BODY
CANCER
Submission Date:
April 01, 2023,
Accepted Date:
April 05, 2023,
Published Date:
April 10, 2023
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume03Issue04-01
I.S. Abdinazarova
Doctoral Student, Department Of Oncology, Tashkent Medical Academy, Uzbekistan
N.E. Atakhanova
Professor Head Of Department Of The Oncology Tashkent Medical Academy, Uzbekistan
N.I. Tursunova
Associate Professor Of Department Of Oncology Tashkent Medical Academy, Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ijmscr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Volume 03 Issue 04-2023
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(ISSN
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VOLUME
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Radiology Medical Center Tashkent City Branch Cancer
Registry 2010-20 In 2010, the analyzed data on uterine
div cancer showed that in 2010, 5,253 patients with
uterine div cancer were registered, and in 2020, 5,017
new cases of uterine div cancer were recorded.
During the analyzed period, 70% of uterine cancer was
recorded in stages I-II. The maximum incidence of
cancer was observed at the age of 45-65 years. [2,5]. In
2018: I stage - 31.2%, II stage - 39.9%, III stage - 16.1%, IV -
5.3%. In 2018, the mortality rate was 0.7 (234 patients)
and the 5-year survival rate was 47.3%. Patients were
divided into the following stages: I stage - 34.8%, II
stage - 41.7%, III stage - 14.4%, IV stage - 3.1%. In 2020, the
mortality rate was 0.8 (256 patients) and the 5-year
survival rate was 49.5%. In 2020, patients were divided
into the following stages: I stage - 35.8%, II stage - 41.7%,
III stage - 11.3%, IV stage - 4.4%. the patient came from
the village. The 5-year survival rate was 48.7%. [3,6]. In
2008-2012, it increased by 1.2 times and in 2012 it was
41.9 per 100,000 women. The death rate from BTS has
been steadily increasing since 2008 and peaked at 3.1 in
2009; from 2012 to 2017, a stable figure of 2.2 was
recorded. When analyzing the statistical indicators of
death from BTS, it should be noted that the rate of 3.1
per 100,000 population in 2009 in the 10-year period
(2008-2017) is much higher. Its decrease since 2010, 1.8
indicators recorded in 2016, indicates the high
efficiency of BTS treatment in Tashkent[1,4].
The object of research was the branch of the Republic
of Specialized Oncology and Radiology Scientific and
Practical Medical Center in Tashkent. Biomaterials
were taken from the uterine div of patients referred
to the Tashkent city branch with suspected uterine
cancer. First of all, under the control of ultrasound
practice, biomaterial was collected using curettage
and “pipelle”
- urogenital probe, and the results of the
research were summarized. The study included women
of reproductive age who complained of acyclic
menstrual cycles, as well as pre- and postmenopausal
women who complained of bloody discharge from the
genital tract, who were found to have abnormal
thickness of the endometrium by ultrasound, who
were under dynamic observation with regard to pre-
cancerous diseases, and who were constantly taking
tamoxifen tablets. and as a result, women suffering
from endometrial hyperplasia, patients whose atypical
hyperplasia was detected in the biomaterial obtained
after scraping, taking into account the complaints of
the uterine div and the conclusion of instrumental
examinations, were included. Patients were divided
into four groups:
I
–
control group. Patients with endometrial tissue
sampling by traditional diagnostic curettage method
II
–
control group. A group of patients with endometrial
tissue sampling by diagnostic curettage from the
uterine div under ultrasound examination (50
patients)
Volume 03 Issue 04-2023
3
International Journal of Medical Sciences And Clinical Research
(ISSN
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2771-2265)
VOLUME
03
ISSUE
04
P
AGES
:
01-12
SJIF
I
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FACTOR
(2021:
5.
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(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
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III main group. A group of 50 patients were sampled for
histological examination of endometrial tissue using a
disposable
“Pipelle”
urogenital
probe
under
ultrasound control.
IV
–
main group. A group of patients (44 patients)
where endometrial tissue was sampled using a
disposable “Pipelle” urogenital probe.
Among the patients included in the study, in patients
with contraindications to traditional curettage, in cases
where curettage was inconvenient, or in women who
refused to undergo curettage at their own will,
endometrial sampling was performed using a
disposable “Pipelle”
- urogenital probe. Patients with
the following contraindications and adverse conditions
were included:
•
Women who have not given birth
•
Patients with a closed cervix
•
Women who underwent cauterization due to
erosion of the cervix
•
Women who gave birth by surgery
•
Women with large uterus according to the
results of instrumental examination
•
Patients diagnosed with adenomyosis or
endometriosis of reproductive age
•
Women of reproductive age with infertility
The biological materials obtained from each group
were placed in a 10% formalin container, sent for
histological
examination,
and
their
pathomorphological conclusion was studied.
Results of pathogistological analysis of patients with
endometrial samples taken by curettage and pipelle-
biopsy methods
1- Table
Analysis of the results of histological examination in the traditional curettage method.
After
operative
treatment
After curettage
Gland
ular
hyperp
lasia
Endo
metria
l
polyp
Adenocarcino
ma
Atypica
l
hyperpl
asia
The
operat
ion
was
not
perfor
med
Total
G1
G2 G3
Glandular
hyperplasia
48
8
1
0
1
0
16
74
Volume 03 Issue 04-2023
4
International Journal of Medical Sciences And Clinical Research
(ISSN
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VOLUME
03
ISSUE
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P
AGES
:
01-12
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
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Polyp
4
1
0
2
1
0
5
13
Adeno
ca
rc
in
oma
G1
0
0
1
0
0
0
0
1
G2
0
0
0
1
0
0
0
1
G3
0
0
0
0
4
0
0
4
Atypical
hyperplasia
0
1
0
2
2
1
1
7
Total
52
10
2
5
8
1
22
100
Analysis of histological examination results. Traditional
curettage method - I When the results of post-
curettage
and
postoperative
pathogistological
examinations of patients included in the control group
were considered, 74 endometrial glandular hyperplasia
were found in the analyzes obtained during curettage.
After surgery, the conclusion of endometrial
hyperplasia was confirmed in only 48 of these patients
(64.9%),
endometrial
polyp
in
8
(10.8%),
adenocarcinoma G1 and G3 (2.7%) in 2. 16 patients (21.6
%) did not undergo surgery, so it was not possible to
analyze their further pathogistological findings.
Endometrial polyps were detected in 13 women during
sampling by curettage, and this diagnosis was
confirmed in only 1 of them, endometrial glandular
hyperplasia in 4, adenocarcinoma G2 and G3 in 3. As 5
women did not undergo operative treatment after
curettage, their post-surgical histological examination
results were not analyzed. Endometrial malignant
tumor disease was detected in 6 patients by curettage
(G1-1, G2 - 1, G3 - 4), adenocarcinoma was diagnosed in
16 women due to the fact that adenocarcinoma was
also detected in women with atypical hyperplasia after
surgery. One more woman diagnosed with atypical
hyperplasia had an endometrial polyp after surgery,
and another woman did not undergo surgery, so it was
not possible to analyze the histological samples after
operative treatment (Table 1).
Volume 03 Issue 04-2023
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(ISSN
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VOLUME
03
ISSUE
04
P
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SJIF
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5.
893
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(2023:
6.
184
)
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2-Table
Diagnostic indicators of the curettage method
Curettage
method
Endometria
l
hyperplasia
Endometria
l polyp
Adenoca
rcinoma
Atypical
hyperplasia
P
Sensitivity
92.31 %
44.5 %
64.57 %
100 %
0,05
Specificity
50.0 %
87.88 %
95.70 %
93.94 %
0,05
Accuracy
72.0 %
80.09 %
90.00 %
94.00 %
0,05
Positive
prognostic
value
66.67 %
38.79 %
100 %
26.58 %
0,05
Negative
prognostic
value
85.71 %
89.78 %
89.36 %
100 %
0,05
P≤0,05
Based on the obtained results, when the diagnostic
indicators of the curettage method (sensitivity,
specificity, accuracy, positive and negative prognostic
values) are analyzed, we can see that the diagnostic
indicators of the curettage method are not high in
endometrial hyperplastic processes and cancer. The
sensitivity of the method is highest in endometrial
glandular hyperplasia and atypical hyperplasia, while
the specificity and specificity are highest in
adenocarcinoma and atypical hyperplasia. The positive
prognostic value is 100% in adenocarcinoma, while the
negative prognostic value is 100% in atypical
hyperplasia (table 2).
3- table
Histological results obtained when the curettage method was used under the control of UTT examination
Volume 03 Issue 04-2023
6
International Journal of Medical Sciences And Clinical Research
(ISSN
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2771-2265)
VOLUME
03
ISSUE
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AGES
:
01-12
SJIF
I
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FACTOR
(2021:
5.
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5.
893
)
(2023:
6.
184
)
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Pathohistologic
al types
Glandul
ar
hyperpl
asia
Endo
metria
l
polyp
Adenocarcino
ma
Atypica
l
hyperpl
asia
Operati
ve
treatme
nt was
not
perform
ed
Total
G1 G2 G3
Glandular
hyperplasia
30
1
0
0
1
0
0
32
Polyp
0
8
0
0
0
0
0
8
Adeno
ca
rc
in
oma
G1
0
0
2
0
0
0
0
2
G2
0
0
0
2
0
0
0
2
G3
0
0
0
0
3
0
0
3
Atypical
hyperplasia
0
0
0
0
0
3
0
3
Total
30
9
2
2
4
3
0
50
UTT + curettage method - II Endometrial sampling was
performed by ultrasound-guided curettage from 50
women presenting with endometrial pathologies in
the control group. According to the results of the
pathogistological examination of the women sampled
by this method, 32 women were diagnosed with
endometrial gland hyperplasia, according to the results
of the histological examination after surgery, 30
women had endometrial gland hyperplasia, 1 woman
had endometrial polyp, and 1 woman had endometrial
low-differentiated adenocarcinoma (G3). determined.
In all 8 women diagnosed with endometrial polyps by
curettage, endometrial polyps were also detected in
histological findings after operative treatment.
Adenocarcinoma was diagnosed in 7 women (2 G1, 2 G2
and 3 G3) and atypical hyperplasia in 3 women by
curettage under the control of UTT examination.
Atypical hyperplasia and adenocarcinoma diagnoses
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were confirmed in all patients with atypical hyperplasia
and adenocarcinoma in the results of histological
examination after surgery (P ≤ 0.05) (Table 3).
4-Table
Diagnostic indicators of the curettage method performed under the control of UTT
UTT + curettage
method
Endometria
l
hyperplasia
Endometria
l polyp
Adenocarcin
oma
Atypical
hyperplasi
a
P
Sensitivity
100 %
88.89 %
87.50 %
100 %
0,05
Specificity
90.00 %
100 %
100 %
100 %
0,05
Accuracy
96.00 %
98.00 %
98.00 %
100 %
0,05
Positive
prognostic value
93.75 %
100 %
100 %
100 %
0,05
Negative
prognostic value
100 %
97.62 %
97.67 %
100 %
0,05
P ≤ 0,05
When the diagnostic indicators of the curettage
method performed under the control of UTT are
considered, we can see that the results are much
different and higher than the traditional curettage
method. All diagnostic indicators of this method were
high in all endometrial pathologies, sensitivity in
endometrial glandular hyperplasia and atypical
hyperplasia, specificity in endometrial polyps,
adenocarcinoma and atypical hyperplasia, and
specificity in atypical hyperplasia was 100%. The
positive prognostic value was the highest (100%) in
endometrial polyps, adenocarcinoma and atypical
hyperplasia, while the negative prognostic value was
100% in atypical hyperplasia (Table 4)..
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5-table
“Pipelle” analysis of histological results obtained after biopsy performe
d under the supervision of UTT
Pathohistolo
gical types
Glandul
ar
hyperpl
asia
Endomet
rial
polyp
Adenocarcinom
a
Atypical
hyperplasi
a
Operat
ive
treatm
ent
was
not
perfor
med
Tot
al
G1
G2
G3
Glandular
hyperplasia
25
0
0
0
0
0
0
25
Polyp
0
7
0
0
0
0
0
7
Adeno
ca
rc
in
oma
G1
0
0
3
0
0
0
0
3
G2
0
0
0
3
0
0
0
3
G3
0
0
0
0
8
0
0
8
Atypical
hyperplasia
0
0
0
0
0
4
0
4
Total
25
7
3
3
8
4
0
50
The method of endometrial sampling using a single-use
“pipelle”
- urogenital probe under the control of UTT:
Endometrial hyperplasia was detected in 25 women by
this method in our main group III, where the method of
endometrial sampling using a single-use Ripelle-
urogenital probe was used under the control of UTT,
and endometrial hyperplasia was confirmed in all of
them even after operative treatment. Endometrial
polyps were detected in 7 women using this method,
and endometrial polyps were confirmed in 7 of these
women. Adenocarcinoma (3 G1, 3 G2, 8 G3) was
diagnosed in 14 women sampled using the Ripelle-
urogenital probe under UTT control, and this diagnosis
was confirmed in all of these women even after
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ISSUE
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P
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(2023:
6.
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)
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operative treatment. In 4 women diagnosed with
atypical hyperplasia, the diagnosis of atypical
hyperplasia was confirmed in the histological
examination after operative treatment (P ≤ 0.05)
(Table 5).
6-table
Diagnostic indicators of the Ripelle-biopsy method performed under the control of UTT
Ripelle - biopsy
Endometri
al
hyperplasi
a
Endometria
l polyp
Adenocarc
inoma
Atypical
hyperplasia
P
Сезгирлиги
100 %
100 %
100 %
100 %
0,05
Specificity
100 %
100 %
100 %
100 %
0,05
Accuracy
100 %
100 %
100 %
100 %
0,05
Positive
prognostic value
100 %
100 %
100 %
100 %
0,05
Negative
prognostic value
100 %
100 %
100 %
100 %
0,05
P≤ 0,05
According to the results obtained by comparing the
histological results obtained after the Ripelle-biopsy
method and the histological results after operative
treatment, all diagnostic parameters (sensitivity,
specificity, accuracy, positive and negative prognostic
values) of this method are the highest in all
endometrial pathologies (100% ) we can see that it has
(Table 6).
7-table.
Analysis of histological results after biopsy obtained with the Pipelle device
Pathohistologic
al types
Glandul
ar
hyperpl
asia
Endomet
rial
polyp
Adenocarcino
ma
Atypica
l
hyperpl
asia
Operati
ve
treatme
nt was
not
perform
ed
Total
G1 G2 G3
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Glandular
hyperplasia
24
2
0
0
0
0
2
28
Polyp
0
4
0
0
0
0
0
4
Adeno
ca
rc
in
oma
G1
0
0
0
0
0
0
0
0
G2
0
0
0
2
0
0
0
2
G3
0
0
0
0
6
0
0
6
Atypical
hyperplasia
0
0
0
1
1
2
0
4
Total
24
6
0
3
7
2
2
44
Taking a biopsy from the endometrium using a
disposable
pipelle-urogenital
probe:
Glandular
hyperplasia was detected in 28 women of the IV main
group as a result of endometrial sampling using a
disposable Pipelle-urogenital probe, 2 women did not
undergo surgery, and endometrial polyps was
detected in 2 women during histological examination
after operative treatment. The diagnosis of glandular
hyperplasia was confirmed in the repeated histological
examination of 24 women. Endometrial polyps were
placed in 4 women using this method, and endometrial
polyps were confirmed in all of these women in the
results of histological examination after operative
treatment. Adenocarcinoma (G2 - 2 and G3 - 6) was
detected in 8 of the women sampled using a
disposable Pipelle-urogenital probe, and according to
the results after the operative treatment, the diagnosis
was confirmed in all patients with adenocarcinoma,
and in 2 of the 4 women with atypical hyperplasia
adenocarcinoma (G2 and G3) and 2 were diagnosed
with atypical hyperplasia (Table 7).
8- table.
Pipelle - diagnostic indicators of the biopsy method
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:
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УТТ +
Pipelle -
биопсия
Endometrial
hyperplasia
Endometria
l polyp
Adenocarcino
ma
Atypical
hyperplasi
a
P
Sensitivity
100 %
95.67 %
80 %
100 %
0,05
Specificity
80.00 %
100 %
100 %
95.24 %
0,05
Accuracy
90.90 %
96.97 %
95.46 %
95.45 %
0,05
Positive
prognostic
value
85.69 %
100 %
100 %
79.43 %
0,05
Negative
prognostic
value
100 %
96.77 %
95.74 %
100 %
0,05
P≤ 0,05
IV When analyzing the diagnostic indicators of the
Ripelle biopsy method used for endometrial biopsy in
our main group, we can see that the sensitivity of this
method is high for endometrial glandular hyperplasia
and atypical hyperplasia (100%). We can see that the
specificity and accuracy indicators are high for
endometrial polyps, adenocarcinoma and atypical
hyperplasia. The positive prognostic value is 100% for
endometrial polyp and adenocarcinoma, while the
negative prognostic value is 100% for endometrial
glandular hyperplasia and atypical hyperplasia. In
general, this method has high diagnostic indicators in
endometrial pathologies (Table 8).
CONCLUSION
Endometrial biopsy using a disposable Pipelle-
urogenital probe is more sensitive than curettage in
detecting endometrial hyperplastic processes and
endometrial cancer. The sensitivity of endometrial
scraping with the help of a pipelle-urogenital probe in
the diagnosis of endometrial cancer was 99.6% in
postmenopausal women and 95% in premenopausal
women. Its sensitivity for atypical endometrial
hyperplasia was 81%. The specificity of all endometrial
biopsy methods for endometrial carcinoma is from 91%
to 100%, and the specificity of the pipette biopsy
method is considered high. Less than 5% of patients in
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control groups I and II had to repeat the biopsy by the
Pipelle-biopsy method due to incorrect sampling. In
addition, comparing the obtained results, we can see
that the UTT-guided curettage method is more
effective
than
the
UTT-guided
Pipelle-biopsy
procedure and has relatively fewer complications than
the simple Pipelle-biopsy.
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