Which is the best technique for endometrial sampling? Aspiration (pipelle) versus dilatation and curettage (D&C)

Purpose

To compare diagnostic accuracy and adequacy of pipelle endometrial biopsy with dilatation and curettage.

Methods

From October 2007 to November 2009, 673 patients were evaluated with pipelle endometrium biopsy, D&C and hysterectomy in the Department of Obstetrics and Gynecology, Istanbul University Cerrahpasa Medical Faculty. 478 patients underwent pipelle and D&C, 212 patients underwent pipelle and hysterectomy and 161 patients underwent D&C and hysterectomy. Uterine findings were grouped under five headings: normal, hyperplasia, focal lesion, atypia, and atrophy. Histologic sections from pipelle biopsy or D&C specimens were compared with each other and hysterectomy specimens. Chi-square, Mc.Nemar, and Fisher-exact tests were used as appropriate. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each method used in the study.

Results

We compared the histological results of pipelle biopsy and D&C. Statistically outcomes of pipelle and D&C were concordant with each other. Concordance rate was 67?% between pipelle and hysterectomy and 70?% between D&C and hysterectomy. Sensitivity of pipelle biopsy in detection of hyperplasia and aytpia was 67 and 75?%, respectively. Sensitivity of D&C for detecting hyperplasia and atypia was 62 and 83?%. NPV of pipelle biopsy and D&C was 99?% for malignancy.

Conclusions

Pipelle biopsy and D&C showed almost equal success rate in the diagnosis of endometrial pathologies. Neither pipelle nor D&C is adequate method for focal endometrial pathologies. Both biopsy methods are not perfect, but pipelle biopsy is a cheaper and easy technique compared with D&C, and ultrasonographic findings of endometrium should be considered prior to endometrial biopsy.     

Accessory fissures of the lung: evaluation by high-resolution computed tomography

This study was performed to classify and assess the frequency of accessory fissures of the lung by high-resolution CT (HRCT) scans. The HRCT scans of 443 patients were retrospectively reviewed. After exclusion of patients with pulmonary parenchymal distortion, pleural disease or those who had had lobectomy, 186 patients were included in the study. The HRCT scans consisted of 1.5-mm sections obtained at 10-mm intervals and reconstructed with a high-spatial-resolution algorithm. In 59 of 186 patients (32%), a total of 69 accessory fissures were detected. The most common fissure was the inferior accessory fissure ( n=40; 21%, 38 on the right, 2 on the left) followed by the left minor fissure ( n=17; 9%). Other accessory fissures observed were the right superior accessory fissure ( n=2; 1%), the azygos fissure ( n=1; 0.5%) and intersegmental fissures between the medial and lateral segments of the right middle lobe ( n=3; 2%), the superior and inferior segments of the lingula ( n=2; 1%), the anterobasal and laterobasal segments of both the right ( n=1; 0.5%) and the left ( n=3; 2%) lower lobe. In conclusion, the inferior accessory fissure and the left minor fissure were the most common accessory fissures seen on HRCT examinations.     

Thrombin-activatable fibrinolysis inhibitor levels in patients with non-small-cell lung cancer

BACKGROUND: An increased incidence of thromboembolic events has been described in patients with cancer. Cancer cells are attributed with producing procoagulant substances such as cysteine protease and tissue factor to activate factor X and factor VII, respectively. However, there are limited data on the pathogenesis behind this hypercoagulability state, and the thrombin generation, fibrinolytic system, and coagulation inhibition system during cancer are largely obscure. In this study, we investigated the changes of different steps of coagulation pathway in patients with non-small-cell lung cancer (NSCLC) and compared the data with those of healthy controls. PATIENTS AND METHODS: Forty-four patients with NSCLC and 36 age-matched controls were recruited for this study. Prothrombin fragment 1 + 2 (F 1 + 2) were used as a marker of thrombin generation; thrombin-activatable fibrinolysis inhibitor (TAFI) immunologic activity level was measured for inhibition of the fibrinolytic system, and tissue factor pathway inhibitor (TFPI) activity was assessed for the coagulation inhibition system. In the patient group, the relationships between TAFI activity levels and patient parameters (age, sex, body mass index [BMI], histopathology, and stage) were evaluated. RESULTS: The TAFI activity, F 1 + 2 levels, and TFPI activity were significantly higher in patients with lung cancer than in subjects in the control group (P < .05; P < .0001; and P < .0001; respectively). However, there were no statistically significant associations between TAFI activity levels and patient age, sex, BMI, histopathology, or stage of disease (P > .05). CONCLUSION: In this study, it was clearly shown that patients with lung cancer have hypercoagulable states and that the pathogenesis of thrombotic events in these patients is multifactorial. Increased TFPI is a reflection of thrombin activity in this patient group. Confirmatory studies with larger patient groups should be performed in this population.     

Asymptomatic groin dermatophyte carriage detected during routine gynaecologic examinations

We investigated the epidemiological characteristics of both symptomatic and asymptomatic dermatophytic groin infections in 1970 women (age: 36.2 ± 12.5) during routine gynaecologic examinations. Bilateral groin samples were collected with sterile cotton swabs premoistened with sterile physiological saline. The samples were then separately inoculated onto Sabouraud glucose agar. Fungi were identified by sequencing the rDNA internal transcribed spacer region. Dermatophytes were recovered from five patients (four Trichophyton rubrum and one Arthroderma vanbreuseghemii, 0.25%) with a diagnosis of asymptomatic carriers (four) and tinea inguinalis (one). In one case, groin carriage converted into tinea inguinalis after 3 weeks. Analysis of risk factors indicated that patients of at least 49 years were more likely to be positive for dermatophyte isolation (P = 0.002). In conclusion, groin dermatophyte carriage is more common than tinea inguinalis and can potentially convert into a symptomatic infection.