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Table 1 Comparison of the RCTs, prospective and retrospective studies included in this literature review. Papers have been grouped by intervention/ comparator

From: Endometrial sampling in low-risk patients with abnormal uterine bleeding: a systematic review and meta-synthesis

Study

Type of study

Age of participants (mean ± SD)

Intervention (n) vs Comparator (n)

Outcome

Pain

Cost

Pipelle versus D&C +/− Hysterectomy

[23] Rauf et al. Pakistan 2014

RCT

46.3 ± 4.45

Pipelle (102) vs D&C (101)

Adequacy

Pipelle 98%

D&C 100%

Pipelle less painful

Pipelle cheaper

[46] Liu et al. China 2015

Prospective Sequential

43.6

Pipelle vs D&C (245)

Adequacy

Pipelle 91.02%

D&C 92.24%

Pipelle less painful

N/A

[47] Gungorduk et al. Turkey 2013

Prospective

Pipelle: 49.8 ± 6.1

D&C: 48.2 ± 6.5

Pipelle + hysterectomy (78) vs D&C + hysterectomy (189)

Adequacy

Pipelle 95%

D&C 96%

Concordance

Pipelle + hysterectomy 62%

D&C + hysterectomy 67%

Pipelle less painful

Pipelle cheaper

[48] Kazandi et al.

Turkey

2012

Prospective Sequential

48 ± 9.43

Pipelle + hysterectomy

Vs

D&C + hysterectomy

(66)

Adequacy

Pipelle 93%

D&C 96%

Concordance

Pipelle and D&C 66%

Pipelle & hysterectomy 64%

Pipelle less painful

Pipelle cheaper

[49] Demirkiran et al. Turkey 2012

Prospective

45.3

Pipelle + hysterectomy (212) vs D&C + hysterectomy

(161)

Adequacy

Pipelle 97%

D&C98%

Concordance

Pipelle and D&C 84%

Pipelle & hysterectomy 67%

D&C and hysterectomy 80%

Pipelle less painful

Pipelle cheaper

[43] Sany et al. UK 2011

Retrospective

?

Pipelle + hysterectomy vs D&C + hysterectomy (total 191)

Concordance

Both techniques 78%

N/A

N/A

[45] Daud et al. UK 2011

Retrospective

55.7 ± 11.4

Pipelle ± hysterectomy (75) vs D&C ± hysterectomy (220)

Concordance

Pipelle + hysterectomy 76%

D&C + hysterectomy 86%

N/A

N/A

[24] Fakhar et al. Pakistan 2008

Prospective Sequential

45.4 ± 7.2

Pipelle versus (D&C) (100)

Adequacy

Pipelle 98%

D&C 100%

NPV for endometrial carcinoma

Pipelle 100%

N/A (both techniques under GA)

Pipelle cheaper

[44] Huang et al. USA 2006

Retrospective + Letter

?

Pipelle + hysterectomy (253) vs D&C + hysterectomy (93)

Concordance

Pipelle and hysterectomy 93.8% (low grade cancer) & 99.2% (high grade cancer)

D&C and hysterectomy 97% (low grade cancer) & 100% (high grade cancer)

N/A

N/A

[37] Macones et al. 2006

[66] Machado et al. Spain 2002

Retrospective

Post-menopausal (68)

Pre- or peri-menopausal (100)

Pipelle (168) vs D&C (92) ± Hysterectomy (76)

Accuracy

Sensitivity 84.2%

Specificity 99.1%

N/A

N/A

[51] Kavak et al. Turkey 1996

Prospective

50.8 ± 7.8

Pipelle ± TVS (78) vs D&C (78)

Concordance

Sensitivity: 73% (increased to 90% with TVS)

Specificity: 100%

N/A

N/A

[50] Ben-Baruch et al. Israel 1993

Prospective

Pre- and post-menopausal

Pipelle (172) vs D&C (97)

Adequacy

Pipelle 90.6%

D&C 68%

N/A

N/A

[68] Sanam et al. Iran 2015

Prospective

>  35

Pipelle (130) vs D&C (130)

Concordance

Pipelle and D&C 94%

Adequacy

Pipelle 84.6%

D&C 90%

N/A

Pipelle cheaper

[75] Gordon New Zealand 1999

Prospective

47.2 ± 1.8

Pipelle (100) vs D&C or hysterectomy (n =?)

Adequacy

Pipelle 67%

N/A

N/A

[69] Goldchmit et al. Israel 1993

Prospective Sequential

48.1

Pipelle and TVS vs D&C (176)

Concordance

Pipelle & D&C 90% (increased to 92% with TVS)

N/A

N/A

[52] Abdelazim et al. Turkey 2013

Prospective Sequential

44.5

Pipelle vs D&C (143)

Adequacy

Pipelle 97.9%

D&C 100%

NPV for endometrial polyp

Pipelle 89.6%

N/A

N/A

[72] Shams Pakistan 2012

Prospective Sequential

47.94

Pipelle vs D&C (50)

N/A

Pipelle less painful

Pipelle cheaper

[53] Rezk et al. Egypt 2016

Prospective

Pipelle: 47.2 ± 3.8

D&C: 46.9 ± 4.1

Pipelle (270) vs D&C (268)

Adequacy

No difference (p˃0.05)

D&C less painful

N/A

Pipelle versus Vabra +/− Hysterectomy

[54] Eddowes et al. UK 1990

Prospective Sequential

41.6

Pipelle vs Vabra Aspirator (100)

Adequacy

Pipelle 88%

Vabra Aspirator 88%

Pipelle less painful

Pipelle cheaper

[55] Naim et al. Malaysia 2007

RCT

> 45

Pipelle (76) vs Vabra Aspirator (71)

Adequacy

Pipelle 73.3%

Vabra 52.4%

N/A

Pipellle cheaper

[28] Kaunitz et al. USA 1988

Prospective Sequential

46

Pipelle vs Vabra (56)

Adequacy

Pipelle & Vabra 91%

Concordance

Pipelle & Vabra 89%

Pipelle less painful

Pipelle cheaper

[56] Rodriguez et al. USA 1993

RCT

?

Pipelle (12) vs Vabra (13) vs Hysterectomy (25)

Surface being sampled:

Pipelle 4.2%

Vabra 41.6%

N/A

N/A

Pipelle versus Tao Brush+/− Hysteroscopy

[30] Williams et al. UK 2008

RCT Sequential

Moderate risk: 45.2 (SE 0.26)

For moderate risk Pipelle (34)

Tao Brush (29)

Adequacy

Both techniques 84%

No significant difference for premenopausal

Tao Brush less painful

N/A

[57] Critchley et al. UK 2004

RCT

Moderate risk: pre-menopausal ˃40 or < 40 with risk for endometrial cancer

Low risk

Pipelle vs Tao Brush

Moderate risk

(Total 326)

Low risk (Total 157)

± hysteroscopy ± TVS

Successful completion of investigation:

Pipelle 85%

Adequacy of sample with Pipelle:

Moderate risk 79%

Tao Brush less painful than Pipelle

Minimal difference

[58] Yang et al. USA 2003

Prospective Sequential

24–86

Pipelle (79) vs Tao Brush (79)

Factors affecting sensitivity: tumour size, type, location within the uterus, sampling mechanism and preparation method

N/A

N/A

[59] Del Priore et al. USA 2001

RCT Sequential

Pre-menopausal: 46

Post-menopausal: 61

Tao Brush vs Pipelle (50)

Sensitivity:

Pipelle 86%

Tao Brush 95.5%

Specificity:

Both 100%

N/A

Tao Brush cheaper than D&C

[60] Yang et al. USA 2000

Prospective Sequential

58

Tao Brush vs Tao Brush + Pipelle (25)

Adequacy

Tao Brush 98%

Pipelle 88%

Tao Brush less painful

Comparable

Pipelle versus Novak

[40] Henig et al. USA 1989

RCT

Pre-menopausal

Pipelle (50) Vs Novak (50)

Adequacy

Pipelle 94%

Novak 98%

Better tolerance with Pipelle

N/A

[26] Stovall et al. USA 1991

RCT

Pipelle: 40

Novak: 44

Pipelle (149) vs Novak (126)

Adequacy

Pipelle 87.2%

Novak 90.5%

Pipelle less painful

Novak might be cheaper

[61] Silver et al. USA 1991

RCT Sequential

28–76

1st Pipelle then Novak (26) vs 1st Novak then Pipelle (29)

Adequacy Similar

Pipelle less painful

N/A

Pipelle versus Hysterectomy

[67] Guido et al. USA 1995

Prospective Sequential

61

Pipelle vs Hysterectomy

(71)

Adequacy

Pipelle 97%

Concordance

Pipelle & hysterectomy 83%

N/A

N/A

[42] Ferry et al. UK 1993

Prospective Sequential

?

Pipelle vs Hysterectomy (37)

Concordance

Pipelle & hysterectomy 67%

N/A

N/A

[41] G Zorlu et al. Turkey 1994

Prospective Sequential

51

Pipelle vs Hysterectomy (26)

Concordance

Pipelle & hysterectomy 95%

Mild pain and discomfort with Pipelle

N/A

Pipelle versus Explora +/− Accurette

[62] Leclair et al. USA 2011

RCT

Pipelle: 45.2 ± 7.3

Explora: 46.1 ± 7.7

Pipelle (37) vs

Explora (32)

Adequacy

Pipelle 91%

Explora 97%

No differences seen

N/A

[32] Lipscomb et al. USA 1994

RCT

N/A

Pre- and post-menopausal

Pipelle (85) vs Accurette (81) vs Explora (82)

Adequacy

Pipelle 85.2%

Accurette 72.5%

Explora 85.4%

No significant difference in pain score

N/A

Pipelle versus Infant Feeding Tube (IFT)

[63] Bhide et al. UK 2007

Prospective

?

Pipelle (29) vs IFT (31)

Adequacy

Pipelle 73%

IFT 71%

Less pain with IFT

N/A

Pipelle Mark 2 versus Pipelle Mark 2 + hysteroscopy

[71] Polena et al. France 2006

Prospective

Sequential

50

Pipelle Mark 2 vs Pipelle Mark 2 ± hysteroscopy (97)

Adequacy of Pipelle Mark 2

88.7%

No difference with conventional Pipelle

Slightly more expensive than conventional Pipelle

Pipelle versus Tis-u-Trap

[27] Koonings et al. USA 1990

RCT

Pipelle: 42.9

Tis-u-trap: 42.3

Pipelle + hysterectomy (74) vs Tis-u-trap + hysterectomy (75)

Adequacy

Pipelle 87.8%

Tis-u-trap 84%

Concordance

Pipelle & hysterectomy 85%

Tis-u-trap & hysterectomy 92%

N/A

Pipelle cheaper

Pipelle versus Endorette

[29] Moberger et al. Sweden 1998

RCT Sequential

57.5 ± 11.5

Pipelle vs Endorette

(152)

Adequacy and concordance

No difference

No significant difference

N/A

Pipelle versus Cytospat +/− Hysterectomy

[31] Antoni et al. Spain 1996

RCT

48.6 ± 9

Pipelle ± hysterectomy or D&C (191) vs Cytospat ± hysterectomy or D&C (174)

Adequacy

Pipelle 75%

Cytospat 76%

Concordance

Pipelle: Benign 84%, Hyperplasia 71%, Malignancy 60%

Cytospat: Benign 82%, Hyperplasia 60%, Malignancy 60%

Better tolerance for Pipelle

Pipelle cheaper

Pipelle versus D&C +/− Hysteroscopy +/− TV US

[85] Tahir et al. UK 1999

RCT

35

Inpatient: Hysteroscopy & D&C (200) vs Outpatient: Pipelle +/− TV US +/− Hysteroscpy (200)

Adequacy

No difference

Concordance

Inpatient: 100&

Outpatient: 82&

More pain in outpatient

N/A

Others

[73] Trolice et al. USA 2000

RCT Anaesthesia for Pipelle

Lidocaine: 42.1 ± 11.9/ Saline: 44.9 ± 12.5

Lidocaine (19) vs Saline (22)

Significant reduction of pain with lidocaine

Less pain with intervention

N/A

[34] Cornier France 1984

Brief communication

Mostly pre-menopausal

Pipelle (250)

No control

Useful for histologic dating of the endometrium

Little discomfort

Low cost

[74] Frishman USA 1990

Letter in response to study [27]

N/A

Pipelle versus Tis-u-Trap

N/A

N/A

Pipelle cheaper

[38] Mc Cluggage Northern Ireland 2006

Review

N/A

Pipelle versus other ES

Difficulties of processing outpatient ES samples

N/A

N/A

[79] Van Den Bosch Belgium 2005

Prospective sequential

Pre-menopausal: 41.6 ± 8.7

Post-menopausal: 59 ± 9.9

US before and after Pipelle (99)

Thickness of the endometrium

ET on average 0.4 mm less after performing Pipelle

N/A

N/A

[76] Brandner et al. Germany 2000

Review

N/A

N/A

Progression of endometrial lesions (potential limitations for ES)

N/A

N/A

[80] Dijkhuizen et al. The Netherlands 2000

Meta-analysis

39 studies including 7914 patients

Different ES

Pipelle is superior to other ES for diagnosing cancer/ hyperplasia

N/A

N/A

[25] Cooper et al. USA 2000

Review

N/A

N/A

Directed biopsy with Hysteroscopy: most accurate ES (not for primary care)

N/A

N/A

[14] Farquhar et al. New Zealand 1996

Survey

68 replies from O&G consultants (48% of all contestants)

N/A

Management of menorrhagia in primary care

N/A

N/A

[78] Youssif et al. Australia 1995

Review

N/A

N/A

Effectiveness and safety of Pipelle

N/A

N/A

[77] Dantas et al. Brazil 1994

Letter

Nurses vs doctors performing Pipelle

N/A

Adequacy No difference

N/A

N/A

[82] Clark et al. UK 2002

Systematic review and meta-analysis

Mixed pre- (21%) and pos-tmenopausal (79%)

Pipelle vs other outpatient techniques

Likelihood ratio of endometrial cancer when Pipelle is:

-ve: 0.1

+ve: 64.6

N/A

N/A

[86] Ahonkallio et al. Finland 2009

Prospective

Range 47–52 Post ablation

Pipelle (57)

Adequacy

29% failure If

endometrium < 5 mm

5% failure if endometrium > 5 mm

N/A

N/A

[81] Du et al. China 2016

Review

N/A

N/A

Most appropriate ES devices for endometrial lesions

Little discomfort

N/A

[64] Masood et al. Pakistan 2015

Cross sectional

Pre- and post-menopausal 35–48

Pipelle (126) vs no comparator

Adequacy

Pipelle 96.82%

N/A

Cost-effective

[39] Seamark UK 1998

Prospective

≥40

42–74

Primary care population

Pipelle (38) vs no comparator

Adequacy

Pipelle 76%

N/A

N/A

[70]Seto UK 2016

Retrospective

Pre-menopausal 46.1 ± 4.6

Post-menopausal

57.2 ± 8.1

Pipelle against hysteroscopy

Positive predictive value for endometrial polyp

Pipelle (pre-menopausal) 53.7%

N/A

N/A

[65] Piatek et al. Poland 2016

Retrospective

Pre- and post-menopausal

Pipelle (312) vs no comparator

Adequacy

83.01%

N/A

N/A

  1. ES Endometrial sampling, AUB Abnormal uterine bleeding, RCT Randomized controlled trials, US Transvaginal ultrasound, N/A Non-applicable,? Unknown