A comparative study on the accuracy of pipelle endometrial biopsy versus conventional dilatation and curettage in patients for diagnosing the cause of abnormal uterine bleeding including post menopausal bleeding

Abstract Background: Abnormal Uterine Bleeding (AUB) is defined as bleeding from the uterus that is irregular in volume, frequency, duration, or timing and occurs outside of normal menstrual cycles. It is a commonly encountered gynaecological problem, it is reported to occur in 9 to 14% women between menarche and menopause. In India the prevalence is 17.9%. The aim was to compare accuracy of Pipelle endometrial biopsy versus conventional dilatation & curettage in patients for diagnosing the cause of abnormal uterine bleeding. Materials and Methods: This cross-sectional study was conducted in Department of Obstetrics and Gynecology at SSMC among 99 women, Tumkur among all women above 35 year old age group as per the inclusion and exclusion criteria. After getting the informed consent endometrial sampling with Pipelle was done then followed by Conventional dilatation and curettage under anesthesia to the same patient. Both samples were sent to pathologist which were screened at the laboratory for histopathology assessment and the results were compared Results: There is a strong agreement between Pipelle sampling and D&C for most histopathological diagnosis. For instance, in proliferative endometrium, Pipelle demonstrated a sensitivity of 95.8% and a perfect specificity of 100%, correctly identifying 46 out of 48 cases. Similarly, secretory endometrium had a sensitivity of 89.5% with 100% specificity, while both forms of endometrial hyperplasia (with and without atypia) and adenocarcinoma were identified with 100% sensitivity and specificity. However, the Pipelle's performance was notably lower for atrophic endometrium, with a sensitivity of 62.5% due to three false negatives, and particularly for endometrial polyps, where sensitivity dropped to 25% despite maintaining a specificity of 100%. These findings suggest that while the Pipelle method is highly reliable for most endometrial conditions, clinicians should be cautious and consider additional diagnostic approaches in cases of atrophic endometrium and suspected polyps. Conclusion: Pipelle is a simple, convenient, safe and yet efficient tool for endometrial assessment. It can be done as an outpatient procedure without any anesthesia, less painful, cost effectiveness, easier to perform and fewer complications when compared to D&C which is done under anesthesia