Comparison of Pipelle endometrial sampling versus dilatation and curettage in cases of abnormal uterine bleeding: A prospective study

Background: Abnormal uterine bleeding (AUB) requires endometrial evaluation to exclude premalignant and malignant lesions, with Pipelle sampling offering a minimally invasive outpatient alternative to conventional dilatation and curettage (D&C). Aims and Objectives: To compare the diagnostic efficacy of Pipelle endometrial sampling with conventional D&C and evaluate the adequacy of Pipelle obtained endometrial tissue for histopathological diagnosis in women with AUB. Materials and Methods: This 1-year prospective observational study, conducted from September 2020 to September 2021, included 110 women aged >35 years with AUB. All underwent Pipelle sampling followed by conventional D&C in the same sitting. Histopathological findings and tissue adequacy were compared, with D&C serving as the reference standard for assessing Pipelle’s diagnostic performance. Results: Most participants were aged 46–50 years (45.5%), and 57.3% had AUB for 3–12 months. Secretory endometrium was the most common finding with D&C (43.6%) and Pipelle (42.7%), followed by proliferative (19.1% each) and atrophic endometrium (9.1% each). Endometrial polyps were detected in 10.9% of D&C and 7.2% of Pipelle samples. Adequate tissue was obtained in 93.6% of D&C and 89.1% of Pipelle samples (P<0.001). Pipelle showed 100% sensitivity and specificity for endometrial carcinoma, hyperplasia, proliferative, and atrophic endometrium. Sensitivity for secretory endometrium was 98%, with 100% specificity. For endometrial polyps, sensitivity, specificity, positive predictive value, and negative predictive value were 66.6%, 100%, 100%, and 89.6%. Conclusion: Pipelle is an effective outpatient alternative to D&C for evaluating AUB, with high tissue adequacy and diagnostic accuracy, although D&C remains preferable when endometrial polyps are suspected.