Diagnostic Accuracy of Pipelle Endometrial Sampling Compared with Hysterectomy Histopathology in Abnormal Uterine Bleeding: A Cross-Sectional Study

Abstract

Background: The term "abnormal uterine bleeding" refers to abnormalities in the menstrual cycle that include the frequency, regularity, duration and volume of menstrual flow. While it heavily impacts women of reproductive age, abnormal bleeding and postmenopausal hemorrhage remain critical indicators for underlying endometrial pathology across all age groups. The Pipelle endometrial biopsy technique has been used to assess abnormal uterine bleeding. It is used as an outpatient procedure and does not require hospitalization.Objectives: To accurately assess the diagnostic confirmation role of the Pipelle endometrial biopsy in relation to the final post-hysterectomy histopathology in patients scheduled for hysterectomy because of abnormal uterine bleeding or postmenopausal hemorrhage.Methods: A cross-sectional study prospectively assessed 70 consecutive patients presenting with abnormal uterine bleeding or postmenopausal bleeding. The cohort included 36 premenopausal women and 34 postmenopausal women, with ages ranging from 28 to 91 years. Between March 1 and December 25, 2023, at Baghdad Teaching Hospital, a Pipelle biopsy was taken and sent for histopathological examination. An analysis of the results was carried out and compared with the results of the hysterectomy specimen of the same patient.Results: Pipelle biopsy findings revealed that 20 cases (28.6%) had bleeding of endometrial origin, 12 (17.1%) had hyperplasia without atypia, 26 (37.2%) had hyperplasia with atypia and 12 (17.1%) had adenocarcinoma. Compared to hysterectomy-based histopathological findings, the Pipelle biopsy demonstrated a positive predictive value (PPV) and negative predictive value (NPV) of 75% and 85.2% for endometrial hyperplasia without atypia, 25% and 94.1% for endometrial hyperplasia with atypia, and 100% and 75.3% for endometrial adenocarcinoma, respectively. The overall diagnostic accuracy for these three conditions was 83.3%, 68.5%, and 81.4%, respectively.Conclusion: The Pipelle is safe and accurate to use in the investigation of abnormal uterine bleeding, especially if the histopathological report shows endometrial carcinoma.