A STUDY ON DIAGNOSTIC ACCURACY OF PIPELLE ENDOMETRIAL BIOPSY WITH HYSTERECTOMY HISTOPATHOLOGICAL REPORT IN PATIENTS WITH PREMENOPAUSAL AND POSTMENOPAUSAL BLEEDING

Abstract

Background: Abnormal uterine bleeding (AUB) is a common gynaecological complaint requiring evaluation to exclude endometrial pathology. Pipelle endometrial biopsy is a minimally invasive outpatient procedure, but its diagnostic accuracy compared to hysterectomy histopathology needs validation. Methods: This prospective observational diagnostic accuracy study was conducted in the Department of Obstetrics and Gynaecology at Sree Balaji Medical College and Hospital, Chennai, over 18 months (July 2024 to December 2025). A total of 120 women aged 40–55 years presenting with AUB and planned for hysterectomy were enrolled. All participants underwent Pipelle endometrial biopsy in the outpatient setting, followed by hysterectomy. Pipelle histopathology findings were compared with hysterectomy specimens as the gold standard. Diagnostic accuracy parameters including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were calculated. Results: The mean age of participants was 49.2 ± 4.1 years, with 56.7% premenopausal and 43.3% postmenopausal. Mean BMI was 28.4 ± 2.8 kg/m², with 81.7% overweight or obese. Heavy menstrual bleeding (35.0%) was the most common presentation. Adequate Pipelle samples were obtained in 85.0% of cases. On hysterectomy histopathology, benign endometrium (36.7%), hyperplasia without atypia (25.0%), atypical hyperplasia (8.3%), endometrial carcinoma (18.3%), and polyps (11.7%) were diagnosed. Pipelle biopsy demonstrated sensitivity of 88.5% (95% CI: 77.0–95.0), specificity of 96.2% (95% CI: 88.0–99.0), PPV of 93.4%, NPV of 92.8%, and overall accuracy of 92.5% for detecting endometrial pathology. However, sensitivity for polyp detection was only 28.6%. Among 12 inadequate Pipelle samples, subsequent hysterectomy revealed significant pathology in 3 cases (25.0%), including one carcinoma and one atypical hyperplasia. Conclusion: Pipelle endometrial biopsy has high diagnostic accuracy for detecting endometrial carcinoma and hyperplasia but poor sensitivity for polyps. Inadequate samples warrant further evaluation. Pipelle is a reliable first-line outpatient investigation for AUB, though negative results do not completely exclude pathology, and suspected focal lesions require hysteroscopic evaluation.