Pipelle Endometrial Biopsy Versus Conventional Dilation and Curettage for the Diagnosis of Endometrial Pathology in Abnormal Uterine Bleeding

Introduction Abnormal uterine bleeding (AUB) is a common issue in gynecological practice and may require evaluation depending on the patient's age and clinical presentation. The aim of this study was to compare the diagnostic accuracy, sample adequacy, patient acceptability, and procedural outcomes of Pipelle endometrial biopsy versus dilation and curettage (D&C) in women with AUB. Methods A prospective observational study was conducted on 125 women aged ≥35 years presenting with AUB. All participants underwent both Pipelle biopsy and D&C sequentially. Histopathological diagnoses from both methods were compared, with D&C serving as the reference standard. Diagnostic performance metrics, sample adequacy, pain scores, procedure duration, cost, complications, and patient-reported outcomes were analyzed. Results Pipelle biopsy showed high diagnostic concordance with D&C (Cohen's Kappa=0.948, p<0.001), with 97.6% agreement. Sensitivity, specificity, positive predictive value, and negative predictive value were 94.1%, 99.8%, 99.6%, and 99.5%, respectively. Sample adequacy was 97.6% for Pipelle versus 100% for D&C (p=0.247). Pipelle was significantly less painful (visual analog scale (VAS) 1.64 vs. 5.81), quicker (3.65 vs. 12.07 minutes), and more cost-effective (₹322.48 vs. ₹1387.40) than D&C (p<0.0001 for all). Pipelle had fewer complications (4% vs. 15.2%, p=0.003) and higher patient acceptability across all domains (p<0.05). Conclusion Pipelle endometrial biopsy is a highly accurate, safe, cost-effective, and well-tolerated alternative to conventional D&C for evaluating AUB in women aged ≥35 years. Its ease of use and outpatient feasibility support its adoption as a first-line diagnostic tool, particularly in resource-limited settings.