Validation of Pipelle endometrial biopsy in patients with abnormal uterine bleeding in Kazakhstani healthcare setting

Background: Abnormal uterine bleeding is a common sign which cover various conditions e/o pathologies. Different approaches are used to evaluate this condition. The aim of this study was to investigate the validity of Pipelle biopsy for endometrial sampling in Kazakhstani women with abnormal uterine bleeding. For this reason, we carried out a prospective study of 120 patients who underwent endometrial sampling due to abnormal uterine bleeding in a tertiary hospital setting in Kazakhstan. Methods: Statistics included descriptive analysis to evaluate the frequency of various endometrial conditions. The validity of Pipelle biopsy sampling was calculated by estimating sensitivity, specificity, accuracy, and positive and negative predictive values. For the Pipelle sampling validity assessment, we analyzed 120 samples, as 21 patients with insufficient samples were excluded. Results: Overall, concordance in histopathologic results was 92.93%. Pipelle sampling identified two cases of adenocarcinoma in our group. Moreover, endometrial hyperplasia was detected with 71.43% sensitivity, 98.82% specificity, PPV of 90.91% and NPV of 95.45%. However, the Pipelle reliability was low in cases of endometrial polyps. In conclusion, the Pipelle method was found to be valid for the diagnosis of endometrial hyperplasia and adenocarcinoma with high SN, SP, PPV and NPV. Conclusions: The Pipelle technique for evaluation of abnormal uterine bleeding in the Kazakhstani health care setting is a useful method with the highest efficacy in ruling out endometrial hyperplasia and diagnosing adenocarcinoma. If endometrial polyp was suspected under ultrasound scan in patients with abnormal uterine bleeding, physicians should consider other tools for endometrial sampling.