Diagnostic Accuracy of Pipelle Aspiration versus Dilatation and Curettage in Endometrial Hyperplasia: a Structured Narrative Review in Women Examines the Relationship between Age and Risk of Atypia

Endometrial hyperplasia (EH) is a common precursor of endometrial cancer and requires precise diagnostic techniques. Pipelike endometrial biopsy has become popular as a minimally invasive outpatient procedure, but its diagnostic reliability in comparison to Dilatation and Curing (D&C), the historical gold standard, is still under debate, particularly among populations such as Iranian women. This study compared the diagnostic accuracy of Pipelle with D&C for EH, focusing on the performance in relation to age and risk stratification based on atypia. A systematic review and a comparative analysis using data from peer reviewed studies involving cohorts from Iran and from international cohorts has been performed. Diagnostic metrics - including sensitivity, specificity, positive and negative predictive values, adequacy of the sample and histopathological concordance - have been extracted and analysed for the age groups and subtypes of hyperplasia. Pipelle demonstrated a high overall concordance with D&C (۹۴.۶) and sensitivity and specificity of more than ۹۴ percent for the detection of atypical hyperplasia and carcinoma of the cervix. However, there were significant limitations in postmenopausal women with an inadequate rate of ۶۳ percent and in non-typical EH, where Pipelle showed a higher rate of progression to carcinoma (۲۷.۳% vs. ۱۵.۰%, p = .۰۲۲) compared to D&C. The accuracy of the diagnosis was also affected by endometrial thickness (۵ mm decreased from Pipelle adequacy to ۲۷%) and patient age (>۵۰ years associated with higher co-morbidity). Pipelle is a reliable first line tool for the evaluation of abnormal uterine bleeding in premenopausal and postmenopausal women, especially to exclude atypical hyperplasia or tumour. However, D&C is still preferable for definitive diagnosis in postmenopausal women, in cases of endometrial thinness or in the presence of suspected non-atypical hyperplasia. Clinical decision-making should integrate age, menopausal status, body mass index and imaging findings in order to optimise diagnostic results and patient outcomesEndometrial hyperplasia (EH) is a common precursor of endometrial cancer and requires precise diagnostic techniques. Pipelike endometrial biopsy has become popular as a minimally invasive outpatient procedure, but its diagnostic reliability in comparison to Dilatation and Curing (D&C), the historical gold standard, is still under debate, particularly among populations such as Iranian women. This study compared the diagnostic accuracy of Pipelle with D&C for EH, focusing on the performance in relation to age and risk stratification based on atypia. A systematic review and a comparative analysis using data from peer reviewed studies involving cohorts from Iran and from international cohorts has been performed. Diagnostic metrics - including sensitivity, specificity, positive and negative predictive values, adequacy of the sample and histopathological concordance - have been extracted and analysed for the age groups and subtypes of hyperplasia. Pipelle demonstrated a high overall concordance with D&C (۹۴.۶) and sensitivity and specificity of more than ۹۴ percent for the detection of atypical hyperplasia and carcinoma of the cervix. However, there were significant limitations in postmenopausal women with an inadequate rate of ۶۳ percent and in non-typical EH, where Pipelle showed a higher rate of progression to carcinoma (۲۷.۳% vs. ۱۵.۰%, p = .۰۲۲) compared to D&C. The accuracy of the diagnosis was also affected by endometrial thickness (۵ mm decreased from Pipelle adequacy to ۲۷%) and patient age (>۵۰ years associated with higher co-morbidity). Pipelle is a reliable first line tool for the evaluation of abnormal uterine bleeding in premenopausal and postmenopausal women, especially to exclude atypical hyperplasia or tumour. However, D&C is still preferable for definitive diagnosis in postmenopausal women, in cases of endometrial thinness or in the presence of suspected non-atypical hyperplasia. Clinical decision-making should integrate age, menopausal status, body mass index and imaging findings in order to optimise diagnostic results and patient outcomes

Keywords:

Pipelle biopsy , dilation and curettage , endometrial hyperplasia , diagnostic accuracy , atypia , Iranian women , age correlation