• Chro Najmaddin Fattah Department of Obstetrics&Gynaecology, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.
  • Sawen Mohamed Ahmed Maternity Teaching Hospital, Sulaimai Directorate of Health, Kurdistan Region, Iraq.




Abnormal uterine bleeding, Endometrial biopsy, D&C, Hysterectomy



Endometrial biopsy is an important technique used in the assessment of the Abnormal Uterine Bleeding (AUB) in women >40 years and post-menopausal women to exclude endometrial pathological abnormalities (endometrial hyperplasia and carcinoma) and confirm benign nature of the problem. Patients will be offered conservative or medical treatment and unnecessary radical surgery can be avoided.


To compare the diagnostic accuracy of endometrial curetting and the subsequent hysterectomy specimen histology in AUB in women > 40 years old and postmenopsal women. Also to evaluate causes of per and post-menopausal bleeding.

Patients and Methods

Endometrial sampling was obtained by dilatation and curetting (D&C) on 80 patients in premenopausal and post-menopausal women. Most of those patients were already planned for hysterectomy for abnormal uterine bleeding. Verbal consent was taken from all patients. Both samples were numbered and sent to a different histolopathologist. The histology report of both D&C and hysterectomy specimens were compared. Hysterectomy report was considered as the gold standard. 


Mean duration between the curetting and hysterectomy was 5 weeks. The histology of 80 samples obtained by D&C show normal endometrium in 25 cases, endometrial hyperplasia without atypia in 36 specimens and with atypia in 4 specimens, endometrial polyps in 10, atrophic endometrium in one specimen, and endometrial carcinoma in 3 specimens. 98.8% of the samples obtained by D&C were adequate for histological examination. Our results show 77.5% of the cases concordance between the D&C and hysterectomy specimen. Accuracy for complex hyperplasia with or without atypical was 100% sensitivity, 100% specificity, followed by simple hyperplasia and benign endometrial causes of AUB condition. 


Abnormal Uterine Bleeding AUB increases with age, with a profound increase in incidence in premenopausal women. Endometrial hyperplasia was the most common cause of AUB. D&C is an accurate, minimally invasive procedure for detecting endometrial pathology especially for complex hyperplasia, and it has high sensitivity and specificity than those of simple hyperplasia.


Sukhbir Singh, MD, Ottawa ON,Carolyn Best, MD, Toronto ON et al,. Abnormal Uterine Bleeding in Pre-Menopausal Women. MAY JOGC MAI 2013 473. No. 292, May 2013 (Replaces No. 106, Aug 2001).

Goldenstein SR. Modern evaluation of endometrium. Obstet Gynecol. 2010; 116:168–76. Doi: 10.1097/AOG.0b013e3181dfd557. DOI: https://doi.org/10.1097/AOG.0b013e3181dfd557

Coulter A, Bradlow J, Agass M et al. Outcome referrals to gynaecology outpatient clinics for menstrual problems: an audit of general practice records. Br J Obstet Gynaecol 1991 ; 98: 789-96. DOI: https://doi.org/10.1111/j.1471-0528.1991.tb13484.x

Oehler MK, Rees MC. Menorrhagia: an update. Acta Obstet Gynecol Scand. 2003; 82:405–22. doi: 10.1034/j.1600-0412.2003.00097. DOI: https://doi.org/10.1034/j.1600-0412.2003.00097.x

T.justin Clark, Accuracy of outpatient endometrial biopsy in the diagnosis of endometrial cancer: a systematic quantitative review. BJOG: an International Journal of obstetrics and gynecology March2002, Vol.109, pp.313–321 DOI: https://doi.org/10.1111/j.1471-0528.2002.01088.x

T.Justin Clark, Janesh K Cupta.endometrial sampling of gynecological pathology. The obstetrician and gynecologist 2002:4:169-174. DOI: https://doi.org/10.1576/toag.2002.4.3.169

Dasgupta Subhankar1, Chakraborty Barunoday2, Karim Rejaul2, Mitra Pradip Kumar4, Ghosh Tarun Kumar5, Abnormal Uterine Bleeding in Peri-Menopause Diagnostic Options and Accuracy. The Journal of Obstetrics and Gynecology of India March / April 2011 pg 189–194. DOI: https://doi.org/10.1007/s13224-011-0022-y

Rajshri P. Damle, N.V. Dravid, Kishor H. Suryawanshi et al. Clinicopathological Spectrum of Endometrial Changes in Peri-menopausal and Post-menopausal Abnormal Uterine Bleeding: A 2 Years Study. Journal of Clinical and Diagnostic Research . 2013 Dec, Vol-7(12), pp 2774-2776 DOI: https://doi.org/10.7860/JCDR/2013/6291.3755

RuthB.Goldstein. Evaluation of the Woman With Postmenopausal Bleeding society of Radiologists in Ultrasound Sponsored Consensus Conference Statement. Ultrasound Quarterly, Vol.18, No.1, pp.61–69, ©2002 Lippincott Williams & Wilkins, Inc., Philadelphia. DOI: https://doi.org/10.1097/00013644-200203000-00007

Mohamed Otify, Joanna Fuller , Jackie . Endometrial pathology in the postmenopausal woman – anevidence based approach to management, DOI: 10.1111/tog.12150 The Obstetrician & Gynaecologist http://onlinetog.org, 2015; 17:29–38. DOI: https://doi.org/10.1111/tog.12150

Kurman RJ, Ronnett BM, Hedrick Ellenson L, Editors. Blaustein’s pathology of the female genital tract. 6th ed. New York: Springer; 2011. DOI: https://doi.org/10.1007/978-1-4419-0489-8

Royal College of Obstetricians and Gynaecology.Green-top Gideline No.67. Management of Endometrial Hyperplasia. London, Engl: Royal College of Obstetricians and Gynaecology; February 2016.

www.acog.org,American Congress of Obstetricians and Gynecologists, Endometrial hyperplasia, FAQ147, May 2011

Sakshi arora, Self Assessment and Review gynecology 7 th edition, june 2015.

May J, Mehasseb MK (2013) Endometrial cancer. Obstet Gynecol Reprod Med 23(9): 263-9. DOI: https://doi.org/10.1016/j.ogrm.2013.06.006

Angioli R, Capriglione S, Aloisi A, Luvero D, Cafa EV et al. (2013) REM (risk of endometrial malignancy): a proposal for a new scoring system to evaluate risk of endometrial malignancy. Clin Cancer Res 19(20): 5733-9. DOI: https://doi.org/10.1158/1078-0432.CCR-13-1376

Muzzafar M, Akhtar KAK, Yasmin S ,Rehman M, Iqbal W, et al. Menstru Irregularities with excessive blood loss: a clinico-pathologicalCorrelation. J Pak Med Assoc 2005; 55:486-489

Azim P, Khan MM, Sharif N, Khattak EG. Evaluation of abnormal uterine bleeding on endometrial biopsies. ISRA Medical Journal. 2011, 3(3);pp 84-86

Jairajpuri ZS, Rana S, Jetley S. Atypical uterine bleeding Histopathological audit of endometrium. A study of 638 cases. Al Ameen J Med Sci 2013 ; 6(1):21-28 57.

Ibrahim Anwar Abdelazim, Amro Aboelezz, and Amr Fathy AbdulKareem. Pipelle endometrial sampling versus conventional dilatation & curettage in patients with abnormal uterine bleeding, J Turk Ger Gynecol Assoc. 2013; 14(1): 1–5. Published online 2013 Mar 1. doi: 10.5152/jtgga.2013.01. DOI: https://doi.org/10.5152/jtgga.2013.01

Sanam M1, Majid MM., Comparison the Diagnostic Value of Dilatation and Curettage Versus Endometrial Biopsy by Pipelle--a Clinical Trial., Asian Pac J Cancer Prev. 2015;16(12):4971-5. DOI: https://doi.org/10.7314/APJCP.2015.16.12.4971

Saadia A, Mubarik A, Zubair A, Jamal S, Zafar A. Diagnostic accuracy of endometrial curettage in endometrial pathology. J Ayub Med Coll Abbottabad 2011; 23:129-31.

Coulter A, Klassen A, Meckenzie I Z, Mcpherson K. Diagnostic dialation and curettage; is it used appropriately? BMJ 1993;306:236-9 DOI: https://doi.org/10.1136/bmj.306.6872.236

Perveen S, Dangal A , Perveen S. Endometrium histology in abnormal uterine bleeding. MC 2011;17:68-70

Ara S, Roohi M. Abnormal uterine bleeding: Histopathological diagnosis by conventional dilatation and curettage. Prof Med J 2011; 18:587-91. DOI: https://doi.org/10.29309/TPMJ/2011.18.04.2641



How to Cite

Fattah C, Ahmed S. DIAGNOSTIC ACCURACY OF ENDOMETRIAL CURETTAGE IN COMPARISON TO HYSTERECTOMY SPECIMENS IN PATIENTS WITH ABNORMAL UTERINE BLEEDING. JSMC [Internet]. 2019 Sep. 21 [cited 2024 Jun. 19];9(3):187-94. Available from: https://jsmc.univsul.edu.iq/index.php/jsmc/article/view/jsmc-10205

Similar Articles

1-10 of 62

You may also start an advanced similarity search for this article.

Most read articles by the same author(s)