Diagnostic Accuracy of Dilation and Curettage for Endometrial Pathology in Abnormal Uterine Bleeding

Abstract

Background: Dilation and curettage (D&C) remains an endometrial sampling method in settings where hysteroscopy or office biopsy is unavailable, unsuitable, or inconclusive. This study evaluated agreement and diagnostic performance of D&C histopathology against subsequent hysterectomy histopathology in women with abnormal uterine bleeding (AUB).
Methods: A cross-sectional diagnostic-accuracy study included 100 consecutive women who underwent hysterectomy for AUB at Benghazi Medical Center from April 2023 to August 2024 and had a documented previous D&C. Clinical characteristics and paired histopathology findings were recorded. Agreement was assessed using Cohen's kappa, and hysterectomy histopathology was used as the reference standard for malignancy.
Results: Mean age was 55.35 ± 8.14 years and 57% of participants were postmenopausal. Agreement was moderate for detailed histopathological findings (κ = 0.505) and for grouped lesion type (κ = 0.487). For malignancy, D&C identified 24 of 31 malignant cases and produced no false-positive malignant diagnoses (κ = 0.826). Sensitivity was 77.4%, specificity 100%, positive predictive value 100%, negative predictive value 90.8%, and accuracy 93%.
Conclusion: In this selected hysterectomy cohort, D&C showed high specificity but imperfect sensitivity for malignancy and only moderate agreement across broader endometrial pathology. A negative D&C should therefore be interpreted with the clinical and imaging findings when suspicion of malignancy persists.