Comparative Study of Hysteroscopy-Guided Endometrial Biopsy with Conventional Methods in Abnormal Uterine Bleeding Patients

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Background: Abnormal uterine bleeding is a common gynecological complaint requiring accurate endometrial evaluation for appropriate management. Conventional endometrial biopsy is a blind procedure that may fail to detect focal intrauterine lesions. Hysteroscopy-guided biopsy enables direct visualization and targeted tissue sampling, potentially improving diagnostic accuracy. Methods: A prospective randomized controlled study was conducted among 100 women aged 20 to 60 years presenting with abnormal uterine bleeding. Participants were equally allocated to undergo either hysteroscopy-guided endometrial biopsy or conventional blind endometrial biopsy. The primary outcomes were tissue adequacy and diagnostic yield. Secondary outcomes included detection of focal lesions, premalignant and malignant pathology, procedure duration, and pain scores. Histopathological examination served as the reference standard. Results: Hysteroscopy-guided biopsy demonstrated significantly higher tissue adequacy than conventional biopsy (96% versus 76%) and markedly reduced the need for repeat biopsy (4% versus 24%). Detection of endometrial polyps, endometrial hyperplasia, atypical hyperplasia, and endometrial carcinoma was superior with hysteroscopy-guided biopsy. Overall diagnostic performance, including sensitivity for focal and premalignant lesions, was higher with hysteroscopy-guided biopsy. Although the procedure required a longer duration and was associated with slightly higher pain scores, it provided greater diagnostic accuracy and improved pathological yield. Conclusion: Hysteroscopy-guided endometrial biopsy is superior to conventional blind endometrial biopsy for evaluating women with abnormal uterine bleeding. Its higher tissue adequacy, improved detection of focal and malignant lesions, and reduced requirement for repeat sampling support its use as the preferred diagnostic approach, particularly when focal pathology or malignancy is suspected.

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