Histopathological Spectrum of Endometrial Lesions in Abnormal Uterine Bleeding: Age-Specific Diagnostic Insights

Background: Abnormal uterine bleeding (AUB) is a very common gynecological complaint with a multifactor etiology that varies with age. Histopathological examination of endometrial lesions allows appropriate diagnosis as well as treatment. Objectives: To examine the histopathological diversity of endometrial disease in women with abnormal uterine bleeding (AUB) and to verify the diagnostic efficiency of dilation and curettage (D&C) across varying age categories and classes of parity. Methodology: A retrospective study of 322 women with AUB was conducted who underwent D&C/D&E. HPE of sample was done at Department of Pathology, Darbhanga Medical College and Hospital Laheriasarai. Patients were also separated by age (18–39, 40–49, ≥50 years) and by parity. Histopathological findings were classified, and results of D&C were cross tabulated against follow-up hysterectomy specimens in 28 cases for validating diagnostic validity. Results: Functional endometrium and benign lesions were most common amongst premenopausal women and multiparous patients, whilst malignant (17.4%) and atrophic variants increased with age. Pregnancy-related diagnoses did not extend past patients aged < 50. D&C was extremely sensitive but not very specific (96.5%) for premalignant and malignant lesions and also not very accurate (75.6%) in distinguishing normal from pathologic endometrium. Hysterectomy grading of endometrioid adenocarcinoma was consistent with initial biopsy grading in majority of cases with minimal upgrading/downgrading (15.4%). Conclusion: Age- and parity-related patterns for endometrial lesions of AUB do exist. D&C is extremely effective for the detection of premalignant change as well as malignant change, justifying its use in age-related diagnostic strategies.