A Randomized Comparative Study to Compare Karman's Cannula and Pipelle Biopsy for Evaluation of Abnormal Uterine Bleeding

OBJECTIVES: This study aimed to compare the diagnostic accuracy, inadequate sampling, pain during the procedure (Visual Analog Scale [VAS] score), and ease of insertion of the Karman's cannula and Pipelle biopsy for patients with abnormal uterine bleeding (AUB). METHODS: This prospective observational randomized comparative study included women of age more than 40 years with complaints of AUB. Two hundred and fifty women were randomly divided into two groups: (1) Group A (n = 125) who underwent endometrial aspiration using Karman's cannula and (2) Group B (n = 125) who underwent Pipelle endometrial sampling. Both the groups were followed by conventional dilation and curettage (D and C) which was considered the gold standard. Sensitivity, specificity, positive predictive value, and negative predictive value for differentiating benign and malignant conditions of endometrium were calculated. RESULTS: Group B had a sensitivity of 89.29% followed by Group A (86.36%); on the other hand, Group A had a specificity of 96.08% followed by Group B (95.74%) (P > 0.05). Inadequacy was comparable among the two groups with 1 inadequate in Group A and 3 inadequate in Group B. Mean VAS score was significantly lesser in Group A than Group B (4.5 ± 2 vs. 5.8 ± 2.1, P < 0.0001). Ease of insertion was similar in Groups A and B (P = 0.345). CONCLUSION: Both procedures were equivalent in diagnostic accuracy, inadequacy, and ease of insertion. However, the use of Karman cannula resulted in less pain and is a much cheaper option in comparison to Pipelle. Overall, either procedure can be performed on an outpatient basis without cervical dilation and anesthesia and thus may be routinely used for women presenting with AUB.