Page 135 - The diagnostic work-up of women with postmenopausal bleeding

The accuracy of endometrial sampling
without knowledge of the results of the reference test had to be clearly stated, and the histology results had to be pre-specified. For the reference standard (D&C or hysteroscopy) it had to be clearly stated that results were interpreted without knowledge of the result of endometrial sampling. For patient flow and timing, the time between endometrial sampling and reference test, if all patients received the same reference test and if all patients were included in the analysis, had to be clearly stated. Applicability was based on patients with PMB, endometrial sampling as the index test, D&C or diagnostic hysteroscopy with histology as reference test.
For all articles, each domain was assessed in terms of risk and bias, and the first three domains were also assessed in terms of applicability for this review. Each item was labelled ‘low’,‘high’, or ‘unclear’. Studies, which scored ‘high bias’ on more than one of four items, were excluded. And only studies, which scored ‘low’ on all three items of concerns on applicability, were included in this review. We included all applicable studies on this subject, regardless of the number of postmenopausal women included and regardless if data were collected prospectively or retrospectively.
Data extraction
For studies, which included pre- and postmenopausal women, we used only those
calculations and conclusions concerning the latter. From each article we extracted
(if available): the reference standard that was used, the number of women who
underwent endometrial sampling, the number of women in whom endometrial
sampling was not possible, failed or showed insufficient material for a pathologic 7 diagnosis, the number of women who underwent both endometrial sampling and the
reference standard, the number of cases with endometrial cancer, atypical hyperplasia or endometrial disease. Hyperplasia without atypia was considered a benign result. Endometrial disease was defined as benign endometrial polyps in one study, and as polyps, hyperplasia and cancer together in most other studies. For this meta-analysis we decided to define endometrial disease as endometrial cancer, atypical hyperplasia and benign endometria polyps together as endometrial disease.
Data analysis
For each study, we calculated the percentage of women in whom endometrial sampling failed to provide a diagnosis, either due to the possibility to obtain tissue (for example, because of cervical stenosis) or due to the fact that the sample that was obtained was insufficient for the pathologist to establish a diagnosis.We described the number of endometrial cancers in women with a failed endometrial sampling.
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