Page 142 - The diagnostic work-up of women with postmenopausal bleeding

Chapter 7
Diagnosis of endometrial disease
As in most studies diagnostic accuracy regarding benign pathology was not described separately, we decided to extract data on the accuracy regarding the diagnosis of endometrial disease, i.e. endometrial cancer, hyperplasia and endometrial polyps together (table 3).The sensitivity of endometrial sampling was 29% in one study using blind D&C and the weighted sensitivity was 39% (range 21-69%) in five studies using hysteroscopy with histology as a reference standard. Specificity was again high, 98-100% regardless of the reference standard used. Figure 3C shows an ROC plot of the performance of the twelve studies that allowed the calculation of both sensitivity and specificity.
Figure 3A1 tm 3C2. Receiver operating curve (ROC) plots demonstrating the accuracy of endometrial sampling in diagnosing endometrial cancer, endometrial (pre) cancer or endometrial disease with D&C or hysteroscopy as a reference standard
A1. ROC plot for endometrial cancer with D&C
A2. ROC plot for endometrial cancer with hysteroscopy as a reference 11:05 Monday, August 17, 2015 1
SR
SROC b
or EC - succesful samples)
as reference
11:05 Monday, August 17, 2015
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1.0 0.8 0.6 0.4 0.2
0.0
0.0 0.2
0.4 0.6
1-specificity Analyzed August 17, 2015
0.8 1.0
1.0 0.8 0.6 0.4 0.2
0.0
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0.4 0.6
1-specificity Analyzed August 17, 2015
0.8 1.0
B1. ROC plot for endometrial (pre) cancer with D&C
B2. ROC plot for endometrial (pre) cancer with
12:27 Friday, August 21, 2015 1 SROC based on Bivariate model (data for SR van Hanegem Pipelle DC for ECAH - succesful samples)
12:27 Friday, August 21, 2015 1
as reference
hysteroscopy as a reference
SROC based on Bivariate model (data for SR van Hanegem Pipelle Hyst for ECAH - succesful samples)
1.0 0.8 0.6 0.4 0.2
0.0
0.0 0.2
0.4 0.6
1-specificity Analyzed August 21, 2015
0.8 1.0
1.0 0.8 0.6 0.4 0.2
0.0
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0.4 0.6
1-specificity Analyzed August 21, 2015
0.8 1.0
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Sensitivity Sensitivity
Sensitivity Sensitivity