Page 156 - The diagnostic work-up of women with postmenopausal bleeding

Chapter 8
Chapter 7 presents the results of the last researched subject of this thesis: a systematic review and meta-analysis on the diagnostic accuracy of endometrial sampling for the diagnoses of endometrial cancer, atypical hyperplasia and endometrial disease (endometrial pathology, including benign polyps).We identified 12 studies comparing the results of endometrial sampling with two different reference standards:five studies on blind dilatation and curettage and seven studies on hysteroscopy with histology. For each included study, we calculated the fraction of women in whom endometrial sampling failed. Furthermore, we extracted numbers of cases of endometrial cancer, atypical hyperplasia and endometrial disease that were identified or missed by endometrial sampling.We assessed the diagnostic accuracy of endometrial sampling and found that specificity of endometrial sampling is very high, irrespective of the type of disease or the reference test that was used. Sensitivity, on the other hand, is lower than previously thought based on existing meta-analyses, for all types of disease, but especially for atypical hyperplasia and endometrial disease, which includes endometrial polyps. From this meta-analysis we can conclude that in cases of women with postmenopausal bleeding, the sensitivity of endometrial sampling to detect endometrial cancer, and especially atypical hyperplasia and endometrial disease, including endometrial polyps, is lower than previously thought.
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