To see if hysteroscopy can accurately diagnose endometrial cancer and hyperplasia in patients who have abnormal uterine bleeding.
Searches of the Cochrane Library, MEDLINE, and EMBASE (1984-2001), manual searches of bibliographies of known primary and review publications, and contact with manufacturers were used to find relevant articles.
If the accuracy of hysteroscopy was measured in women with abnormal uterine bleeding, using histopathologic results as a reference standard, studies were chosen blindly, independently, and in triplicate. The search yielded 3486 articles, with 208 of them rated possibly suitable and retrieved for further data extraction. Sixty-five main studies with a total of 26,346 women were examined. Each study’s data was abstracted based on its features and quality. The diagnostic accuracy results were separated into two contingency tables: one for endometrial cancer and the other for endometrial illness. As a summary accuracy metric, pooled likelihood ratios (LRs) were employed. Endometrial cancer was shown to have a pretest risk of 3.9% (95% confidence interval [CI], 3.7% -4.2% ). A positive hysteroscopy result (pooled LR, 60.9; 95 % CI, 51.2-72.5) elevated the risk of cancer to 71.8% (95% CI, 67.0% -76.6%), whereas a negative hysteroscopy result (pooled LR, 0.15; 95% CI, 0.13-0.18) lowered the risk to 0.6% (95% CI, 0.5% -0.8%). There was statistical variability in the pooling of LRs, but neither spectrum composition nor research quality could explain it. When compared to cancer, the overall accuracy for diagnosing endometrial illness was low, and the findings were inconsistent. Postmenopausal women and those who were treated in an outpatient environment had better accuracy.
Reference:jamanetwork.com/journals/jama/article-abstract/195338?resultClick=1
