Diagnostic accuracy of endometrial sampling tests for detecting endometrial cancer: a systematic review and meta-analysis

Objectives To determine the diagnostic accuracy of different endometrial sampling tests for detecting endometrial carcinoma. Design Systematic review and meta-analysis of studies of diagnostic accuracy. Data sources Cochrane Library, MEDLINE/PubMed, CINAHL, Web of Science and Scopus, from the date of inception of the databases to 18 January 2023. Additionally, the reference lists of included studies and other systematic reviews were thoroughly searched. Eligibility criteria We included published cross-sectional studies that evaluated any endometrial sampling test (index tests) in women (participants) with clinical suspicion of endometrial carcinoma (target condition) in comparison with histopathology of hysterectomy specimens (reference standard). We excluded case-control and case series studies. No restrictions on language or date of publication were applied. Data extraction and synthesis Two independent reviewers extracted study data and assessed study quality using the revised quality assessment tool for diagnostic accuracy studies (QUADAS-2). We used bivariate diagnostic random-effects meta-analysis and presented the results in a summary receiver operating characteristic curve. We assessed the certainty of evidence as recommended by the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) approach. Results: Twelve studies (1607 participants), published between 1986 and 2022, contributed data to the meta-analysis results. Seven studies were judged to be at a low risk of bias in all domains and all studies had low applicability concerns. The most studied index tests were Pipelle and conventional dilation and curettage (D & C). The sensitivity, specificity, positive likelihood ratio and negative likelihood ratio (95% CIs) for Pipelle were 0.774 (0.565 to 0.900), 0.985 (0.927 to 0.997), 97.000 (14.000 to 349.000) and 0.241 (0.101 to 0.442) and for conventional D & C were 0.880 (0.281 to 0.993), 0.984 (0.956 to 0.995), 59.300 (14.200 to 153.000) and 0.194 (0.007 to 0.732), respectively. Conclusion High certainty evidence indicates that endometrial sampling using Pipelle or conventional D & C is accurate in diagnosing endometrial cancer. Studies assessing other endometrial sampling tests were sparse.