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- Title
Accuracy of Hysteroscopy in the Diagnosis of Endometrial Cancer and Hyperplasia: A Systematic Quantitative Review.
- Authors
Clark, T. Justin; Voit, Doris; Gupta, Janesh K.; Hyde, Christopher; Song, Fujian; Khan, Khalid S.
- Abstract
Context: Hysteroscopy (direct endoscopic visualization of the endometrial cavity) is used extensively in the evaluation of common gynecologic problems, such as menorrhagia and postmenopausal bleeding. However, there is a continuing debate about the value of this technology in the diagnosis of serious endometrial disease. Objective: To determine the accuracy of hysteroscopy in diagnosing endometrial cancer and hyperplasia in women with abnormal uterine bleeding. Data Sources: Relevant articles were identified through searches of the Cochrane Library, MEDLINE, and EMBASE (1984-2001), manual searches of bibliographies of known primary and review articles, and contact with manufacturers. Study Selection: Studies were selected blindly, independently, and in duplicate if accuracy of hysteroscopy was estimated in women with abnormal uterine bleeding, using histopathologic findings as a reference standard. Our search identified 3486 articles; 208 of these were deemed to be potentially eligible and were retrieved for detailed data extraction. Sixty-five primary studies were analyzed, including 26 346 women. Data Extraction: Data were abstracted on characteristics and quality from each study. Results for diagnostic accuracy were extracted to form 2 × 2 contingency tables separately for endometrial cancer and endometrial disease (cancer, hyperplasia, or both). Pooled likelihood ratios (LRs) were used as summary accuracy measures. Data Synthesis: The pretest probability of endometrial cancer was 3.9% (95% confidence interval [CI], 3.7%-4.2%). A positive hysteroscopy result (pooled LR, 60.9; 95% CI, 51.2-72.5) increased the probability 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) reduced the probability of cancer to 0.6% (95% CI, 0.5%-0.8%). There was statistical heterogeneity in pooling of LRs, but an explanation for this could not be found in spectrum composition and study quality. The overall...
- Subjects
HYSTEROSCOPY; DIAGNOSIS of endometrial diseases; CANCER diagnosis; UTERINE hemorrhage; HYPERPLASIA; DIAGNOSIS
- Publication
JAMA: Journal of the American Medical Association, 2002, Vol 288, Issue 13, p1610
- ISSN
0098-7484
- Publication type
Article
- DOI
10.1001/jama.288.13.1610