Endometrial thickness to rule out endometrial cancer

January 01, 0001

Endometrial thickness to rule out endometrial cancer

These authors from multiple European countries estimated the accuracy of endometrial thickness measurement in the detection of endometrial cancer among women with postmenopausal bleeding using individual patient data and multiple meta-analytic strategies. They identified 90 studies reporting on endometrial thickness measurements and endometrial carcinoma in women with postmenopausal bleeding.

They found: "We contacted 79 primary investigators to obtain the individual patient data of their reported studies, of which 13 could provide data. Data on 2,896 patients, of which 259 had carcinoma, were included. Several approaches were used in the analyses of the acquired data. First, we performed receiver operator characteristics (ROC) analysis per study, resulting in a summary area under the ROC curve (AUC) calculated as a weighted mean of AUCs from original studies. Second, individual patient data were pooled and analyzed with ROC analyses irrespective of study with standardization of distributional differences across studies using multiples of the median and by random effects logistic regression. Finally, we also used a two-stage procedure, calculating sensitivities and specificities for each study and using the bivariate random effects model to estimate summary estimates for diagnostic accuracy. This resulted in rather comparable ROC curves with AUCs varying between 0.82 and 0.84 and summary estimates for sensitivity and specificity located along these curves. These curves indicated a lower AUC than previously reported meta-analyses using conventional techniques."

The authors concluded: "Previous meta-analyses on endometrial thickness measurement probably have overestimated its diagnostic accuracy in the detection of endometrial carcinoma. We advise the use of cutoff level of 3 mm for exclusion of endometrial carcinoma in women with postmenopausal bleeding."

This recommendation is a change from current practice and appears to be well founded.

For the full abstract, click here.

Obstet Gynecol 116(1):160-167, July 2010
© to the American College of Obstetricians and Gynecologists
Endometrial Thickness Measurement for Detecting Endometrial Cancer in Women With Postmenopausal Bleeding: A Systematic Review and Meta- Analysis. Anne Timmermans, Brent C. Opmeer, Khalid S. Khan, et al. Correspondence to Dr. Timmermans: [email protected]

Category: X. Female Genital System, Breast. Keywords: endometrial thickness, postmenopausal bleeding, endometrial cancer, diagnostic testing, meta-analysis of diagnostic test studies, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 3 August 2010

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