A systematic review and meta-analysis of the diagnostic accuracy of endometrial sampling tests for detecting endometrial cancer

Abstract Objectives to determine the diagnostic accuracy of different endometrial sampling tests for detecting endometrial carcinoma. Design a systematic review and meta-analysis of studies of diagnostic accuracy. Eligibility criteria We included published diagnostic test accuracy studies of women, of all ages, who had an endometrial sampling for preoperatively detecting endometrial cancer with verification using histopathology of hysterectomy specimens as the reference standard. We excluded case control and case series studies. Information sources We searched the Cochrane library, MEDLINE/PubMed, CINAHL, Web of Science, and Scopus from the date of inception of the databases to January 18, 2023. We did not apply any restrictions on language or date of publication. We searched the references of included studies and other systematic reviews. Risk of bias We extracted study data and assessed study quality using the revised quality assessment tool for diagnostic accuracy studies (QUADAS-2). Synthesis of results 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 approach. Results Twelve included studies, published between 1986 and 2022, recruited 1607 participants. Seven studies were low risk of bias in all domains and all studies had low applicability concerns. The most examined index tests were Pipelle and conventional dilation and curettage. For diagnosing endometrial carcinoma, the sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio (95% confidence intervals), for Pipelle were 0.774 (0.565, 0.900), 0.985 (0.927, 0.997), 97.000 (14.000, 349.000), and 0.241 (0.101, 0.442)and for conventional dilation and curettage were 0.773 (0.333, 0.959), 0.987 (0.967, 0.995), 62.300 (18.600, 148.000), and 0.268 (0.042, 0.676); respectively. Conclusion High certainty evidence indicates that pre-operative endometrial sampling particularly using Pipelle or conventional curettage is accurate in diagnosing endometrial cancer. Studies assessing other endometrial sampling tests were sparse. Systematic review registration Center for Open Science, osf.io/h8e9z