The accuracy of endometrial sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia - A meta-analysis

BACKGROUND. Endometrial assessment by means of biopsy or sampling of endome trial cells is a minimally invasive alternative for dilatation and curettag e (D&C) or hysteroscopy. The use of this technique is believed to reduce th e cost of the diagnostic work-up for abnormal uterine bleeding without redu cing accuracy. Because the authors were not aware of any systematic review of this test, they performed a meta-analysis to assess the accuracy of endo metrial sampling devices in the detection of endometrial carcinoma and atyp ical hyperplasia. METHODS, The authors searched the literature for studies published between 1966 and 1999 comparing the results of endometrial sampling with findings a t D&C, hysteroscopy, and/or hysterectomy. They found 39 studies that includ ed 7914 women. For each study, the fraction of patients was calculated in w hich endometrial sampling failed. Furthermore, the authors calculated the f raction of cases of endometrial carcinoma and atypical hyperplasia that wer e identified correctly as well a:; the fraction of women in whom these dise ases were diagnosed false positively. RESULTS, The detection rate for endometrial carcinoma was higher in postmen opausal women compared with premenopausal women. In both postmenopausal and premenopausal women, the Pipelle was the best device, with detection rates of 99.6% and 91%, respectively. For the detection of atypical hyperplasia, there was only one study that reported explicitly on postmenopausal women, thereby hampering the possibility of subgroup analysis. Again, the Pipelle was the most sensitive technique with a sensitivity of 81%. The specificit y of all devices was > 98%. CONCLUSIONS. Endometrial biopsy with the Pipelle is superior to other endom etrial techniques in the detection of endometrial carcinoma and atypical hy perplasia. The accuracy of the Pipelle is higher in postmenopausal women co mpared with premenopausal women. Cancer 2000;89:1765-72. (C) 2000 American Cancer Society.