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Accuracy of outpatient endometrial biopsy in the diagnosis of endometrial cancer: a systematic quantitative review

2002; Wiley; Volume: 109; Issue: 3 Linguagem: Inglês

10.1111/j.1471-0528.2002.01088.x

1471-0528

T. Justin Clark, Christopher H. Mann, Neil Shah, Khalid S. Khan, Fujian Song, Janesh Gupta,

Endometriosis Research and Treatment

Objective To determine the accuracy of outpatient endometrial biopsy in diagnosing endometrial cancer in women with abnormal uterine bleeding. Design A systematic quantitative review of published research. Methods Studies were selected if accuracy of outpatient endometrial biopsy was estimated compared with a reference standard. Diagnostic accuracy was determined by pooled likelihood ratios for positive and negative test results. There were 1013 subjects in 13 diagnostic evaluations reported in 11 primary studies. Results A positive test result on outpatient biopsy diagnosed endometrial cancer with a pooled likelihood ratio of 66.48 (95% CI 30.04–147.13) while a negative test result had a pooled likelihood ratio of 0.14 (95% CI 0.08–0.27). The post test probability of endometrial cancer was 81.7% (95% CI 59.7%–92.9%) for a positive test and 0.9% (95% CI 0.4%–2.4%) for a negative test. Conclusion Outpatient endometrial biopsy has a high overall accuracy in diagnosing endometrial cancer when an adequate specimen is obtained. A positive test result is more accurate for ruling in disease than a negative test result is for ruling it out. Therefore, in cases of abnormal uterine bleeding where symptoms persist despite negative biopsy, further evaluation will be warranted.