Outpatient diagnosis of endometrial cancer in women with first episode of postmenopausal bleeding

Clark J, Barton P, Gupta J, Khan K
Record ID 32005000202
Authors' objectives:

The aim of this report is to summarise the current evidence regarding the diagnostic accuracy of outpatient endometrial evaluation using endometrial biopsy (EB), ultrasound scan (USS) and outpatient hysteroscopy (OPH) and to determine the optimum combination of these tests for the investigation of women with post-menopausal bleeding (PMB) for endometrial cancer, which represents the best value for money.

Authors' results and conclusions: There was statistical heterogeneity in pooling of likelihood ratios, for USS and OPH, but an explanation for this could not be found in spectrum composition and study quality. For a postmenopausal woman with vaginal bleeding with a 5% pre-test probability of endometrial cancer, her probability of cancer is approximately 80% following a positive EB or OPH and between 0.4 and 0.8 % following a negative USS, depending upon whether a 4 or 5mm threshold for abnormality is used. A positive test result following EB or OPH is more useful for predicting endometrial cancer than USS, whereas a negative test result following USS is more useful for excluding endometrial cancer than EB or OPH.
Authors' recommendations: In most circumstances women presenting for the first time with PMB should undergo initial evaluation with pelvic ultrasound using a threshold of 4mm or 5mm to define abnormal results. Clinical guidelines should be developed and disseminated based on this report.
Authors' methods: Systematic review
Project Status: Completed
Year Published: 2002
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: England
MeSH Terms
  • Costs and Cost Analysis
  • Postmenopause
  • Uterine Hemorrhage
  • Endometrial Neoplasms
Organisation Name: West Midlands Health Technology Assessment Collaboration
Contact Address: Elaena Donald-Lopez, West Midlands Health Technology Assessment Collaboration, Department of Public Health and Epidemiology, University of Birmingham, Edgbaston, Birmingham B15 2TT Tel: +44 121 414 7450; Fax: +44 121 414 7878
Contact Name: louise.a.taylor@bham.ac.uk
Contact Email: louise.a.taylor@bham.ac.uk
Copyright: University of Birmingham
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