From the Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands; Department of Clinical Epidemiology and Biostatistics, Academic Medical Centre, Amsterdam, The Netherlands; the Department of Obstetrics and Gynecology, Birmingham Women's Health Care NHS Trust, Birmingham, UK; the Horten Centre, University of Zurich, Zurich, Switzerland; the Department of Obstetrics and Gynecology, Lund University Hospital, Lund, Sweden; the Department of Obstetrics and Gynecology, Birmingham Women's Health Care NHS Trust, Birmingham, UK; the Department of Obstetrics and Gynecology, Birmingham Women's Health Care NHS Trust, Birmingham, UK; the Department of Obstetrics & Gynecology, Sandwell & West Birmingham Hospital NHS Trust, Birmingham, UK; the Department of Obstetrics and Gynecology, University Hospital Leuven, Leuven, Belgium; the Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands; the Department of Reproductive and Developmental Sciences, University of Edinburgh, Edinburgh, UK; the Department of Gynecology, Escola Paulista de Medicina, Federal University of Sao Paolo, Brazil; the Department of Gynecology, University of Sassari, Sassari, Italy; the Department of Obstetrics and Gynecology, Rijnstate Hospital, Arnhem, The Netherlands; the Department of General Practice, Academic Medical Centre, Amsterdam, The Netherlands; and the Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands.
Obstet Gynecol. 2010 Jul;116(1):160-167. doi: 10.1097/AOG.0b013e3181e3e7e8.
To estimate the accuracy of endometrial thickness measurement in the detection of endometrial cancer among women with postmenopausal bleeding with individual patient data using different meta-analytic strategies.
Original data sets of studies detected after reviewing the included studies of three previous reviews on this subject. An additional literature search of published articles using MEDLINE databases was preformed from January 2000 to December 2006 to identify articles reporting on endometrial carcinoma and sonographic endometrial thickness measurement in women with postmenopausal bleeding.
We identified 90 studies reporting on endometrial thickness measurements and endometrial carcinoma in women with postmenopausal bleeding.
TABULATION, INTEGRATION, AND RESULTS: 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.
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.
使用不同的荟萃分析策略，基于个体患者资料，评估经阴道超声测量子宫内膜厚度在诊断绝经后出血患者子宫内膜癌中的准确性。
在评价纳入的 3 项关于该主题的综述的基础上，查阅文献以获得检测到的研究的原始数据集。从 2000 年 1 月至 2006 年 12 月，我们通过 MEDLINE 数据库进行了已发表文章的补充文献检索，以确定报道绝经后出血患者子宫内膜癌和超声子宫内膜厚度测量的文章。
我们发现了 90 项报道绝经后出血患者子宫内膜厚度测量和子宫内膜癌的研究。
表格说明、整合和结果：我们联系了 79 位主要研究者，以获取其报道研究的个体患者资料，其中 13 位可以提供资料。共纳入了 2896 例患者的数据，其中 259 例患有癌症。对获得的数据进行了多种分析。首先，我们对每项研究进行了受试者工作特征（ROC）分析，得到的汇总 ROC 曲线下面积（AUC）是对原始研究 AUC 的加权均值。其次，我们对个体患者数据进行了汇总分析，无论研究如何，均采用中位数倍数进行标准化分布差异，并用随机效应逻辑回归进行分析。最后，我们还使用了两阶段程序，为每项研究计算敏感性和特异性，并使用双变量随机效应模型估计诊断准确性的汇总估计值。这导致了相当可比的 ROC 曲线，AUC 介于 0.82 和 0.84 之间，并且汇总了位于这些曲线的敏感性和特异性估计值。这些曲线表明，使用传统技术的先前荟萃分析可能高估了经阴道超声测量子宫内膜厚度诊断子宫内膜癌的准确性。我们建议使用 3mm 的截断值排除绝经后出血患者的子宫内膜癌。
先前关于经阴道超声测量子宫内膜厚度的荟萃分析可能高估了其在诊断绝经后出血患者子宫内膜癌中的准确性。我们建议在绝经后出血患者中使用 3mm 的截断值来排除子宫内膜癌。
