Abstract
PurposeThe current ACR and ACOG guidelines recommend a ≤4 mm endometrial thickness threshold for excluding endometrial cancer in symptomatic postmenopausal patients. This systematic review and meta-analysis aims to re-evaluate the optimal endometrial thickness threshold on imaging for excluding cancer in symptomatic postmenopausal patients. Materials and methodsA systematic search of MEDLINE, EMBASE, Cochrane Library, and Scopus from inception to October 2023 was performed in addition to a grey literature search. Studies were included if they evaluated the diagnostic imaging accuracy of endometrial thickness thresholds for detecting endometrial cancer in symptomatic postmenopausal patients. The reference standard was histopathology. Full-text review and data extraction were performed independently by two reviewers. Risk of bias and applicability were assessed using the QUADAS-2 tool. Meta-analysis was performed using a bivariate mixed-effects regression model. ResultsThirty-five studies with 6302 patients met inclusion criteria. Mean age range was 51-68 years. The sensitivities and specificities with 95% confidence intervals for the 2-7 mm thresholds are 95% (84-98%) and 22% (8-49%) for ≤2 mm, 94% (82-98%) and 35% (24-47%) for ≤3 mm, 95% (86-98%) and 45% (34-56%) for ≤4 mm, 88% (75-95%) and 56% (42-68%) for ≤5 mm, 84% (63-94%) and 60% (43-74%) for ≤6 mm, and 85% (56-96%) and 62% (49-73%) for ≤7 mm. Studies were deemed predominantly low risk for bias across domains. ConclusionThis comprehensive meta-analysis supports the ≤4 mm endometrial thickness threshold for excluding endometrial cancer in symptomatic postmenopausal patients.
Published Version
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