Objectives to determine the diagnostic accuracy of different endometrial sampling tests for detecting endometrial carcinoma.

Design a systematic review and meta-analysis of studies of diagnostic accuracy.

Eligibility criteria We included published cross-sectional studies of women, of all ages, who had an endometrial sampling for preoperatively detecting endometrial cancer with verification using histopathology of hysterectomy specimens as the reference standard. We excluded case control and case series studies.

Information sources We searched the Cochrane library, MEDLINE/PubMed, CINAHL, Web of Science, and Scopus from the date of inception of the databases to December 31, 2022. We did not apply any restrictions on language or date of publication. We searched the references of included studies and other systematic reviews.

Risk of bias We extracted study data and assessed study quality using the revised quality assessment tool for diagnostic accuracy studies (QUADAS-2).

Synthesis of results We used bivariate diagnostic random-effects meta-analysis and presented the results in a summary receiver operating characteristic curve. We assessed the certainty of evidence as recommended by the GRADE approach.

Results Ten included studies, published between 1986 and 2020, recruited 1390 participants. Seven studies were low risk of bias in all domains and all studies had low applicability concerns. The most commonly studies index tests were Pipelle and conventional dilation and curettage. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio (95% confidence intervals), for Pipelle were 0.774 (0.565, 0.900), 0.985 (0.927, 0.997), 97.000 (14.000, 349.000), and 0.241 (0.101, 0.442) and for conventional dilation and curettage were 0.880 (0.281, 0.993), 0.984 (0.956, 0.995), 59.300 (14.200, 153.000), and 0.194 (0.007, 0.732); respectively.

Conclusion High certainty evidence indicates that pre-operative endometrial sampling particularly using Pipelle or conventional curettage is accurate in diagnosing endometrial cancer. Studies assessing other endometrial sampling tests were sparse.

Systematic review registration Center for Open Science, osf.io/h8e9z

Strengths and limitations of this study

This systematic review included only high quality diagnostic test accuracy studies, specifically with low verification bias.

This systematic review used QUADAS-2 tool for quality appraisal and the Grading of Recommendations, Assessment, Development and Evaluation recommendations for certainty of evidence.

The meta-analysis provided a robust synthesis of the evidence of the diagnostic accuracy of endometrial sampling tests for women typically seen in clinical practice with suspected endometrial hyperplasia or carcinoma.

The possibility of unpublished studies always exists. The potential for publication bias was not assessed due to the lack of validated methods for diagnostic test accuracy reviews.

The authors have declared no competing interest.

https://osf.io/sgfkr

This study did not receive any funding

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.

Yes

All data produced in the present work are contained in the manuscript

https://osf.io/fp3st/