The value of hysteroscopy and transvaginal ultrasonography in the diagnosis of endometrial hyperplasia: a systematic review and meta-analysis

The systematic evaluation of the diagnostic value of hysteroscopy and transvaginal ultrasonography for endometrial hyperplasia. A systematic search was performed using China Knowledge Network Database, Wanfang Chinese Database, China Biomedical Literature Database, China Science and Technology Journal Database, PubMed, Medline, The Cochrane Library, and web of science from their dates of inception to December 31, 2017, hysteroscopy and transvaginal ultrasonography were used for the diagnosis of endometrial lesions in those studies. Two researchers screened the literature, extracted data, and evaluated the methodological quality of the included studies independently based on the inclusion criteria. A total of 1,354 cases were incorporate into analysis from 9 diagnostic studies meta-analysis showed that the diagnostic accuracy of hysteroscopy for endometrial hyperplasia lesions were: combined sensitivity =0.73 (95% CI: 0.68-0.77), combined specificity =0.92 (95% CI: 0.90-0.93), combined positive likelihood ratio =9.87 (95% CI: 4.08-23.84), combined negative likelihood ratio =0.34 (95% CI: 0.22-0.52), combined diagnostic odds ratio =31.64 (95% CI: 10.34-96.78), area under the summary receiver operating characteristic curve =0.8830. The combined sensitivity of transvaginal ultrasonography for those lesions were 0.69 (95% CI: 0.64-0.74), combined specificity was 0.78 (95% CI: 0.76-0.81), combined negative likelihood ratio was 3.40 (95% CI: 2.46-4.70), combined negative likelihood ratio was 0.41 (95% CI: 0.34-0.50), combined diagnostic odds ratio was 8.94 (95% CI: 5.80-13.79), and area under the summary receiver operating characteristic curve was 0.8180. Compared with transvaginal ultrasonography, hysteroscopy have higher sensitivity, specificity, and area under the summary receiver operating characteristic curve for the diagnose of endometrial hyperplasia, hysteroscopy should be selected priority as the auxiliary diagnosis.