Relationship Between Endometrial Thickness And Endometrial Cancer Risk In Asymptomatic Postmenopausal Women : A Meta Analysis

Objective:To study the normal range of endometrial thickness in asymptomatic women and to diagnose the sensitivity and specificity of endometrial cancer with endometrial thickness by studying the relationship between endometrial thickness and risk of endometrial cancer in postmenopausal women.Try to find a reasonable endometrial thickness threshold to determine if further testing is needed.Methods:Search Chinese databases(VIP,Wanfang Data and China National Knowledge Internet)and foreign language databases(PubMed,EMBASE,Web of Science,Cochrane Library)by computer,and collect database for database construction until December 2018.A literature examining the association of endometrial thickness and endometrial cancer in asymptomatic postmenopausal women.Literature screening and data extraction were performed according to the established inclusion and exclusion criteria,and the literature was screened and managed using EndNote X9 software.The QUATAS-2 tool included in Rev Man 5.3 software was used to evaluate the literature quality and risk of bias in the included clinical studies.Meta-analysis of the included literature was performed using Rev Man 5.3 software and Meta-Disc 1.4 software.Results:A total of 22 articles were included in the study,9 of which were used for Objective 1(estimating the normal range of endometrial thickness),and 15 were available for Objective 2(endometrial thickness for the diagnosis of endometrial cancer).The results show that the average endometrial thickness of asymptomatic postmenopausal women who did not use hormone replacement was 2.98 mm(95% CI,2.56-3.41 mm).The sensitivity of endometrial cancer by measuring endometrial thickness was 66.7%,specificity was 81.4%,positive likelihood ratio = 1.880 <10,negative likelihood ratio = 0.556>0.1,The sensitivity and specificity of diagnosis of endometrial cancer and atypical hyperplasia of endometrium were 64.7% and 81.1%,positive likelihood ratio = 2.186 <10,and negative likelihood ratio = 0.540>0.1.The results of the two groups were similar.The sensitivity and specificity of endometrial cancer diagnosed at ET=4mm,5mm,6mm,8mm,and 10 mm were calculated.The sensitivity ranged from 33.3% to 100%,and the specificity ranged from 69.8% to 94.7%.The positive likelihood ratio was calculated.Both were <10,the negative likelihood ratio was >0.1,and the AUC was between 0.5 and 0.7742.Conclusion:The estimated total thickness of endometrium in asymptomatic women after menopause is 2.98 mm(95% CI,2.56-3.41 mm);The endometrial thickness of asymptomatic women after menopause has a certain correlation with the risk of endometrial cancer,but only measuring endometrial thickness can not be used as the basis for the exclusion or diagnosis of endometrial cancer,and also need to be further evaluated in combination with high risk factors;After analysis,no specific cut-off value of endometrial thickness is perfectly applicable.No matter which cut-off value is used,endometrial cancer is missed or misdiagnosed.In comparison,when 10 mm as the cut-off value has the most diagnostic value,it has higher sensitivity and specificity.