Page 28 - The diagnostic work-up of women with postmenopausal bleeding

Chapter 2
Selection criteria
This review focused on systematic reviews in which the results of the diagnostic test of interest were compared with the results of a reference standard.The following criteria were used to select articles:
1. Population of interest was women with postmenopausal uterine bleeding.
2. The four types of diagnostic test of interest were: (a) measurement of endometrial thickness by transvaginal sonography (TVS); (b) outpatient endometrial sampling;(c) saline infusion sonography (SIS);or (d) hysteroscopy
(i.e. endoscopic visual interpretation).
3. The reference standard was the endometrial histological findings from
inpatient endometrial sampling, D&C or hysterectomy.
4. The primary outcome measure was the accuracy with which endometrial
cancer and/or hyperplasia were diagnosed.
Studies in which more than 10% of the women used Tamoxifen were excluded, because of different pathophysiology and different characteristics of the uterine cavity. For studies that included pre- and postmenopausal women we used only those calculations and conclusions concerning the latter. The systematic reviews were selected by two reviewers working independently (NvH and MCB), through assessment of the titles and abstracts of all retrieved studies. In case of disagreement the article was included for full reading and/or assessed by a third reviewer (AT).
Additionally, we identified national and international guidelines on diagnostic procedures for PMB. From every guideline we extracted the diagnostic pathway recommended and points of policy.
Quality assessment
The methodological quality of each selected paper was assessed using the Cochrane checklist for systematic reviews of diagnostic studies.14This list of criteria was designed to assess the usability of a review for guideline development. Because there is no validated checklist for the quality assessment of systematic reviews, this checklist was used as an aid in the reviewers’ evaluation of the quality of the original review, but no decisions regarding the inclusion or exclusion of articles were based on this assessment.
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