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Quality assessment
The results of the quality assessment are reported in Figure 2. Overall, study quality
was good.The quality of the formulation of the objective was rated as moderate
(according to the checklist, studies scored well on this item if they described the 2 patient population, the intervention, the reference standard and the desired result).
All studies scored positively on items concerning the literature search, description of
study characteristics and correctly performed meta-analysis. Study quality assessment
was adequately performed in 55% (5/9) of the reviews.
Figure 2. Methodological quality of included studies Figure 2. Methodological quality of included studies
Transvaginal sonography
The main goal ofTVS is to exclude endometrial cancer.Almost every guideline refers to a meta-analysis performed in 1998 by Smith-Bindman et al16 It used traditional statistical methods to combine the data from 35 published studies regarding the use of TVS in the evaluation of women with PMB. Using the reported data from each study, 2 × 2 tables were constructed of endometrial thickness measured by TVS (above or below a threshold) against the presence or absence of endometrial cancer. Only 16 of the 35 included studies reported the number of women who could not tolerate TVS (mean 0%) and only 14 studies reported non-diagnostic results (mean 0%). With a cut-off value of 5 millimetres (mm), the sensitivity for detecting endometrial cancer was 96%, and the specificity 61%. This combination of sensitivity and specificity reduces a pre-test probability of 10% for endometrial cancer to a post-test probability (for a negative test) of 1%.Thus, based on the post- test probability of 1%, conservative management is recommended to women with an endometrial thickness of 5 mm.
Diagnostic evaluation
Is the objective adequately formulated Is the literature search adequately performed Is the selection of included articles adequately performed
Is the quality assessment adequately performed Is the data abstraction adequately described Are the most important characteristics of included studies described Is the meta-analysis performed correctly
0% 25% 50%
75% 100%
Yes (high quality) Unclear No (low quality)
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