title: Validity of intraoperative gross examination of myometrial invasion in patients with endometrial cancer: a meta-analysis.
abstract: OBJECTIVE
  The current recommended endometrial cancer surgical treatment is abdominal extrafascial total hysterectomy with bilateral salpingo-oophorectomy followed by pelvic lymphadenectomy if >50% myometrial invasion is estimated by intraoperative gross examination (IGE). This meta-analysis aims to quantify evidence regarding the validity/predictive value of IGE staging compared with final histology.
  
  
  METHODS
  Meta-analysis of studies published until October 2011.
  
  
  METHODS
  Systematic search, according to PRISMA guidelines, of the six major medical literature databases - Medline, Scopus, EMBASE, Google Scholar, Ovid, Cochrane.
  
  
  METHODS
  Sixteen eligible studies including 2567 endometrial cancer patients.
  
  
  METHODS
  Pooled sensitivity/specificity, accuracy, negative/positive predictive value (NPV/PPV) and diagnostic odds ratio (DOR) of IGE were calculated and the summary receiver operator characteristic (sROC) curve was constructed. A meta-regression analysis was used to explore the role of potential modifiers of sensitivity and specificity.
  
  
  METHODS
  Pooled diagnostic measures of IGE indices. Results. Sixteen studies (15 retrospective, one prospective) meeting the inclusion criteria were qualitatively analyzed. Pooled IGE estimates were: sensitivity = 0.75 (95%CI: 0.72-0.78), specificity = 0.92 (95%CI 0.90-0.94), accuracy = 0.87 (95%CI 0.86-0.88), NPV = 0.89 (95%CI 0.87-0.92), PPV = 0.80 (95%CI 0.76-0.84) and DOR = 36.9 (95%CI 28.7-47.4). No significant modifiers were identified for sensitivity or specificity.
  
  
  CONCLUSIONS
  The synthesized measures presented here for the first time showed that accuracy, sensitivity and specificity of IGE were 87, 75 and 92%, respectively, which indicates that IGE is useful for estimating depth of myometrial invasion and staging of endometrial cancer in clinical practice. The degree to which the relatively low values of some of its performance indicators could be improved remains to be elucidated in order for the values to be comparable with those from frozen section biopsies.
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece.
authors.forename: Ioannis D
authors.initials: ID
authors.lastname: Mavromatis
authors.forename: Constantine N
authors.initials: CN
authors.lastname: Antonopoulos
authors.forename: Ioannis L
authors.initials: IL
authors.lastname: Matsoukis
authors.forename: Constantinos C
authors.initials: CC
authors.lastname: Frangos
authors.forename: Alkistis
authors.initials: A
authors.lastname: Skalkidou
authors.forename: George
authors.initials: G
authors.lastname: Creatsas
authors.forename: Eleni Th
authors.initials: ET
authors.lastname: Petridou
mesh_terms: D016889:Endometrial Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D009215:Myometrium / Q000473:pathology* / Q000601:surgery*; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D012372:ROC Curve; D012044:Regression Analysis; D012680:Sensitivity and Specificity