Re-Evaluating the Progesterone Challenge Test as a Physiologic Marker of Endometrial Cancer Risk: A Systematic Review...

Area of Science:

• Gynecology
• Oncology
• Diagnostic Accuracy

Background:

• Rising incidence of obesity-related endometrial cancer necessitates low-cost, physiologic screening methods.
• The progesterone challenge test (PCT) is a potential tool for identifying hormonally active endometrium.
• Previous research suggests PCT may detect endometrial pathology.

Purpose of the Study:

• To systematically evaluate the diagnostic accuracy of the PCT.
• To assess PCT's role in detecting endometrial hyperplasia, intraepithelial neoplasia, and carcinoma.
• To determine PCT's potential as a physiologic marker for endometrial cancer risk in asymptomatic postmenopausal women.

Main Methods:

• Systematic review and meta-analysis following PRISMA-DTA guidelines.
• Searched multiple databases (MEDLINE, EMBASE, etc.) and grey literature.
• Included prospective studies comparing PCT to endometrial biopsy; analyzed data using hierarchical summary receiver operating characteristic models.

Main Results:

• Nineteen studies (n=3902) included. Pooled sensitivity: 95%, specificity: 87% for endometrial pathology.
• Positive predictive value: 32%, negative predictive value: 100%.
• Including endometrial proliferation decreased sensitivity to 82% but increased positive predictive value to 70%.

Conclusions:

• The PCT demonstrates high diagnostic accuracy for estrogen-driven endometrial pathology in asymptomatic postmenopausal women.
• The PCT is a simple, physiologic test with potential as a risk stratification tool.
• Re-evaluation of PCT could inform precision prevention strategies for endometrial cancer.