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Objective <p>This systematic review and meta-analysis aimed to evaluate the diagnostic accuracy of endometrial thickness (EMT) alone, serum human chorionic gonadotropin (hCG) alone, and their combination for detecting retained products of conception (RPOC), providing evidence-based references for standardized clinical diagnosis.</p> Methods <p>We systematically searched PubMed, Cochrane Library, Scopus, China National Knowledge Infrastructure (CNKI), and Wanfang Database for diagnostic studies published from January 2014 to June 2025. Study quality was assessed using the QUADAS-2 tool, and meta-analyses were performed using Stata 17.0 software. Primary outcomes included pooled sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the receiver operating characteristic curve (AUC). Heterogeneity was explored via subgroup analyses (ultrasound technique, study population, reference standard, hCG cutoff) and I² statistic/Cochran’s Q test. Publication bias was evaluated using Deeks’ funnel plot asymmetry test, and sensitivity analyses were conducted by sequential exclusion of individual studies.</p> Results <p>Analysis of 15 studies (3,268 patients) showed that serum hCG alone (cutoff: 50 mIU/mL) had a sensitivity of 0.89, specificity of 0.87, and AUC of 0.92. EMT alone (cutoff: 8&#xa0;mm) had a sensitivity of 0.72, specificity of 0.86, and AUC of 0.84. The combination achieved a sensitivity of 0.93, specificity of 0.91, and AUC of 0.96. Subgroup analysis confirmed higher diagnostic efficacy for transvaginal versus transabdominal ultrasound (AUC: 0.86 vs. 0.79).</p> Conclusion <p>Serum hCG alone has higher diagnostic accuracy for RPOC than EMT alone, and their combination significantly improves diagnostic performance. We suggest the clinical use of the combined protocol: “serum hCG (cutoff: 50 mIU/mL) + TVUS-measured EMT (cutoff: 8&#xa0;mm)” for RPOC diagnosis, with recognition of study limitations (e.g., heterogeneity in EMT measurement, limited cutoff exploration). Future research should validate optimal cutoffs for diverse populations and evaluate the protocol’s impact on patient outcomes.</p>

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Diagnostic accuracy of transvaginal ultrasound-measured endometrial thickness and serum hCG levels in detecting retained products of conception: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2026年3月3日

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  • Ying Li,
  • Huaying Fang,
  • Wenqin Xia,
  • Shan Xu,
  • Meifang Guo

摘要

Objective

This systematic review and meta-analysis aimed to evaluate the diagnostic accuracy of endometrial thickness (EMT) alone, serum human chorionic gonadotropin (hCG) alone, and their combination for detecting retained products of conception (RPOC), providing evidence-based references for standardized clinical diagnosis.

Methods

We systematically searched PubMed, Cochrane Library, Scopus, China National Knowledge Infrastructure (CNKI), and Wanfang Database for diagnostic studies published from January 2014 to June 2025. Study quality was assessed using the QUADAS-2 tool, and meta-analyses were performed using Stata 17.0 software. Primary outcomes included pooled sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the receiver operating characteristic curve (AUC). Heterogeneity was explored via subgroup analyses (ultrasound technique, study population, reference standard, hCG cutoff) and I² statistic/Cochran’s Q test. Publication bias was evaluated using Deeks’ funnel plot asymmetry test, and sensitivity analyses were conducted by sequential exclusion of individual studies.

Results

Analysis of 15 studies (3,268 patients) showed that serum hCG alone (cutoff: 50 mIU/mL) had a sensitivity of 0.89, specificity of 0.87, and AUC of 0.92. EMT alone (cutoff: 8 mm) had a sensitivity of 0.72, specificity of 0.86, and AUC of 0.84. The combination achieved a sensitivity of 0.93, specificity of 0.91, and AUC of 0.96. Subgroup analysis confirmed higher diagnostic efficacy for transvaginal versus transabdominal ultrasound (AUC: 0.86 vs. 0.79).

Conclusion

Serum hCG alone has higher diagnostic accuracy for RPOC than EMT alone, and their combination significantly improves diagnostic performance. We suggest the clinical use of the combined protocol: “serum hCG (cutoff: 50 mIU/mL) + TVUS-measured EMT (cutoff: 8 mm)” for RPOC diagnosis, with recognition of study limitations (e.g., heterogeneity in EMT measurement, limited cutoff exploration). Future research should validate optimal cutoffs for diverse populations and evaluate the protocol’s impact on patient outcomes.