Diagnostic Performance of Micro-RNAs as Biomarkers for Endometrial Cancer: A Systematic Review and Meta-Analysis

<ns5:p>Background Endometrial cancer (EC) represents one of the most common gynecologic malignancies in the world. Despite advancements in imaging and histopathology, the early detection of EC remains suboptimal. MicroRNAs (miRNAs), known for their stability in biofluids and regulatory role in tumor biology, have emerged as promising non-invasive biomarkers. This meta-analysis evaluates the diagnostic performance of miRNAs in EC. Methods A systematic review and meta-analysis were conducted following PRISMA guidelines. Searches were performed in major databases up to August 2025. Studies reporting the sensitivity and specificity of miRNA-based diagnostics for EC were included. Pooled diagnostic performance, such as sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratio (DOR), and area under the ROC curve (AUC), was calculated using a bivariate random-effects model. Subgroup analyses and sensitivity tests were conducted to explore heterogeneity and assess robustness. Results Fifty-two studies from 12 articles involving 1,098 EC patients and 957 controls were analyzed. The pooled sensitivity and specificity were 0.86 (95% CI: 0.82–0.89) and 0.81 (95% CI: 0.75–0.85), respectively. The DOR was 20.9, and the AUC was 0.91, indicating high overall diagnostic accuracy. Subgroup analyses revealed superior performance for miRNA panels and serum-based assays. Sensitivity analyses confirmed the model’s stability. No significant publication bias was detected. Conclusions Circulating miRNAs demonstrate high diagnostic accuracy for EC and may serve as effective non-invasive tools for early detection. Further prospective studies with standardized protocols are essential for clinical translation.</ns5:p>