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

Background Endometrial cancer (EC) is a common gynecologic malignancy with a growing need for accurate, minimally invasive diagnostic biomarkers. MicroRNAs (miRNAs) are stable across multiple biological specimens and have emerged as promising diagnostic candidates. This meta-analysis evaluated the diagnostic performance of single-miRNA biomarkers and multi-miRNA panels for EC. Methods A systematic review and diagnostic test accuracy meta-analysis was conducted according to PRISMA 2020. PubMed/MEDLINE, Embase, Web of Science, and ScienceDirect were searched through August 2025. Only one diagnostic estimate per independent participant cohort was included within each co-primary analysis. Single-miRNA biomarkers and multi-miRNA panels were analyzed separately using bivariate random-effects models. Pooled sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratio (DOR), and SROC AUC were estimated. Results Eleven articles were included. Eight independent estimates contributed to the single-miRNA analysis and five to the multi-miRNA panel analysis. Single miRNAs yielded a pooled sensitivity of 0.90 (95% CI 0.82–0.95), specificity of 0.87 (0.75–0.94), DOR of 59.96 (18.59–193.37), and AUC of 0.95 (0.92–0.96). Multi-miRNA panels showed a sensitivity of 0.92 (0.87–0.95), specificity of 0.95 (0.88–0.98), DOR of 212.96 (67.84–668.52), and AUC of 0.95 (0.93–0.97). Sensitivity analyses supported the overall robustness of the findings. Conclusions MiRNA-based biomarkers show promising diagnostic discrimination for EC, but current evidence remains insufficient for routine clinical implementation. Prospective multicenter validation with standardized assays and prespecified thresholds is required.