Prediction of endometrial malignancy in women with postmenopausal bleeding and sonographic endometrial thickness ≥ 4.5 mm.
Forskningsoutput: Tidskriftsbidrag › Artikel i vetenskaplig tidskrift
OBJECTIVE: To build mathematical models to evaluate the individual risk of endometrial malignancy in women with postmenopausal bleeding and sonographic endometrial thickness ≥ 4.5 mm using clinical data, sonographic endometrial thickness and power Doppler ultrasound findings. METHODS: Of 729 consecutive patients with postmenopausal bleeding, 261 with sonographic endometrial thickness ≥ 4.5 mm and no fluid in the uterine cavity were included. They underwent transvaginal two-dimensional gray scale and power Doppler ultrasound examination of the endometrium. The ultrasound image showing the most vascularized section through the endometrium as assessed by power Doppler was frozen, the endometrium was outlined, and the percentage vascularized area (vascularity index) was calculated using computer software. The ultrasound examiner also estimated the color content of the endometrial scan on a visual analogue scale (VAS) graded from 0 to 100 (VAS score). A structured history was taken to collect clinical information. Multivariate logistic regression was used to create mathematical models to predict endometrial malignancy. RESULTS: There were 63 (24%) malignant and 198 benign endometria. Women with malignant endometrium were older (median 74 years vs. 65; P = 0.0005) and fewer used hormonal replacement therapy (HRT) and warfarin. Women with malignant endometrium had thicker endometrium (median 20.8 mm vs. 10.2; P = 0.0005) and higher values for vascularity index and VAS score. When using only clinical data to build a model to estimate the risk of endometrial malignancy, a model including the variables age, use of warfarin and use of HRT had the largest area (0.74, 95% CI 0.67 - 0.81) under the receiver operating characteristic curve (AUC). A model including age, use of warfarin and endometrial thickness had AUC (0.82, 95% CI 0.76 - 0.87), and one including age, use of HRT, endometrial thickness and vascularity index had AUC (0.91, 95% CI 0.87 - 0.95). Using a risk cut-off of 11%, the model including age, use of HRT, endometrial thickness and vascularity index had sensitivity 90%, specificity 71%, positive likelihood ratio 3.14 and negative likelihood ratio 0.13. CONCLUSIONS: The diagnostic performance of models predicting endometrial cancer increases substantially when sonographic endometrial thickness and power Doppler information are added to clinical variables. The models are likely to be clinically useful but need to be prospectively validated. Copyright © 2010 ISUOG. Published by John Wiley & Sons, Ltd.
|Enheter & grupper|
Ämnesklassifikation (UKÄ) – OBLIGATORISK
|Tidskrift||Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology|
|Status||Published - 2011|
|Peer review utförd||Ja|