A risk-scoring model for the prediction of endometrial cancer among symptomatic postmenopausal women with endometrial thickness > 4 mm.

Luca Giannella,Ezio Bergamini,Tiziano Setti,Fausto Boselli,Lillo Bruno Cerami,Kabala Mfuta

doi:10.1155/2014/130569

Abstract

Objective. To develop and test a risk-scoring model for the prediction of endometrial cancer among symptomatic postmenopausal women at risk of intrauterine malignancy. Methods. We prospectively studied 624 postmenopausal women with vaginal bleeding and endometrial thickness > 4 mm undergoing diagnostic hysteroscopy. Patient characteristics and endometrial assessment of women with or without endometrial cancer were compared. Then, a risk-scoring model, including the best predictors of endometrial cancer, was tested. Univariate, multivariate, and ROC curve analysis were performed. Finally, a split-sampling internal validation was also performed. Results. The best predictors of endometrial cancer were recurrent vaginal bleeding (odds ratio (OR) = 2.96), the presence of hypertension (OR = 2.01) endometrial thickness > 8 mm (OR = 1.31), and age > 65 years (OR = 1.11). These variables were used to create a risk-scoring model (RHEA risk-model) for the prediction of intrauterine malignancy, with an area under the curve of 0.878 (95% CI 0.842 to 0.908; P < 0.0001). At the best cut-off value (score ≥ 4), sensitivity and specificity were 87.5% and 80.1%, respectively. Conclusion. Among symptomatic postmenopausal women with endometrial thickness > 4 mm, a risk-scoring model including patient characteristics and endometrial thickness showed a moderate diagnostic accuracy in discriminating women with or without endometrial cancer. Based on this model, a decision algorithm was developed for the management of such a population.

Highlights

It is known that about 90–95% of postmenopausal women with endometrial cancer report a vaginal bleeding experience [1, 2], whereas about 10% of symptomatic postmenopausal women reveal an intrauterine malignancy [3]
We enrolled 648 symptomatic postmenopausal women with endometrial thickness > 4 mm referred to diagnostic hysteroscopy. 24 women were excluded from this prospective study because a cervical canal stenosis made impracticable an outpatient hysteroscopy for intolerable pain
Significant differences were present with regard to age (P < 0.0001), time since menopause (P < 0.0001), hormone replacement therapy (HRT) use (P = 0.0001), recurrent vaginal bleeding (P < 0.0001), presence of hypertension (P < 0.0001), endometrial echogenicity (P < 0.0001), and endometrial thickness (P < 0.0001) (Table 1)

Summary

Introduction

It is known that about 90–95% of postmenopausal women with endometrial cancer report a vaginal bleeding experience [1, 2], whereas about 10% of symptomatic postmenopausal women reveal an intrauterine malignancy [3]. An endometrial thickness ≤ 4 mm is a cutoff value for which a conservative management should be adopted In the latter case the posttest probability of having an endometrial cancer drops from 10% to 0.8% [4, 5]. Among symptomatic postmenopausal women with endometrial thickness > 4 mm, there is an increased risk of cancer [6, 7]. In these cases, further examinations are needed and, usually, an endometrial sampling or an outpatient hysteroscopy should be performed. Approximately 80–90% of these examinations will not reveal a cancer in a population considered at risk of malignancy [8]. This apparent “inappropriateness” is justified by the fact that our goal is to miss the lowest number of women with cancer

Methods

Results

Conclusion