Valeur de l’échographie pour prédire le cancer de l’endomètre dans les métrorragies post-ménopausiques

Abstract

ObjectiveTo build mathematical models for evaluating the individual risk of endometrial malignancy in women with postmenopausal bleeding and a thick endometrium using clinical data, sonographic endometrial thickness and power Doppler ultrasound findings. MethodsA total of 117 patients underwent transvaginal two-dimensional gray-scale and power Doppler ultrasound examination of the endometrium before getting endometrial biopsy. Inclusion criteria were post-menopausal bleeding and a thick endometrium greater than 5mm. The ultrasound image showing the most vascularized section through the endometrium as assessed by power Doppler was frozen to estimate endometrial thickness and features. The vascularity index was calculated using computer software. A structured history was taken to collect clinical information. Multivariate logistic regression analysis was used to create mathematical models to predict endometrial malignancy. ResultsThere were 31 (26.4%) malignant and 86 (74.6%) benign endometria… Women with a malignant endometrium were older (median age 61 vs 56years, P=0.036) and had a thicker endometrium (median thickness 18.8mm vs 12.5; P=0.002) and higher values for vascularity index. When using only clinical data to build a model for estimating the risk of endometrial malignancy, a model including the variables age had the largest area under the receiver–operating characteristics curve (AUC), with a value of 0.69 (95% confidence interval [CI], 0.59–0.79). A model including age and endometrial thickness had an AUC of 0.72 (95% CI, 0.50–0.96), and one including age, endometrial thickness and vascularity index had an AUC of 0.91 (95% CI, 0.62–0.97). Using a risk cut-off of 12%, the latter model had sensitivity 89%, specificity 74%, positive likelihood ratio 3.42 and negative likelihood ratio 0.14. DiscussionPostmenopausal bleeding is a frequent cause of consultation in gynecological particularly in peri- or post-menopausal period. They are the main alarm sign of endometrial carcinoma. Vaginal ultrasound has become the “gold standard” in the initial exploration. It is a powerful tool to estimate the individual risk of malignancy in symptomatic postmenopausal women in order to optimize the management. The diagnostic performance of models predicting endometrial cancer increases substantially when sonographic and power Doppler information are added to clinical variables. This model seems to be clinically useful but need to be prospectively validated.