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Ultrasound-based ri...
Ultrasound-based risk model for preoperative prediction of lymph-node metastases in women with endometrial cancer : model-development study
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- Eriksson, L. S.E. (author)
- Karolinska Institutet,Karolinska Institute,Karolinska University Hospital
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- Epstein, E. (author)
- Karolinska Institute,Stockholm South General Hospital
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- Testa, A. C. (author)
- Catholic University of the Sacred Heart, Rome
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- Fischerova, D. (author)
- Charles University in Prague
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- Valentin, L. (author)
- Lund University,Lunds universitet,Obstetrisk, gynekologisk och prenatal ultraljudsdiagnostik,Forskargrupper vid Lunds universitet,Obstetric, Gynaecological and Prenatal Ultrasound Research,Lund University Research Groups,Skåne University Hospital
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- Sladkevicius, P. (author)
- Lund University,Lunds universitet,Obstetrisk, gynekologisk och prenatal ultraljudsdiagnostik,Forskargrupper vid Lunds universitet,Obstetric, Gynaecological and Prenatal Ultrasound Research,Lund University Research Groups,Skåne University Hospital
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- Franchi, D. (author)
- European Institute of Oncology
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- Frühauf, F. (author)
- Charles University in Prague
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- Fruscio, R. (author)
- San Gerardo Hospital
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- Haak, L. A. (author)
- Charles University in Prague
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- Opolskiene, G. (author)
- Vilnius University
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- Mascilini, F. (author)
- Policlinico Universitario Agostino Gemelli
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- Alcazar, J. L. (author)
- University of Navarra
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- Van Holsbeke, C. (author)
- Hospital Oost-Limburg
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- Chiappa, V. (author)
- Istituto Nazionale dei Tumori
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- Bourne, T. (author)
- Queen Charlotte's and Chelsea Hospital,Catholic University of Leuven
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- Lindqvist, P. G. (author)
- Karolinska Institutet,Karolinska Institute,Stockholm South General Hospital
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- Van Calster, B. (author)
- Catholic University of Leuven
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- Timmerman, D. (author)
- Catholic University of Leuven,University Hospitals Leuven
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- Verbakel, J. Y. (author)
- University of Oxford,Catholic University of Leuven
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- Van den Bosch, T. (author)
- University Hospitals Leuven
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- Wynants, L. (author)
- Catholic University of Leuven,Maastricht University
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(creator_code:org_t)
- 2020-09
- 2020
- English 10 s.
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In: Ultrasound in Obstetrics and Gynecology. - : Wiley. - 0960-7692 .- 1469-0705. ; 56:3, s. 443-452
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Abstract
Subject headings
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- Objective: To develop a preoperative risk model, using endometrial biopsy results and clinical and ultrasound variables, to predict the individual risk of lymph-node metastases in women with endometrial cancer. Methods: A mixed-effects logistic regression model for prediction of lymph-node metastases was developed in 1501 prospectively included women with endometrial cancer undergoing transvaginal ultrasound examination before surgery, from 16 European centers. Missing data, including missing lymph-node status, were imputed. Discrimination, calibration and clinical utility of the model were evaluated using leave-center-out cross validation. The predictive performance of the model was compared with that of risk classification from endometrial biopsy alone (high-risk defined as endometrioid cancer Grade 3/non-endometrioid cancer) or combined endometrial biopsy and ultrasound (high-risk defined as endometrioid cancer Grade 3/non-endometrioid cancer/deep myometrial invasion/cervical stromal invasion/extrauterine spread). Results: Lymphadenectomy was performed in 691 women, of whom 127 had lymph-node metastases. The model for prediction of lymph-node metastases included the predictors age, duration of abnormal bleeding, endometrial biopsy result, tumor extension and tumor size according to ultrasound and undefined tumor with an unmeasurable endometrium. The model's area under the curve was 0.73 (95% CI, 0.68–0.78), the calibration slope was 1.06 (95% CI, 0.79–1.34) and the calibration intercept was 0.06 (95% CI, –0.15 to 0.27). Using a risk threshold for lymph-node metastases of 5% compared with 20%, the model had, respectively, a sensitivity of 98% vs 48% and specificity of 11% vs 80%. The model had higher sensitivity and specificity than did classification as high-risk, according to endometrial biopsy alone (50% vs 35% and 80% vs 77%, respectively) or combined endometrial biopsy and ultrasound (80% vs 75% and 53% vs 52%, respectively). The model's clinical utility was higher than that of endometrial biopsy alone or combined endometrial biopsy and ultrasound at any given risk threshold. Conclusions: Based on endometrial biopsy results and clinical and ultrasound characteristics, the individual risk of lymph-node metastases in women with endometrial cancer can be estimated reliably before surgery. The model is superior to risk classification by endometrial biopsy alone or in combination with ultrasound.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Cancer och onkologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cancer and Oncology (hsv//eng)
Keyword
- decision support model
- diagnostic imaging
- endometrial neoplasm
- lymphatic metastasis
- neoplasm staging
- ultrasonography
Publication and Content Type
- art (subject category)
- ref (subject category)
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- By the author/editor
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Eriksson, L. S.E ...
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Epstein, E.
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Testa, A. C.
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Fischerova, D.
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Valentin, L.
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Sladkevicius, P.
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show more...
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Franchi, D.
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Frühauf, F.
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Fruscio, R.
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Haak, L. A.
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Opolskiene, G.
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Mascilini, F.
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Alcazar, J. L.
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Van Holsbeke, C.
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Chiappa, V.
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Bourne, T.
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Lindqvist, P. G.
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Van Calster, B.
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Timmerman, D.
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Verbakel, J. Y.
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Van den Bosch, T ...
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Wynants, L.
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Cancer and Oncol ...
- Articles in the publication
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Ultrasound in Ob ...
- By the university
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Lund University
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Karolinska Institutet