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The Risk of Endomet...
The Risk of Endometrial Malignancy and Other Endometrial Pathology in Women with Abnormal Uterine Bleeding : An Ultrasound-Based Model Development Study by the IETA Group
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- Wynants, Laure (author)
- Maastricht University,Catholic University of Leuven
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- Verbakel, Jan Yvan Jos (author)
- University of Oxford,Catholic University of Leuven
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- Valentin, Lil (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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- De Cock, Bavo (author)
- Catholic University of Leuven
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- Angela Pascual, M. (author)
- University Hospital Dexeus
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- Leone, Francesco P.G. (author)
- University of Milan
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- Sladkevicius, Povilas (author)
- Skåne University Hospital
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- Heremans, Ruben (author)
- University Hospitals Leuven,Catholic University of Leuven
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- Alcazar, Juan Luis (author)
- University of Navarra
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- Votino, Angelo (author)
- University Hospital Brugmann
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- Fruscio, Robert (author)
- University of Milano-Bicocca
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- Epstein, Elisabeth (author)
- Karolinska Institutet,Karolinska Institute
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- Bourne, Tom (author)
- Imperial College London,Catholic University of Leuven
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- Van Calster, Ben (author)
- Catholic University of Leuven,Leiden University Medical Centre
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- Timmerman, Dirk (author)
- Catholic University of Leuven,University Hospitals Leuven
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- Van Den Bosch, Thierry (author)
- Catholic University of Leuven,University Hospitals Leuven
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(creator_code:org_t)
- 2022-02-11
- 2022
- English 8 s.
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In: Gynecologic and Obstetric Investigation. - : S. Karger AG. - 0378-7346 .- 1423-002X. ; 87:1, s. 54-61
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Abstract
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- Objectives: The aim of this study was to develop a model that can discriminate between different etiologies of abnormal uterine bleeding. Design: The International Endometrial Tumor Analysis 1 study is a multicenter observational diagnostic study in 18 bleeding clinics in 9 countries. Consecutive women with abnormal vaginal bleeding presenting for ultrasound examination (n = 2,417) were recruited. The histology was obtained from endometrial sampling, D&C, hysteroscopic resection, hysterectomy, or ultrasound follow-up for >1 year. Methods: A model was developed using multinomial regression based on age, body mass index, and ultrasound predictors to distinguish between: (1) endometrial atrophy, (2) endometrial polyp or intracavitary myoma, (3) endometrial malignancy or atypical hyperplasia, (4) proliferative/secretory changes, endometritis, or hyperplasia without atypia and validated using leave-center-out cross-validation and bootstrapping. The main outcomes are the model's ability to discriminate between the four outcomes and the calibration of risk estimates. Results: The median age in 2,417 women was 50 (interquartile range 43-57). 414 (17%) women had endometrial atrophy; 996 (41%) had a polyp or myoma; 155 (6%) had an endometrial malignancy or atypical hyperplasia; and 852 (35%) had proliferative/secretory changes, endometritis, or hyperplasia without atypia. The model distinguished well between malignant and benign histology (c-statistic 0.88 95% CI: 0.85-0.91) and between all benign histologies. The probabilities for each of the four outcomes were over- or underestimated depending on the centers. Limitations: Not all patients had a diagnosis based on histology. The model over- or underestimated the risk for certain outcomes in some centers, indicating local recalibration is advisable. Conclusions: The proposed model reliably distinguishes between four histological outcomes. This is the first model to discriminate between several outcomes and is the only model applicable when menopausal status is uncertain. The model could be useful for patient management and counseling, and aid in the interpretation of ultrasound findings. Future research is needed to externally validate and locally recalibrate the model.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Reproduktionsmedicin och gynekologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Obstetrics, Gynaecology and Reproductive Medicine (hsv//eng)
Keyword
- Abnormal uterine bleeding
- Endometrial disease
- Endometrial neoplasms
- Prediction model
- Ultrasonography
Publication and Content Type
- art (subject category)
- ref (subject category)
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- By the author/editor
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Wynants, Laure
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Verbakel, Jan Yv ...
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Valentin, Lil
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De Cock, Bavo
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Angela Pascual, ...
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Leone, Francesco ...
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Sladkevicius, Po ...
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Heremans, Ruben
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Alcazar, Juan Lu ...
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Votino, Angelo
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Fruscio, Robert
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Epstein, Elisabe ...
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Bourne, Tom
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Van Calster, Ben
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Timmerman, Dirk
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Van Den Bosch, T ...
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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 Obstetrics Gynae ...
- Articles in the publication
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Gynecologic and ...
- By the university
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Lund University
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Karolinska Institutet