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Ultrasound Scoring of Endometrial Pattern for Fast-track Identification or Exclusion of Endometrial Cancer in Women with Postmenopausal Bleeding

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

DOI

  1. Outcome of repeated hysteroscopic resection of the endometrium

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  • Margit Dueholm
  • Ina Marie Dueholm Hjorth
  • Katja Dahl
  • Estrid Stær Hansen
  • Gitte Ørtoft
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STUDY OBJECTIVE: To evaluate the risk of endometrial cancer (REC) scoring system for the prediction of high and low probability of endometrial cancer (EC) in women with postmenopausal bleeding (PMB).

DESIGN: A prospective study (Canadian Task Force classification II-1).

SETTING: An academic hospital.

PATIENTS: Nine hundred fifty consecutive patients with PMB underwent transvaginal ultrasonography (TVS) and REC scoring between November 2013 and December 2015.

INTERVENTIONS: Obstetrics and gynecology residents supervised by trained physicians scored endometrial patterns according to the previously established REC scoring system. The reference standard was endometrial samples, endometrial thickness (ET, 4-4.9 mm), operative hysteroscopy or hysterectomy (ET ≥5 mm), and 1-year follow-up in all patients presenting with ET <4 mm. Diagnostic performance for the prediction of probability of malignancy was assessed using the REC scoring system.

MEASUREMENTS AND MAIN RESULTS: The area under the receiver operating characteristic curve of the TVS REC scoring system was 97% (95% confidence interval [CI], 95%-98%) for the prediction of malignancy. In 656 patients with ET ≥4 mm, REC scoring effectively predicted a high probability of malignancy with sensitivity (95% confidence interval) of 92% (95% CI, 87%-95%) and specificity of 94% (95% CI, 91%-96%). An REC score of 0 was present in 206 (32%) patients with ET ≥4 mm and was associated with a low negative likelihood ratio of 0.026 for EC. There were only 7 patients with EC/atypical hyperplasia among these 206 patients.

CONCLUSION: The REC scoring system identified or ruled out most ECs, clearly showing that more specific image analysis at first-line TVS can accelerate the diagnosis of EC in patients with PMB and may allow for improved selection of second-line strategies in patients with ET ≥4 mm.

OriginalsprogEngelsk
TidsskriftJournal of minimally invasive gynecology
Vol/bind26
Udgave nummer3
Sider (fra-til)516-525
ISSN1553-4650
DOI
StatusUdgivet - 1 mar. 2019

ID: 55854455