A Risk-Scoring Model for the Prediction of Endometrial Cancer among Symptomatic Postmenopausal Women with Endometrial Thickness > 4 mm

Abstract EN

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.