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

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  • Additional Information
    • Source:
      Publisher: Elsevier Country of Publication: United States NLM ID: 101235322 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1553-4669 (Electronic) Linking ISSN: 15534650 NLM ISO Abbreviation: J Minim Invasive Gynecol
    • Publication Information:
      Original Publication: Philadelphia, PA : Elsevier, c2005-
    • Subject Terms:
      Postmenopause* ; Uterine Hemorrhage*; Endometrial Neoplasms/*diagnostic imaging; Aged ; Aged, 80 and over ; Denmark ; Endometrial Neoplasms/diagnosis ; Endometrial Neoplasms/pathology ; Endometrial Neoplasms/surgery ; Female ; Humans ; Hysterectomy ; Hysteroscopy ; Middle Aged ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity ; Ultrasonography
    • Abstract:
      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.
      (Copyright © 2018 AAGL. Published by Elsevier Inc. All rights reserved.)
    • Contributed Indexing:
      Keywords: Color Doppler; Endometrial neoplasms; Ultrasonography; Uterine hemorrhage
    • Publication Date:
      Date Created: 20180627 Date Completed: 20190731 Latest Revision: 20191210
    • Publication Date:
      20240829
    • Accession Number:
      10.1016/j.jmig.2018.06.010
    • Accession Number:
      29944932