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Ultrasound assessment of endometrial morphology and vascularity to predict endometrial malignancy in women with postmenopausal bleeding and sonographic endometrial thickness >/= 4.5 mm.

Opolskiene, Gina LU ; Sladkevicius, Povilas LU and Valentin, Lil LU (2007) In Ultrasound in Obstetrics & Gynecology 30(3). p.332-340
Abstract
Objectives To determine which endometrial morphology characteristics as assessed by gray-scale ultrasound and which endometrial vessel characteristics as assessed by power Doppler ultrasound are useful for discriminating between benign and malignant endometrium in women with postmenopausal bleeding (PMB) and sonographic endometrial thickness > 4.5 mm and to develop logistic regression models to calculate the individual risk of endometrial malignancy in women with PMB, endometrial thickness > 4.5 mm, good visibility of the endometrium and detectable Doppler signals in the endometrium. Methods Of 223 consecutive patients with PMB and sonographic endometrial thickness > 4.5 mm, 120 fulfilled our inclusion criteria. They underwent... (More)
Objectives To determine which endometrial morphology characteristics as assessed by gray-scale ultrasound and which endometrial vessel characteristics as assessed by power Doppler ultrasound are useful for discriminating between benign and malignant endometrium in women with postmenopausal bleeding (PMB) and sonographic endometrial thickness > 4.5 mm and to develop logistic regression models to calculate the individual risk of endometrial malignancy in women with PMB, endometrial thickness > 4.5 mm, good visibility of the endometrium and detectable Doppler signals in the endometrium. Methods Of 223 consecutive patients with PMB and sonographic endometrial thickness > 4.5 mm, 120 fulfilled our inclusion criteria. They underwent transvaginal gray-scale and power Doppler ultrasound examination, wbich was videotaped for later analysis by two examiners with more than 15 years' experience in gynecological ultrasonography. They independently assessed endometrial morphology and vascularity using predetermined criteria. Their agreed-upon description was compared with the histological diagnosis. Univariate and multivariate logistic regression analyses were used. The best diagnostic test was defined as the one with the largest area under the receiver-operating characteristics curve (AUC). Results Thirty (25%) endometria were malignant. Interobserver agreement for the description of endometrial morphology and vascularity was moderate to good (Kappa 0.49-0.78). The best ultrasound variables to predict malignancy were heterogeneous endometrial echogenicity (AUC 0.83), endometrial thickness (AUC 0.80), and irregular branching of endometrial blood vessels (AUC 0.77). A logistic regression model including endometrial thickness and heterogeneous endometrial echogenicity bad an AUC of 0.91. Its mathematically best risk cut-off yielded a positive likelihood ratio of 4.4, and a negative likelihood ratio of 0.1. Adding Doppler information to the model improved diagnostic performance marginally (AUC 0.92). Conclusions In selected high-risk women with PMB and an endometrial thickness of > 4.5 mm, calculation of the individual risk of endometrial malignancy using regression models including gray-scale and Doppler characteristics can be used to tailor management. These models would need to be tested prospectively before introduction into clinical practice. Copyright (c) 2007 ISUOG. Publisbed by John Wiley & Sons, Ltd. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
ultrasonography, endometrial neoplasms, Doppler ultrasound, postmenopausal bleeding, regression analysis
in
Ultrasound in Obstetrics & Gynecology
volume
30
issue
3
pages
332 - 340
publisher
John Wiley & Sons
external identifiers
  • wos:000249962300016
  • scopus:34748888943
ISSN
1469-0705
DOI
10.1002/uog.4104
language
English
LU publication?
yes
id
b1d34ec4-06ba-49ee-9112-031d3bdd1e4a (old id 606984)
alternative location
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=17688304&dopt=Abstract
date added to LUP
2007-12-19 10:51:26
date last changed
2017-08-27 05:32:32
@article{b1d34ec4-06ba-49ee-9112-031d3bdd1e4a,
  abstract     = {Objectives To determine which endometrial morphology characteristics as assessed by gray-scale ultrasound and which endometrial vessel characteristics as assessed by power Doppler ultrasound are useful for discriminating between benign and malignant endometrium in women with postmenopausal bleeding (PMB) and sonographic endometrial thickness > 4.5 mm and to develop logistic regression models to calculate the individual risk of endometrial malignancy in women with PMB, endometrial thickness > 4.5 mm, good visibility of the endometrium and detectable Doppler signals in the endometrium. Methods Of 223 consecutive patients with PMB and sonographic endometrial thickness > 4.5 mm, 120 fulfilled our inclusion criteria. They underwent transvaginal gray-scale and power Doppler ultrasound examination, wbich was videotaped for later analysis by two examiners with more than 15 years' experience in gynecological ultrasonography. They independently assessed endometrial morphology and vascularity using predetermined criteria. Their agreed-upon description was compared with the histological diagnosis. Univariate and multivariate logistic regression analyses were used. The best diagnostic test was defined as the one with the largest area under the receiver-operating characteristics curve (AUC). Results Thirty (25%) endometria were malignant. Interobserver agreement for the description of endometrial morphology and vascularity was moderate to good (Kappa 0.49-0.78). The best ultrasound variables to predict malignancy were heterogeneous endometrial echogenicity (AUC 0.83), endometrial thickness (AUC 0.80), and irregular branching of endometrial blood vessels (AUC 0.77). A logistic regression model including endometrial thickness and heterogeneous endometrial echogenicity bad an AUC of 0.91. Its mathematically best risk cut-off yielded a positive likelihood ratio of 4.4, and a negative likelihood ratio of 0.1. Adding Doppler information to the model improved diagnostic performance marginally (AUC 0.92). Conclusions In selected high-risk women with PMB and an endometrial thickness of > 4.5 mm, calculation of the individual risk of endometrial malignancy using regression models including gray-scale and Doppler characteristics can be used to tailor management. These models would need to be tested prospectively before introduction into clinical practice. Copyright (c) 2007 ISUOG. Publisbed by John Wiley & Sons, Ltd.},
  author       = {Opolskiene, Gina and Sladkevicius, Povilas and Valentin, Lil},
  issn         = {1469-0705},
  keyword      = {ultrasonography,endometrial neoplasms,Doppler ultrasound,postmenopausal bleeding,regression analysis},
  language     = {eng},
  number       = {3},
  pages        = {332--340},
  publisher    = {John Wiley & Sons},
  series       = {Ultrasound in Obstetrics & Gynecology},
  title        = {Ultrasound assessment of endometrial morphology and vascularity to predict endometrial malignancy in women with postmenopausal bleeding and sonographic endometrial thickness >/= 4.5 mm.},
  url          = {http://dx.doi.org/10.1002/uog.4104},
  volume       = {30},
  year         = {2007},
}