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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

Wynants, Laure ; Verbakel, Jan Yvan Jos ; Valentin, Lil LU orcid ; De Cock, Bavo ; Angela Pascual, M. ; Leone, Francesco P.G. ; Sladkevicius, Povilas LU orcid ; Heremans, Ruben ; Alcazar, Juan Luis and Votino, Angelo , et al. (2022) In Gynecologic and Obstetric Investigation 87(1). p.54-61
Abstract

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... (More)

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.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Abnormal uterine bleeding, Endometrial disease, Endometrial neoplasms, Prediction model, Ultrasonography
in
Gynecologic and Obstetric Investigation
volume
87
issue
1
pages
8 pages
publisher
Karger
external identifiers
  • pmid:35152217
  • scopus:85129996907
ISSN
0378-7346
DOI
10.1159/000522524
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2022 The Author(s). Published by S. Karger AG, Basel.
id
ce8564ca-7bbf-4658-a4fa-51d75648ab6f
date added to LUP
2022-08-18 15:39:22
date last changed
2024-10-31 19:32:08
@article{ce8564ca-7bbf-4658-a4fa-51d75648ab6f,
  abstract     = {{<p>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&amp;C, hysteroscopic resection, hysterectomy, or ultrasound follow-up for &gt;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.</p>}},
  author       = {{Wynants, Laure and Verbakel, Jan Yvan Jos and Valentin, Lil and De Cock, Bavo and Angela Pascual, M. and Leone, Francesco P.G. and Sladkevicius, Povilas and Heremans, Ruben and Alcazar, Juan Luis and Votino, Angelo and Fruscio, Robert and Epstein, Elisabeth and Bourne, Tom and Van Calster, Ben and Timmerman, Dirk and Van Den Bosch, Thierry}},
  issn         = {{0378-7346}},
  keywords     = {{Abnormal uterine bleeding; Endometrial disease; Endometrial neoplasms; Prediction model; Ultrasonography}},
  language     = {{eng}},
  month        = {{05}},
  number       = {{1}},
  pages        = {{54--61}},
  publisher    = {{Karger}},
  series       = {{Gynecologic and Obstetric Investigation}},
  title        = {{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}},
  url          = {{http://dx.doi.org/10.1159/000522524}},
  doi          = {{10.1159/000522524}},
  volume       = {{87}},
  year         = {{2022}},
}