Development and Validation of a Nomogram Prediction Model for Endometrial Malignancy in Patients with Abnormal Uterine Bleeding

Abstract

Purpose This study aimed to identify the risk factors and sonographic variables that could be integrated into a predictive model for endometrial cancer (EC) and atypical endometrial hyperplasia (AEH) in women with abnormal uterine bleeding (AUB). Materials and Methods This retrospective study included 1837 patients who presented with AUB and underwent endometrial sampling. Multivariable logistic regression was developed based on clinical and sonographic covariates [endometrial thickness (ET), resistance index (RI) of the endometrial vasculature] assessed for their association with EC/AEH in the development group (n=1369), and a predictive nomogram was proposed. The model was validated in 468 patients. Results Histological examination revealed 167 patients (12.2%) with EC or AEH in the development group. Using multivariable logistic regression, the following variables were incorporated in the prediction of endometrial malignancy: metabolic diseases [odds ratio (OR)=7.764, 95% confidence intervals (CI) 5.042–11.955], family history (OR=3.555, 95% CI 1.055–11.971), age ≥40 years (OR=3.195, 95% CI 1.878–5.435), RI ≤0.5 (OR=8.733, 95% CI 4.311–17.692), and ET ≥10 mm (OR=8.479, 95% CI 5.440–13.216). A nomogram was created using these five variables with an area under the curve of 0.837 (95% CI 0.800–0.874). The calibration curve showed good agreement between the observed and predicted occurrences. For the validation group, the model provided acceptable discrimination and calibration. Conclusion The proposed nomogram model showed moderate prediction accuracy in the differentiation between benign and malignant endometrial lesions among women with AUB.

Risk stratification model integrating nutritional and inflammatory factors for predicting 1-year mortality after valvular heart surgery: a retrospective cohort study

“…Nomograms are a reliable tool to integrate and quantify potential risk factors by assigning a score to each factor 25 , and they have been actively studied in the field of cancer management 26 – 29 . In CABG patients with heart failure, a nomogram model for predicting in-hospital mortality had a better C -index than EuroSCORE II alone, highlighting the usefulness of a risk stratification nomogram tailored to the characteristics of the surgical patient group 30 , 31 .…”

Rapid identification of endometrial hyperplasia and endometrial endometrioid cancer in young women

“…The variables included were BMI ≥ 30 kg/m 2 , diabetes, and endometrial thickness > 11 mm, and the AUC value of the model was 0.854. By enrolling 1369 AUB patients, including 167 AH/EEC patients, Ruan et al [ 25 ] constructed a prediction model of AH/EEC. The final included indicators were metabolic diseases, family history, age ≥ 40 years, ultrasonic blood flow RI ≤ 0.5, and ET ≥ 10 mm, and the AUC value of the model was 0.837.…”

“…The final included indicators were metabolic diseases, family history, age ≥ 40 years, ultrasonic blood flow RI ≤ 0.5, and ET ≥ 10 mm, and the AUC value of the model was 0.837. The study population of Bagepalli [ 19 ], Jha [ 20 ], Giannella [ 18 ], Ruan [ 25 ], and Tingthanatikul [ 23 ] was AUB patients. Our study targeted young women (age < 40 years), patients with endometrial abnormalities, as suggested by AUB or TVUS, were studied, and therefore, the results have a wider range of clinical applicability.…”

Analysis of Characteristics of Endometrial Carcinoma in Peri- and Postmenopausal Women with Abnormal Uterine Bleeding

“…These symptoms are the primary clinical manifestations of endometrial carcinoma. As the prevalence continues to increase [3], two distinct bleeding patterns display different clinical characteristics, such as variations in stage characteristics and degrees of differentiation. However, there are no related reports available.…”