<p>A Novel Risk-Scoring Model for Prediction of Premalignant and Malignant Lesions of Uterine Endometrium Among Symptomatic Premenopausal Women</p>

Abstract

Purpose Uterine cancer is the second most prevalent cancer of the female genital tract, with 90% of it being of endometrial origin. The aim of this research was to create and validate a risk-scoring model using patients’ clinical variables in predicting premalignant and malignant lesions of the uterine endometrium among premenopausal women with abnormal uterine bleeding (AUB). Methods This is a retrospective cohort study conducted at a tertiary hospital of Southern India for a period of 5 years from July 2014 to August 2019, including women aged ≤55 years who had AUB and underwent endometrial biopsy. The incidence of atypical endometrial hyperplasia (AEH) and endometrial cancer (EC) was determined, and clinical and demographic variables were compared among cases (AEH/EC) and controls (no AEH/EC) using simple logistic regression. A risk-scoring model was derived and validated with a split-sample internal validation method. Results A total of 472 premenopausal women presenting with AUB were included in the study. There were 20 women (4.2%) with AEH and eight (1.7%) with EC. We found a statistically significant positive correlation of an anovulatory pattern of bleeding (odds ratio [OR]=3.4; p =0.009), age ≥45 years (OR=1.12; p =0.01), body mass index (BMI) ≥30 kg/m 2 (OR=2.46; p =0.04) and diabetes mellitus (OR=3.00; p =0.02) with a higher risk of AEH/EC diagnosis upon histopathological examination of endometrial biopsy specimens of the study population. A risk-scoring model (PAD30) was created using these variables to predict premalignant and malignant endometrial lesions. The best cutoff score derived by the receiver operating characteristics (ROC) curve, of ≥5, had a sensitivity of 85.7% and specificity of 87.6% with an area under the curve (AUC) of 0.84 (95% CI 0.75–0.93; p =0.04). With a positive likelihood ratio of 6.91, our prediction model increases the post-test probability of AEH/EC to 30.6% from 6% of the pre-test probability. Conclusion The proposed model demonstrated a moderate diagnostic accuracy in predicting premalignant and malignant lesions of the uterine endometrium among symptomatic premenopausal women.

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

“…EH/EEC is the cause of AUB in 5%–14% of AUB patients [ 18 ]. Bagepalli Srinivas et al [ 19 ] retrospectively analyzed the clinical data of 472 women with AUB (including 20 with AH and 8 with EEC) who were aged ≤ 55 years and established a predictive scoring model for AH/EC in symptomatic premenopausal women. This model included the variables of age ≥ 45 years (1 point), anovulatory bleeding (3 points), combined diabetes (3 points), and BMI ≥ 30 kg/m 2 (2 points).…”

“…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.…”