Management of pre‐, peri‐, and post‐menopausal abnormal uterine bleeding: When to perform endometrial sampling?

Papakonstantinou, Efthymia; Adonakis, Georgios

doi:10.1002/ijgo.13988

Cited by 16 publications

(10 citation statements)

References 58 publications

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“… 1 Patients aged ≥45 years were mostly perimenopausal and postmenopausal women, for whom endometrial sampling are usually recommended if they present AUB. 17 These facts indicate the importance of endometrial sampling, especially for the diagnosis of premalignant lesions (such as hyperplasia) in women aged over 40 years presenting with AUB. The existing evidence indicates that 40 years is an appropriate cutoff age for model developing.…”

Section: Discussionmentioning

confidence: 99%

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

Ruan

Chen

et al. 2023

Yonsei Med J

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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.

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Section: Discussionmentioning

confidence: 99%

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

Ruan

Chen

et al. 2023

Yonsei Med J

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“…For the elderly with abnormal uterine bleeding, all kinds of evaluations are justified by the common acceptance that postmenopausal bleeding is “cancer until proven otherwise” ( 20 ). Thus, for women with abnormal uterine bleeding, the necessity of endometrial sampling is mainly based on the risk of endometrial cancer ( 20 , 21 ).…”

Section: Discussionmentioning

confidence: 99%

Oncological Safety of Diagnostic Hysteroscopy for Apparent Early-Stage Type II Endometrial Cancer: A Multicenter Retrospective Cohort Study

et al. 2022

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ObjectiveTo study the oncological safety of diagnostic hysteroscopy for women with apparent early-stage type II endometrial cancer.Patients and MethodsA total of 429 women with presumed early-stage type II endometrial cancer were included. The 5-year disease-free survival (DFS) and overall survival (OS) were estimated and compared using the Kaplan-Meier method and the log-rank test among patients diagnosed by Dilation & Curettage (D&C) or diagnostic hysteroscopy. The Cox proportional hazards regression model was employed to adjust for potential confounding factors.Results160 cases underwent D&C and 269 cases were diagnosed by diagnostic hysteroscopy. The 5-year DFS rate was 72.17% in the diagnostic hysteroscopy group and 76.16% in the D&C group, diagnostic hysteroscopy was not associated with deteriorated 5-year DFS rate (HR 1.25, 95% CI 0.84-1.86, P=0.281). The 5-year OS rate was 67.23% in the diagnostic hysteroscopy group and 70.71% in the D&C group, diagnostic hysteroscopy did not increase the risk of all-cause death (HR 1.11, 95% CI 0.78-1.57, P=0.573). Multivariable analysis showed that the method of endometrial sampling was not independently associated with DFS (aHR 1.38, 95% CI 0.92-2.07, P=0.122) and OS (aHR 1.23, 95% CI 0.85-1.77, P=0.272).ConclusionFor apparent early-stage type II endometrial cancer, endometrial sampling by diagnostic hysteroscopy was as safe as D&C.

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“…AUB occurs in one-third of women during the reproductive period and accounts for more than 70% of all gynecologic consultations in perimenopausal and postmenopausal women. 2 , 3 , 4 Among AUBs, uterine intracavitary bleeding commonly has structural causes including endometrial polyps (EP), endometrial hyperplasia (EH), subendometrial fibroids (EF) and endometrial cancer (EC). 5 …”

Section: Introductionmentioning

confidence: 99%

“… 11 , 12 , 13 These non-invasive findings are more acceptable first-line imaging modalities than invasive modalities such as endometrial biopsy or hysteroscopy. 4 , 14 Moreover, some studies have attempted to find correlations between the uterine size or endometrial thickness and the hemoglobin (Hb) concentration; however, the results remains limited in the literature. 15 , 16 If these findings are significant, clinicians can assess the prognosis of early anemia and provide earlier interventions, such as administration of iron for preventing the suspected anemia afterwards.…”

Section: Introductionmentioning

confidence: 99%

Assessment of paraclinical characteristics in peri- and postmenopausal bleeding women: is there a correlation between hemoglobin levels and ultrasonic indices?

Nguyen

2023

Journal of Taibah University Medical Sciences

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Management of pre‐, peri‐, and post‐menopausal abnormal uterine bleeding: When to perform endometrial sampling?

Cited by 16 publications

References 58 publications

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

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

Oncological Safety of Diagnostic Hysteroscopy for Apparent Early-Stage Type II Endometrial Cancer: A Multicenter Retrospective Cohort Study

Assessment of paraclinical characteristics in peri- and postmenopausal bleeding women: is there a correlation between hemoglobin levels and ultrasonic indices?

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