REM (Risk of Endometrial Malignancy): A Proposal for a New Scoring System to Evaluate Risk of Endometrial Malignancy

Abstract

Purpose: It is often difficult to distinguish a benign endometrial disease from a malignancy and tools to help the physician are needed to triage patients into high and low risk of endometrial cancer. The purpose of this study was to obtain a predictive model to assess the risk of endometrial malignancy (REM) in women with ultrasound endometrial abnormalities.Experimental Design: Women, between ages 45 to 80 years, diagnosed through ultrasound with endometrial abnormalities and scheduled to have surgery were enrolled on a prospective study at the Department of Gynaecologic Oncology of Campus Bio-Medico, University of Rome. Preoperative clinical, ultrasound and laboratory characteristics were taken into account. Logistic regression algorithm was used to categorize patients into low-and high-risk groups for endometrial cancer.Results: A total of 675 patients were considered for the analysis: 88 with endometrial cancer and 587 with benign endometrial disease. We divided the patients into two groups: training set (TS) and verification set (VS). Preoperative age, symptom, HE4 levels, and ultrasound endometrial thickness were found statistically significant, and were included into a multivariate logistic regression model to determine the probability to have endometrial cancer. In the TS, REM reported 93.3% sensitivity and 97.1% specificity Conclusions: Our data support the use of REM to triage patients into low-and high-risk groups for endometrial cancer, even if an external validation of the model is needed.

Prediction models for endometrial cancer for the general population or symptomatic women: A systematic review

“…Two studies only included women with postmenopausal bleeding and endometrial thickness larger than 4 mm (Giannella et al, 2014) or 4.5 mm (Opolskiene et al, 2011). One study included women aged 40-65 years with ultrasound endometrial abnormalities (endometrial thickness, polyps and submucous myoma) and scheduled hysteroscopy (Angioli et al, 2013).…”

“…Six out of eight studies had an EPV of more than ten, the other studies had an EPV of 8 (Weber et al, 1999) and below 1 (Madkour, 2017). Continuous predictors were kept continuous in seven studies (Wong et al, 2016;Burbos et al, 2010;Giannella et al, 2014;Weber et al, 1999;Burbos et al, 2011;Opolskiene et al, 2011;Angioli et al, 2013), one study dichotomized the continuous predictors (Madkour, 2017).…”

“…All studies used logistic regression analyses for model development. Six studies performed a preselection of predictors based on univariable analyses, with a p-value of 0.20 (Wong et al, 2016;Weber et al, 1999) or p-value of 0.05 (Giannella et al, 2014;Opolskiene et al, 2011;Madkour, 2017;Angioli et al, 2013). The methods and criteria for selection of predictors during multivariable modelling varied among the studies.…”

“…Forward selection, backward selection and full model approaches were used. Selection was based on p-values of 0.05 in five studies (Wong et al, 2016;Giannella et al, 2014;Weber et al, 1999;Opolskiene et al, 2011;Angioli et al, 2013). One study did not clearly report the methods that were used during multivariable modelling (Madkour, 2017).…”

Reply: Should the lowest common denominator set the standard for ultrasound, and does endometrial pattern evaluation belong to centers of ultrasound excellence?

“…We appreciate these comments by Angioli et al and their interest in our risk of endometrial cancer (REC) score system 1 . Score systems should be simple, but most crucially they have to be efficient.…”