Sensitivity of transvaginal ultrasound screening for endometrial cancer in postmenopausal women: a case-control study within the UKCTOCS cohort

Jacobs, Ian; Gentry‐Maharaj, Aleksandra; Burnell, Matthew; Manchanda, Ranjit; Singh, Naveena; Sharma, Aarti; Ryan, Andy; Seif, Mourad W.; Amso, Nazar; Turner, George F.; Brunell, Carol; Fletcher, Gwendolen; Rangar, Rani; Ford, Kathy; Godfrey, Keith; Lopes, Alberto; Oram, David; Herod, Jonathan; Williamson, Karin; Scott, Ian; Jenkins, Howard J.; Mould, Tim; Woolas, Robert; Murdoch, J.; Dobbs, Stephen; Leeson, Simon; Cruickshank, D.J.; Skates, Steven J.; Fallowfield, Lesley; Parmar, Mahesh; Campbell, Stuart; Menon, Usha

doi:10.1016/s1470-2045(10)70268-0

Cited by 198 publications

(168 citation statements)

References 37 publications

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“…The analysis performed only in women with endometrial cancer without postmenopausal bleeding and with a cutoff of 5 mm showed sensitivity of 77.1% and specificity of 85.8%. This study has proved the usage of trans-vaginal ultrasonography as a screening tool in postmenopausal women [19]. In a large retrospective meta-analysis it was found that the detection rate for endometrial carcinoma with endometrial biopsy was 99.6% in postmenopausal and 91% in premenopausal women [20].…”

Section: Discussionmentioning

confidence: 69%

Power morcellation for women undergoing laparoscopic supracervical hysterectomy — safety of procedure and clinical experience from 426 cases

et al. 2016

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Objectives: Minimally invasive gynaecological surgeries are performed for several malignant and nonmalignant indications. The aim of our study was to evaluate the rate of unexpected malignancies among women who underwent laparoscopical supracervical hysterectomy (LASH) with power morcellation. Material and methods:The retrospective analysis included clinical data of 426 consecutive female patients who underwent LASH with power morcellation due to presumed benign disorders (78.4% -symptomatic uterine fibromas, 12.7% -abnormal uterine bleeding, 8.9% -suspicion of uterine adenomyosis) between January 2011 and December 2015. Premalignant or malignant preoperative abnormalities in the cervix and the uterine corpus were contraindications for LASH. Results:The unexpected malignancies were found in four patients from study group: one ovarian cancer located on the inner part of simple ovarian cyst and 3 endometrial carcinomas (0.9%) were documented. All these patients underwent abdominal reoperations and no histological abnormalities were detected in the extirpated cervix and adnexa. Conclusions:The incidence of unintended endometrial carcinoma in morcellated uterus after LASH was relatively small. However, careful pre-operative counseling should be undertaken in order to exclude the possibility of any malignant disease in uteri among women scheduled to power morcellation.

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Section: Discussionmentioning

confidence: 69%

Power morcellation for women undergoing laparoscopic supracervical hysterectomy — safety of procedure and clinical experience from 426 cases

et al. 2016

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“…Recent observational data from a large-scale cohort in the United Kingdom provided some indication of the utility of targeted screening high-risk groups (12). Limiting TVS screening to a higher risk group selected on the basis of epidemiologic risk factors improved sensitivity and specificity to 84% and 90% respectively, and calculations showed that 40% of EC cases could have been diagnosed by screening only 25% of the population.…”

Section: Discussionmentioning

confidence: 99%

“…Risk models may help balance expected benefits against possible harms of preventive treatments and can also be a useful tool for selecting women who may benefit from screening programs (11,12).…”

Section: Introductionmentioning

confidence: 99%

An epidemiological model for prediction of endometrial cancer risk in Europe

et al. 2015

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Endometrial cancer is the fourth most frequent cancer in women in Europe, and as its incidence is increasing, prevention strategies gain further pertinence. Risk prediction models can be a useful tool for identifying women likely to benefit from targeted prevention measures. On the basis of data from 201,811 women (mostly aged 30-65 years) including 855 incident endometrial cancer cases from eight countries in the European Prospective Investigation into Cancer and Nutrition cohort, a model to predict endometrial cancer (EC) was developed. A step-wise model selection process was used to select confirmed predictive epidemiologic risk factors. Piece-wise constant hazard rates in 5-year age-intervals were estimated in a cause-specific competing risks model, five-fold-cross-validation was applied for internal validation.Risk factors included in the risk prediction model were body-mass index (BMI), menopausal status, age at menarche and at menopause, oral contraceptive use, overall and by different BMI categories and overall duration of use, parity, age at first full-term pregnancy, duration of menopausal hormone therapy and smoking status (specific for pre, peri-and post-menopausal women). These variables improved the discriminating capacity to predict risk over 5 years from 71% for a model based on age alone to 77% (overall C statistic), and the model was wellcalibrated (ratio of expected to observed cases = 0.99).Our model could be used for the identification of women at increased risk of EC in Western Europe. To achieve an EC-risk model with general validity, a large-scale cohort-consortium approach would be needed to assess and adjust for population variation. Husing_EndometrCaRiskmodel_EurJEpidemiol_2015_authorversion4

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“…Few studies have evaluated the relationship between the size of the polyp and the risk of malignancy [15][16][17]24,25 . In this study, a size of 30 mm showed the best sensitivity (47.8%) and specificity (66.1%) in predicting malignancy in endometrial polyps.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of sonography and hysteroscopy in the diagnosis of premalignant and malignant polyps in postmenopausal women

Godoy¹,

Antunes²,

Morais³

et al. 2013

Rev. Bras. Ginecol. Obstet.

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PURPOSE: To evaluate the accuracy of sonographic endometrial thickness and hysteroscopic characteristics in predicting malignancy in postmenopausal women undergoing surgical resection of endometrial polyps. METHODS: Five hundred twenty-one (521) postmenopausal women undergoing hysteroscopic resection of endometrial polyps between January 1998 and December 2008 were studied. For each value of sonographic endometrial thickness and polyp size on hysteroscopy, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated in relation to the histologic diagnosis of malignancy. The best values of sensitivity and specificity for the diagnosis of malignancy were determined by the Receiver Operating Characteristic (ROC) curve. RESULTS: Histologic diagnosis identified the presence of premalignancy or malignancy in 4.1% of cases. Sonographic measurement revealed a greater endometrial thickness in cases of malignant polyps when compared to benign and premalignant polyps. On surgical hysteroscopy, malignant endometrial polyps were also larger. An endometrial thickness of 13 mm showed a sensitivity of 69.6%, specificity of 68.5%, PPV of 9.3%, and NPV of 98% in predicting malignancy in endometrial polyps. Polyp measurement by hysteroscopy showed that for polyps 30 mm in size, the sensitivity was 47.8%, specificity was 66.1%, PPV was 6.1%, and NPV was 96.5% for predicting cancer. CONCLUSIONS: Sonographic endometrial thickness showed a higher level of accuracy than hysteroscopic measurement in predicting malignancy in endometrial polyps. Despite this, both techniques showed low accuracy for predicting malignancy in endometrial polyps in postmenopausal women. In suspected cases, histologic evaluation is necessary to exclude malignancy. ResumoOBJETIVO: Avaliar a acurácia da espessura endometrial ecográfica e características histeroscópicas em predizer malignidade em mulheres na pós-menopausa submetidas à ressecção cirúrgica de pólipos endometriais. MÉTODOS: Quinhentos e vinte e uma (521) mulheres na pós-menopausa submetidas à ressecção histeroscópica de pólipo endometrial entre janeiro de 1998 e dezembro de 2008 foram incluídas no estudo. Para cada valor de espessura endometrial ecográfica e tamanho dos pólipos na histeroscopia, a sensibilidade, a especificidade, valor preditivo positivo (VPP) e valor preditivo negativo (VPN) foram calculados em relação ao diagnóstico histológico de malignidade. Os melhores valores de sensibilidade e especificidade para o diagnóstico de malignidade foram determinados pela curva Receiver Operating Characteristic (ROC). RESULTADOS: O diagnóstico histológico identificou a presença de pré-malignidade ou malignidade em 4,1% dos casos. A espessura endometrial medida por ultrassonografia em casos de pólipos malignos foi maior quando comparado com pólipos benignos e pré-malignos. Na histeroscopia os pólipos malignos também foram maiores. A espessura endometrial de 13 mm mostrou uma sensibilidade de 69,6%, especificidade de 68,5%, VPP de 9,3% e VP...

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Sensitivity of transvaginal ultrasound screening for endometrial cancer in postmenopausal women: a case-control study within the UKCTOCS cohort

Cited by 198 publications

References 37 publications

Power morcellation for women undergoing laparoscopic supracervical hysterectomy — safety of procedure and clinical experience from 426 cases

Power morcellation for women undergoing laparoscopic supracervical hysterectomy — safety of procedure and clinical experience from 426 cases

An epidemiological model for prediction of endometrial cancer risk in Europe

Accuracy of sonography and hysteroscopy in the diagnosis of premalignant and malignant polyps in postmenopausal women

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