Prediction of Endometrial Hyperplasia and Cancer among Premenopausal Women with Abnormal Uterine Bleeding

Luca Giannella, Lillo Bruno Cerami, Tiziano Setti, Ezio Bergamini, Fausto Boselli

Research output: Contribution to journalArticle

Abstract

Objective. To create a prediction model including clinical variables for the prediction of premalignant/malignant endometrial pathology in premenopausal women with abnormal uterine bleeding (AUB). Methods. This is an observational retrospective study including 240 premenopausal women with AUB referred to diagnostic hysteroscopy. Based on the presence of endometrial hyperplasia (EH) or cancer (EC), the women were divided into cases (EH/EC) and controls (no EH/EC). Univariate, stepwise logistic regression and ROC curve analysis were performed. Results. 12 women had EH/EC (5%). Stepwise logistic regression analysis showed that EH/EC associated significantly with BMI ≥ 30 (OR=7.70, 95% CI 1.90 to 31.17), diabetes (OR=9.71, 95% CI 1.63 to 57.81), and a thickened endometrium (OR=1.20, 95% CI 1.08 to 1.34, criterion > 11 mm). The AUC was 0.854 (95% confidence intervals 0.803 to 0.896, p<0.0001). Considering the pretest probability for EH/EC of 5%, the prediction model with a positive likelihood ratio of 8.14 showed a posttest probability of 30%. The simultaneous presence of two or three risk factors was significantly more common in women with EH/EC than controls (50% vs. 6.6 and 25% vs. 0%, respectively, p<0.0001). Conclusion. When premenopausal vaginal bleeding occurs in diabetic obese women with ET > 11 mm, the percentage of premalignant/malignant endometrial pathology increases by 25%. It is likely that the simultaneous presence of several risk factors is necessary to significantly increase the probability of endometrial pathology.

Original languageEnglish
Article number8598152
JournalBioMed Research International
Volume2019
DOIs
Publication statusPublished - Jan 1 2019

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Endometrial Hyperplasia
Uterine Hemorrhage
Pathology
Endometrial Neoplasms
Logistics
ROC Curve
Logistic Models
Medical problems
Regression analysis
Hysteroscopy
Endometrium
Area Under Curve
Observational Studies
Retrospective Studies
Regression Analysis
Confidence Intervals

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Immunology and Microbiology(all)

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Prediction of Endometrial Hyperplasia and Cancer among Premenopausal Women with Abnormal Uterine Bleeding. / Giannella, Luca; Cerami, Lillo Bruno; Setti, Tiziano; Bergamini, Ezio; Boselli, Fausto.

In: BioMed Research International, Vol. 2019, 8598152, 01.01.2019.

Research output: Contribution to journalArticle

Giannella, Luca ; Cerami, Lillo Bruno ; Setti, Tiziano ; Bergamini, Ezio ; Boselli, Fausto. / Prediction of Endometrial Hyperplasia and Cancer among Premenopausal Women with Abnormal Uterine Bleeding. In: BioMed Research International. 2019 ; Vol. 2019.
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abstract = "Objective. To create a prediction model including clinical variables for the prediction of premalignant/malignant endometrial pathology in premenopausal women with abnormal uterine bleeding (AUB). Methods. This is an observational retrospective study including 240 premenopausal women with AUB referred to diagnostic hysteroscopy. Based on the presence of endometrial hyperplasia (EH) or cancer (EC), the women were divided into cases (EH/EC) and controls (no EH/EC). Univariate, stepwise logistic regression and ROC curve analysis were performed. Results. 12 women had EH/EC (5{\%}). Stepwise logistic regression analysis showed that EH/EC associated significantly with BMI ≥ 30 (OR=7.70, 95{\%} CI 1.90 to 31.17), diabetes (OR=9.71, 95{\%} CI 1.63 to 57.81), and a thickened endometrium (OR=1.20, 95{\%} CI 1.08 to 1.34, criterion > 11 mm). The AUC was 0.854 (95{\%} confidence intervals 0.803 to 0.896, p<0.0001). Considering the pretest probability for EH/EC of 5{\%}, the prediction model with a positive likelihood ratio of 8.14 showed a posttest probability of 30{\%}. The simultaneous presence of two or three risk factors was significantly more common in women with EH/EC than controls (50{\%} vs. 6.6 and 25{\%} vs. 0{\%}, respectively, p<0.0001). Conclusion. When premenopausal vaginal bleeding occurs in diabetic obese women with ET > 11 mm, the percentage of premalignant/malignant endometrial pathology increases by 25{\%}. It is likely that the simultaneous presence of several risk factors is necessary to significantly increase the probability of endometrial pathology.",
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AB - Objective. To create a prediction model including clinical variables for the prediction of premalignant/malignant endometrial pathology in premenopausal women with abnormal uterine bleeding (AUB). Methods. This is an observational retrospective study including 240 premenopausal women with AUB referred to diagnostic hysteroscopy. Based on the presence of endometrial hyperplasia (EH) or cancer (EC), the women were divided into cases (EH/EC) and controls (no EH/EC). Univariate, stepwise logistic regression and ROC curve analysis were performed. Results. 12 women had EH/EC (5%). Stepwise logistic regression analysis showed that EH/EC associated significantly with BMI ≥ 30 (OR=7.70, 95% CI 1.90 to 31.17), diabetes (OR=9.71, 95% CI 1.63 to 57.81), and a thickened endometrium (OR=1.20, 95% CI 1.08 to 1.34, criterion > 11 mm). The AUC was 0.854 (95% confidence intervals 0.803 to 0.896, p<0.0001). Considering the pretest probability for EH/EC of 5%, the prediction model with a positive likelihood ratio of 8.14 showed a posttest probability of 30%. The simultaneous presence of two or three risk factors was significantly more common in women with EH/EC than controls (50% vs. 6.6 and 25% vs. 0%, respectively, p<0.0001). Conclusion. When premenopausal vaginal bleeding occurs in diabetic obese women with ET > 11 mm, the percentage of premalignant/malignant endometrial pathology increases by 25%. It is likely that the simultaneous presence of several risk factors is necessary to significantly increase the probability of endometrial pathology.

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