Department of Obstetrics and Gynecology, Skåne University Hospital Malmö, Lund University, Malmö, Sweden.
Ultrasound Obstet Gynecol. 2011 Feb;37(2):232-40. doi: 10.1002/uog.8871. Epub 2011 Jan 19.
To build mathematical models for evaluating the individual risk of endometrial malignancy in women with postmenopausal bleeding and sonographic endometrial thickness ≥ 4.5 mm using clinical data, sonographic endometrial thickness and power Doppler ultrasound findings.
Of 729 consecutive patients with postmenopausal bleeding, 261 with sonographic endometrial thickness ≥ 4.5 mm and no fluid in the uterine cavity were included. They underwent transvaginal two-dimensional gray-scale and power Doppler ultrasound examination of the endometrium. The ultrasound image showing the most vascularized section through the endometrium as assessed by power Doppler was frozen, the endometrium was outlined and the percentage vascularized area (vascularity index) was calculated using computer software. The ultrasound examiner also estimated the color content of the endometrial scan on a visual analog scale (VAS) graded from 0 to 100 (VAS score). A structured history was taken to collect clinical information. Multivariate logistic regression analysis was used to create mathematical models to predict endometrial malignancy.
There were 63 (24%) malignant and 198 (76%) benign endometria. Women with a malignant endometrium were older (median age 74 vs. 65 years; P = 0.0005) and fewer used hormone replacement therapy and warfarin. Women with a malignant endometrium had a thicker endometrium (median thickness 20.8 vs. 10.2 mm; P = 0.0005) and higher values for vascularity index and VAS score. When using only clinical data to build a model for estimating the risk of endometrial malignancy, a model including the variables age, use of warfarin and use of hormone replacement therapy had the largest area under the receiver-operating characteristics curve (AUC), with a value of 0.74 (95% confidence interval (CI), 0.67-0.81). A model including age, use of warfarin and endometrial thickness had an AUC of 0.82 (95% CI, 0.76-0.87), and one including age, use of hormone replacement therapy, endometrial thickness and vascularity index had an AUC of 0.91 (95% CI, 0.87-0.95). Using a risk cut-off of 11%, the latter model had sensitivity 90%, specificity 71%, positive likelihood ratio 3.14 and negative likelihood ratio 0.13.
The diagnostic performance of models predicting endometrial cancer increases substantially when sonographic endometrial thickness and power Doppler information are added to clinical variables. The models are likely to be clinically useful but need to be prospectively validated.
利用临床资料、超声子宫内膜厚度和能量多普勒超声检查结果，建立评估绝经后出血且超声子宫内膜厚度≥4.5mm 妇女子宫内膜恶性肿瘤个体风险的数学模型。
对 729 例连续绝经后出血患者进行研究，其中 261 例超声子宫内膜厚度≥4.5mm 且宫腔内无积液。对所有患者均行经阴道二维灰阶和能量多普勒超声检查子宫内膜。应用能量多普勒超声评估子宫内膜最血管化节段，冻结超声图像，用计算机软件勾勒出子宫内膜并计算血管化面积百分比（血管指数）。超声检查者还使用视觉模拟量表（VAS）对子宫内膜扫描的彩色内容进行评估（VAS 评分从 0 到 100 级）。采集结构化病史以收集临床信息。采用多变量逻辑回归分析建立预测子宫内膜恶性肿瘤的数学模型。
共发现 63 例（24%）恶性和 198 例（76%）良性子宫内膜病变。患有恶性子宫内膜的患者年龄更大（中位年龄 74 岁比 65 岁；P=0.0005），且使用激素替代疗法和华法林的患者更少。患有恶性子宫内膜的患者子宫内膜更厚（中位厚度 20.8 毫米比 10.2 毫米；P=0.0005），血管指数和 VAS 评分更高。仅使用临床数据建立子宫内膜恶性肿瘤风险估计模型时，包括变量年龄、华法林使用和激素替代疗法使用的模型具有最大的受试者工作特征曲线下面积（AUC），为 0.74（95%置信区间（CI），0.67-0.81）。包括年龄、华法林使用和子宫内膜厚度的模型 AUC 为 0.82（95%CI，0.76-0.87），而包括年龄、激素替代疗法使用、子宫内膜厚度和血管指数的模型 AUC 为 0.91（95%CI，0.87-0.95）。使用风险截断值为 11%，后一种模型的敏感性为 90%，特异性为 71%，阳性似然比为 3.14，阴性似然比为 0.13。
当将超声子宫内膜厚度和能量多普勒信息添加到临床变量中时，预测子宫内膜癌的模型的诊断性能显著提高。这些模型可能具有临床应用价值，但需要前瞻性验证。
