title: Comparing the performance of two clinical models in estimating the risk of endometrial cancer in symptomatic postmenopausal women.
abstract: OBJECTIVE
  The aim of this study was to internally evaluate the accuracy measures of the two newly developed predictive models, called DEFAB and DFAB, used to estimate the risk of endometrial cancer in postmenopausal women presenting with vaginal bleeding.
  
  
  METHODS
  Prospective study including postmenopausal women presenting with vaginal bleeding.
  
  
  RESULTS
  Over a 46-month-period, 3795 postmenopausal women presented with vaginal bleeding and were included in the study. A total of 221 (6%) women were diagnosed with endometrial carcinoma. The DEFAB predictive model incorporates known risk factors such as presence of Diabetes, Endometrial thickness measurement on transvaginal ultrasonography, Frequency of bleeding, Age, and Body mass index. The DFAB model is based on the above clinical characteristics excluding the ultrasonography result. For the recommended cut-off values, there was no evidence (p-value=0.221) of a difference in the diagnostic ability with respect to sensitivity, specificity, area under receiver operating curve, positive predictive value and negative predictive value. There was strong evidence (p-value<0.0001) to suggest that the diagnostic ability of DEFAB and DFAB agree as evidenced by the excellent Kappa statistic 0.950 (95% CI 0.940-0.960). We found strong evidence (p-value<0.0001) that the variables incorporated in both predictive models simultaneously correctly classify an individual to either having cancer or not having cancer with respect to logistic discriminant analysis.
  
  
  CONCLUSIONS
  We recommend that these two predictive models can be used interchangeably.
authors.affiliation: Medical Statistician, School of Medicine, Health Policy & Practice, University of East Anglia, Norwich NR4 7TJ, United Kingdom. p.musonda@uea.ac.uk
authors.forename: Patrick
authors.initials: P
authors.lastname: Musonda
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Burbos
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Duncan
authors.forename: Simon G
authors.initials: SG
authors.lastname: Crocker
authors.forename: Edward P
authors.initials: EP
authors.lastname: Morris
authors.forename: Joaquin J
authors.initials: JJ
authors.lastname: Nieto
mesh_terms: D000368:Aged; D015331:Cohort Studies; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008875:Middle Aged; D008954:Models, Biological; D017698:Postmenopause; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012306:Risk; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D006113:United Kingdom / Q000453:epidemiology; D014592:Uterine Hemorrhage / Q000209:etiology*