title: A risk-scoring model for the prediction of endometrial cancer among symptomatic postmenopausal women with endometrial thickness > 4 mm.
abstract: OBJECTIVE
  To develop and test a risk-scoring model for the prediction of endometrial cancer among symptomatic postmenopausal women at risk of intrauterine malignancy.
  
  
  METHODS
  We prospectively studied 624 postmenopausal women with vaginal bleeding and endometrial thickness > 4 mm undergoing diagnostic hysteroscopy. Patient characteristics and endometrial assessment of women with or without endometrial cancer were compared. Then, a risk-scoring model, including the best predictors of endometrial cancer, was tested. Univariate, multivariate, and ROC curve analysis were performed. Finally, a split-sampling internal validation was also performed.
  
  
  RESULTS
  The best predictors of endometrial cancer were recurrent vaginal bleeding (odds ratio (OR) = 2.96), the presence of hypertension (OR = 2.01) endometrial thickness > 8 mm (OR = 1.31), and age > 65 years (OR = 1.11). These variables were used to create a risk-scoring model (RHEA risk-model) for the prediction of intrauterine malignancy, with an area under the curve of 0.878 (95% CI 0.842 to 0.908; P < 0.0001). At the best cut-off value (score ≥ 4), sensitivity and specificity were 87.5% and 80.1%, respectively.
  
  
  CONCLUSIONS
  Among symptomatic postmenopausal women with endometrial thickness > 4 mm, a risk-scoring model including patient characteristics and endometrial thickness showed a moderate diagnostic accuracy in discriminating women with or without endometrial cancer. Based on this model, a decision algorithm was developed for the management of such a population.
authors.affiliation: Local Health Authority of Reggio Emilia, Division of Obstetrics and Gynecology, Cesare Magati Hospital, Viale Martiri della Libertà 6, Scandiano, 42019 Reggio Emilia, Italy.
authors.forename: Luca
authors.identifier: 0000-0002-6405-8522
authors.initials: L
authors.lastname: Giannella
authors.affiliation: Local Health Authority of Reggio Emilia, Division of Obstetrics and Gynecology, Cesare Magati Hospital, Viale Martiri della Libertà 6, Scandiano, 42019 Reggio Emilia, Italy.
authors.forename: Kabala
authors.initials: K
authors.lastname: Mfuta
authors.affiliation: Local Health Authority of Reggio Emilia, Division of Obstetrics and Gynecology, Cesare Magati Hospital, Viale Martiri della Libertà 6, Scandiano, 42019 Reggio Emilia, Italy.
authors.forename: Tiziano
authors.initials: T
authors.lastname: Setti
authors.affiliation: Local Health Authority of Reggio Emilia, Division of Obstetrics and Gynecology, Cesare Magati Hospital, Viale Martiri della Libertà 6, Scandiano, 42019 Reggio Emilia, Italy.
authors.forename: Lillo Bruno
authors.initials: LB
authors.lastname: Cerami
authors.affiliation: Local Health Authority of Reggio Emilia, Division of Obstetrics and Gynecology, Cesare Magati Hospital, Viale Martiri della Libertà 6, Scandiano, 42019 Reggio Emilia, Italy.
authors.forename: Ezio
authors.initials: E
authors.lastname: Bergamini
authors.affiliation: Institute of Obstetrics and Gynecology, Oncology Prevention Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy.
authors.forename: Fausto
authors.initials: F
authors.lastname: Boselli
mesh_terms: D000368:Aged; D015992:Body Mass Index; D016889:Endometrial Neoplasms / Q000453:epidemiology* / Q000473:pathology; D004717:Endometrium / Q000473:pathology*; D005260:Female; D006801:Humans; D017698:Postmenopause; D011379:Prognosis; D012372:ROC Curve; D014592:Uterine Hemorrhage / Q000453:epidemiology* / Q000473:pathology