Rate of premalignant and malignant endometrial lesion in “low-risk” premenopausal women with abnormal uterine bleeding undergoing endometrial biopsy
1
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
ObjectiveTo determine the incidence of endometrial hyperplasia and endometrial cancer (EH/EC) in low-risk premenopausalwomen with abnormal uterine bleeding (AUB) undergoing endometrial biopsy and to build a predictive model thatincludes clinical variables for predicting EH/EC in these women. MethodsThis retrospective study was conducted between January 2015 and March 2020. All premenopausal women aged<55 years with AUB who underwent endometrial sampling during a specified time period were included. Dataregarding baseline characteristics, sonographic findings, and histological reports were collected from patient recordsheets. ResultsDuring the specified time period, 1,089 premenopausal women underwent endometrial biopsy for AUB. Completedata analysis was done for 1,084 women. Of the endometrial samples, 95.3% revealed benign pathology, whereas4.7% of the samples had major endometrial pathology EH/EC. On step-wise logistic regression analysis, intermenstrualbleeding (IMB) (OR, 3.15), body mass index (BMI) >25 kg/m2 (odds ratio [OR], 4.4705), age >40 years (OR, 1.14),endometrial thickness (ET) >13 mm (OR, 2.59), and hypothyroidism (OR, 1.35) were significantly associated with EH/EC. Considering the pretest probability for an EH/EC of 4.7%, this prediction model with a likelihood ratio of 14.2%demonstrated a post-test probability of 41% in the presence of the above-mentioned variables. ConclusionThe risk of EH/EC was lower in low-risk premenopausal women with AUB. However, premenopausal women with IMBaged >40 years, hypothyroidism, BMI >25 kg/m2, and thickened endometrium (ET >13 mm) are at high risk of EH/EC;therefore, endometrial biopsy should be considered early in their management plan.
Abstract
ObjectiveTo determine the incidence of endometrial hyperplasia and endometrial cancer (EH/EC) in low-risk premenopausalwomen with abnormal uterine bleeding (AUB) undergoing endometrial biopsy and to build a predictive model thatincludes clinical variables for predicting EH/EC in these women. MethodsThis retrospective study was conducted between January 2015 and March 2020. All premenopausal women aged<55 years with AUB who underwent endometrial sampling during a specified time period were included. Dataregarding baseline characteristics, sonographic findings, and histological reports were collected from patient recordsheets. ResultsDuring the specified time period, 1,089 premenopausal women underwent endometrial biopsy for AUB. Completedata analysis was done for 1,084 women. Of the endometrial samples, 95.3% revealed benign pathology, whereas4.7% of the samples had major endometrial pathology EH/EC. On step-wise logistic regression analysis, intermenstrualbleeding (IMB) (OR, 3.15), body mass index (BMI) >25 kg/m2 (odds ratio [OR], 4.4705), age >40 years (OR, 1.14),endometrial thickness (ET) >13 mm (OR, 2.59), and hypothyroidism (OR, 1.35) were significantly associated with EH/EC. Considering the pretest probability for an EH/EC of 4.7%, this prediction model with a likelihood ratio of 14.2%demonstrated a post-test probability of 41% in the presence of the above-mentioned variables. ConclusionThe risk of EH/EC was lower in low-risk premenopausal women with AUB. However, premenopausal women with IMBaged >40 years, hypothyroidism, BMI >25 kg/m2, and thickened endometrium (ET >13 mm) are at high risk of EH/EC;therefore, endometrial biopsy should be considered early in their management plan.
참고문헌 (19)
- Fraser IS, "Health-related quality of life and economic burden of abnormal uterine bleeding", Expert Rev Obstet Gynecol, 4, pp.179~189 (2009)
- Munro MG, "FIGO classification system(PALM-COEIN)for causes of abnormal uterine bleeding in nongravid women of reproductive age", Int J Gynaecol Obstet, 113, pp.3~13 (2011)
- Bignardi T, "Abnormal uterine and post-menopausal bleeding in the acute gynaecology unit", Best Pract Res Clin Obstet Gynaecol, 23, pp.595~607 (2009)
- Lacey JV Jr, "Endometrial hyperplasia and the risk of progression to carcinoma", Maturitas, 63, pp.39~44 (2009)
- Lacey JV Jr, "Absolute risk of endometrial carcinoma during 20-year follow-up among women with endometrial hyperplasia", J Clin Oncol, 28, pp.788~792 (2010)
- Singh S, "Abnormal uterine bleeding in pre-menopausal women", J Obstet Gynaecol Can, 35, pp.473~475 (2013)
- "Committee on Practice Bulletins-Gynecology. Practice bulletin no. 128: diagnosis of abnormal uterine bleeding in reproductive-aged women", Obstet Gynecol, 120, pp.197~206 (2012)
- Emons G, "New WHO classification of endometrial hyperplasias", Geburtshilfe Frauenheilkd, 75, pp.135~136 (2015)
- Wise MR, "Body mass index trumps age in decision for endometrial biopsy : cohort study of symptomatic premenopausal women", Am J Obstet Gynecol, 215, pp.598.e1~598.e8 (2016)
- Farquhar CM, "An evaluation of risk factors for endometrial hyperplasia in premenopausal women with abnormal menstrual bleeding", Am J Obstet Gynecol, 181, pp.525~529 (1999)
- Giannella L, "Prediction of endometrial hyperplasia and cancer among premenopausal women with abnormal uterine bleeding", Biomed Res Int, 2019, pp.8598152~ (2019)
- Sattanakho P, "Rate of significant endometrial pathology in women at low risk for endometrial hyperplasia or cancer presenting with abnormal uterine bleeding", Pragmat Obs Res, 11, pp.13~18 (2020)
- Doherty MT, "Concurrent and future risk of endometrial cancer in women with endometrial hyperplasia: a systematic review and meta-analysis", PLoS One, 15, pp.e0232231~ (2020)
- Pennant ME, "Premenopausal abnormal uterine bleeding and risk of endometrial cancer", BJOG, 124, pp.404~411 (2017)
- Deurenberg-Yap M, "The paradox of low body mass index and high body fat percentage among Chinese, Malays and Indians in Singapore", Int J Obes Relat Metab Disord, 24, pp.1011~1017 (2000)
- Guraslan H, "Could body mass index be an indicator for endometrial biopsy in premenopausal women with heavy menstrual bleeding?", Arch Gynecol Obstet, 294, pp.395~402 (2016)
- Wang Y, "Relationship between hypothyroidism and endometrial cancer", Aging Dis, 10, pp.190~196 (2019)
- 박유란, "Endometrial thickness cut-off value by transvaginal ultrasonography for screening of endometrial pathology in premenopausal and postmenopausal women", Obstetrics & Gynecology Science, 62(6), pp.445~453 (2019), 대한산부인과학회[DOI]
- Gawron I, "Endometrial cancer and hyperplasia rate in women before menopause with abnormal uterine bleeding undergoing endometrial sampling", Przegl Lek, 74, pp.139~143 (2017)