Page 54 - The diagnostic work-up of women with postmenopausal bleeding

Chapter 3
endometrial cancer.An AUC of 0.5 describes a non-informative test, whereas an AUC of 1.0 represents a test that discriminates perfectly between presence and absence of a disease.29 Clinical usefulness measures how close a prediction for an individual patient is to her actual outcome.This is mostly reported as accuracy (percentage of patients correctly classified), sensitivity or specificity, positive or negative predictive value (PPV or NPV) or likelihood ratios (LR) of a prediction model.30 As we are interested in identifying a group of patients with a high risk for endometrial cancer, we are most interested in a high sensitivity, high NPV and a low negative LR.
Results
Study identification and selection
Of 754 articles identified by the MEDLINE and EMBASE search, a total of nine articles met the inclusion criteria of our review.31-39 We identified another three articles by scanning the reference lists of included articles,40-42 however none of these matched our inclusion criteria after reading the abstract and full text version of these articles (Figure 1).
Figure 1. Study selection diagram Figure 1. Study selection diagram
754 potentially relevant studies identified and screened for
retrieval from electronic search
22 studies retrieved for more detailed evaluation
732 studies excluded on basis of title/abstract*
16 studies excluded*
seven models based on one variable four diagnosis, not prognosis
one review
three pre- and postmenopausal women included
52
nine prognostic articles included after consensus by two independent reviewers
* The reference list for excluded studies is available from the corresponding author.