Page 55 - The diagnostic work-up of women with postmenopausal bleeding

Study characteristics
Study characteristics are shown in Table 1. Of the nine selected articles on predic-
tion models for women with PMB, five articles described the development of one
model and four articles described two or more different prediction models. In the
nine selected articles, four models were based primarily on patient characteristics,31,
34, 36, 38 four prediction models were based on a combination of patient character-
istics and grey-scale transvaginal sonography (TVS) findings,31, 33, 36 two prediction
models were based on a combination of patient characteristics, hysteroscopy and/ 3 or grey-scale TVS findings,31 two prediction models were based on TVS findings
only37, 39 and three models used Doppler TVS findings as a predictor variable.35, 37, 38 Patient selection and inclusion criteria were not the same in all articles. All nine articles included women with PMB, but three of these articles studies a population of women with a high risk profile for endometrial cancer, based on a endometrial thickness of 5mm.35, 37, 38
0% 20% 40% 60% 80% 100%
Prediction models
Figure 2. Quality of included studies
1. Study participation
Description of setting and study period
6
3
Description of in- and exclusion criteria
9
Consecutive patient selection
7
2
Number of patients reported
9
Rate of patients with endometrial cancer reported
9
Clear description of patient characteristics
7
1
1
2. Predictor variables
Clear definition of all predictor variables evaluated
9
Description of proportion of participants with complete or Missing data
1
2
3. Outcome measurement
Clear definition of outcome (endometrial cancer/hyperplasia)
9
Histology performed in all patients
6
3
4. Analysis
Description of all evaluation measures
8
1
Description of model building strategy (e.g. logistic regression)
8
1
Yes No Unclear
Study quality
The results of the quality assessment are reported in Figure 2. Overall, study quality was good.The quality of the description of the setting and study period was rated as moderate; this was not described in three out of nine articles.Three articles in- cluded all women with postmenopausal bleeding, but performed histology only in patients with an increased endometrial thickness. All three articles explained that no further investigations were performed in women with an endometrial thickness less than five mm, because evidence suggests a ver y low probability of cancer below this threshold.33, 34, 36
53