Page 62 - The diagnostic work-up of women with postmenopausal bleeding

Chapter 3
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Table 3. Evaluation of model development and model performance
Specification of model performance at internal validation
First author, Development year phase
Prediction model
Discrimination#
Calibration
Clinical usefulness
Result as reported in paper
Epstein 2002 Internal validation
Subjective prob of cancer (PH, TVS, Doppler) Objective prob of cancer (PH,TVS, Doppler)
0.88 0.88
- -
Sens 0.75, Spec 0.96 Sens 0.88, Spec 0.81
Power Doppler can contribute to diagnosis of endometrial cancer.
Randelzhofer Internal 2002 validation
ET+endometrial structure + myometrial border
(cut-off point ET>10mm)
-
Estimated prob 2.8% vs. 2.1% real malignant
Sens 0.97, Spec 0.62 NPV 0.98,
Accuracy 0,72
The combined assessment of ET and endometrial morphology may improve diagnostic accuracy.
Bachmann Internal 2003 validation
PH
PH+ET PH+hysteroscopy PH+ET+hysterscopy
0.8 0.82 0.910 0.914
-
-
Not much increased value in testing with ultrasound, if hysteroscopy was already performed.
Bruchim 2004 Model derivation
ET+time since menopause
-
- -
-
Time since menopause and ET can define when invasive testing is needed.
Opmeer Internal 2006 validation
PH
PH+TVS if prob>4%
0.76 0.76 0.9
NPV 0.990 Efficiency +0.6 NPV 0.990 Efficiency -0.16 NPV 0.996 Efficiency -0.05
Compared with US only, efficiency gain is reflected in increased AUC and reduced number of procedures, with PH+US in a sequential strategy.
Opolskiene Internal 2007* validation
PH+TVS, histology if prob >4%
Burbos 2010 Internal validation
DEFAB: diabetes, ET, frequency of bleeding, age and BMI (DEFAB 3)
Sens 0.82 Spec 0.50 Accuracy 0.52 LR- 0.36
Fair accuracy in separating women without cancer from women with cancer.
ET, echogenicity (and Doppler)
0.91 / 0.92 0.77 / 0.66
- -
Sens 0.93/0.87 Spec 0.79/0.83 LR- 0.1 / 0.2
A model including ET and heterogeneous echogenicity of the endometrium was best in predicting endometrial cancer, with Doppler diagnostic performance improved marginally