Page 75 - The diagnostic work-up of women with postmenopausal bleeding

External validation of a prediction model
prediction of endometrial cancer in women with postmenopausal bleeding based on the following patient characteristics: age, time since menopause, body mass index (BMI), diabetes, parity, hypertension, use of anticoagulants, history of cancer and dysfunction of the thyroid gland.The first statistical model, based on characteristics of the women only, is referred to as the ‘patient characteristics model’.The second model is an extension of the first model in which characteristics of the women are combined with the measurement of endometrial thickness by TVS and is referred to as the ‘patient characteristics and TVS model’. Further statistical details on the development of the model can be found in the Appendix of the original article.16
Study population used for external validation 4
The two models and three strategies were externally validated by retrospectively applying them on two prospectively collected databases:
• Dutch database: This database studying 559 women included all women presenting with postmenopausal bleeding between January 2009 and April 2011 (36% of women presented at the TweeSteden Hospital, 18% at the Maxima Medical Centre in Veldhoven and 46% at the St. Antonius Hospital in Nieuwegein,the Netherlands).This database was not primarily established to validate the two mathematical models of Opmeer et al Menopause was defined as at least one year of amenorrhea, after the age of forty. If there were doubts about menopausal status the status was established by testing of the follicle-stimulating hormone (FSH).The following patient characteristics were recorded: age, years since menopause, BMI, parity, HRT use,hypertension,diabetes,use of anticoagulants and endometrial thickness as measured by TVS. If endometrial thickness exceeded four millimetres, endometrial sampling using the Pipelle® (Labaratoire CCD, Paris, France) was performed. In case of a failed endometrial sampling hysteroscopy with directed biopsy was performed. Failure was classified as either a technical failure or as an endometrial sampling in which the amount of tissue was insufficient for a reliable diagnosis. All women were instructed to contact the hospital if recurrence of bleeding occurred.
• Swedish database:This database includes all women presenting with PMB at the Skåne University Hospital in Malmö postmenopausal bleeding clinic
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