Page 87 - The diagnostic work-up of women with postmenopausal bleeding

External validation of a prediction model
could be selected based on their characteristics, however with a very low specificity which means that many women need to undergo further invasive testing with a small chance of diagnosing a (pre) cancer.
This study shows that after external validation in two independent datasets,
the two multivariable models maintain their diagnostic performance and are able to
select women with PMB not using HRT with a low risk of having endometrial cancer.
By using the ‘patient characteristic and TVS’ model in a sequential or integrated
strategy, the number of women that need further invasive procedures to obtain
material for histological assessment can be decreased only a little, compared to
the current diagnostic pathway in which patient characteristics are not taken into account.Therefore we think that these models are moderately useful in current 4 daily practice. In the Netherlands, TVS is easy accessible in daily practice. A model
based on patient characteristics would only be useful if a larger amount of invasive
procedures could be decreased. Future research should focus on adjusting the model
with different thresholds or subgroups of patients. Furthermore, as Doppler will be
used more and more in clinical practice it would be worth it to externally validate
a model which uses Doppler features.
Conclusions
The two models for endometrial cancer based on patient characteristics and TVS, maintained their diagnostic performance in two independent validation databases. The use of a ‘patient characteristic and TVS’ model in a sequential or integrated strategy, could slightly reduce the number of invasive procedures, compared to the current diagnostic pathway in which patient characteristics are not taken into account, without loss in detection of endometrial cancer.The ‘patient characteristics’ model is able to select women with a low risk of endometrial cancer, who can be reassured without further testing.This is especially useful in a setting whereTVS is not (directly) available.
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