A Novel Risk-Scoring Model for Prediction of Premalignant and Malignant Lesions of Uterine Endometrium Among Symptomatic Premenopausal Women

Figures & data

Figure 1 Flowchart of participants.

Table 1 Univariate Analysis of Demographic and Clinical Characteristics Associated with Atypical Endometrial Hyperplasia and/or Endometrial Cancer (AEH/EC)

Risk Factors	Women with AEH/EC	Women Without AEH/EC	OR (95% CI)	p Value
	(n=28) (6%)	(n=444) (94%)
Age (years)*	45 (40–49)	41 (37–45)	1.12 (1.02–1.21)	0.001^a
Age at menarche (years)*	12 (10–14)	11 (11–13)	1.2 (0.4–1.8)	0.29^a
Duration of AUB (months)*	12 (6–18)	6 (4–12)	1.3 (0.3–1.2)	0.01^a
Endometrial thickness (mm)*	12 (9–16)	8 (6–10)	2.1 (1.4–2.45)	0.001^a
BMI (kg/m^2)*
<30	17 (60.7%)	385 (86.7%)	1.00	0.001^b
≥30	11 (39.3%)	59 (13.3%)	4.22 (1.88–9.45)
Parity
Multiparity	22 (82.2%)	376 (79%)	1.00	0.8^b
Nulliparity	6 (17%)	68 (21.15%)	2.11 (0.63–3.24)
Current hormonal therapy
No	22 (78.6%)	315 (70.9%)	1.00	0.3^b
Yes	6 (21.4%)	129 (29.1%)	0.9 (0.45–1.75)
Menstrual cycle regularity
Regular	8 (28.6%)	204 (45.9%)	1.00	0.08^b
Irregular	20 (71.4%)	240 (54.1%)	1.58 (0.78–3.21)
Duration of menstrual cycle
<7 days	7 (25%)	78 (25%)	1.00
7–14 days	14 (50%)	307 (69.1%)	0.55 (0.18–1.65)	0.07^c
>14 days	7 (25%)	59 (13.3%)	1.37 (0.58–3.25)
Intermenstrual bleeding
No	24 (85.7%)	390 (87.8%)	1.00	0.53^b
Yes	4 (14.3%)	54 (12.2%)	0.64 (0.28–1.48)
Frequency of menstrual cycle
More frequent (once in <21 days)	7 (25%)	78 (25%)	0.55 (0.18–1.65)
Normal frequency (once in 21–35 days)	14 (50%)	307 (69.1%)	1.00	0.08^c
Less frequent (once in >35 days)	7 (25%)	59 (13.3%)	1.37 (0.58–3.25)
Bleeding pattern*
Ovulatory bleeding	6 (21.4%)	235 (52.9%)	1.00	0.003^b
Anovulatory bleeding	22 (78.6%)	209 (47.1%)	4.12 (1.64–10.36)
Diabetes*
No	19 (67.9%)	402 (90.5%)	1.00	0.001^b
Yes	9 (32.1%)	42 (9.5%)	4.53 (1.92–10.65)
Hypertension
No	23 (82.6%)	337 (77.1%)	1.00	0.2^b
Yes	5 (21.4%)	106 (23.9%)	0.54 (0.19–1.57)
Family history of breast cancer*
No	26 (92.8%)	471 (99.8%)	1.00	0.001^b
Yes	2 (7.14%)	1 (0.2%)	2.111 (0.72–6.18)
Family history of colon cancer*
No	27 (97.5%)	444 (100%)	–	0.001^b
Yes	1 (3.5%)	0 (0)

Notes: Values are expressed as median and interquartile range (IQR). ^aTwo-sampled Wilcoxon rank sum test (Mann–Whitney U-test), ^bchi-squared test, ^cFisher’s exact test. Anovulatory bleeding includes irregular or infrequent cycles with prolonged bleeding (>7 days); ovulatory bleeding includes regular cycles with heavy bleeding. *Statistically significant findings.

Abbreviations: AUB, abnormal uterine bleeding; BMI, body mass index; OR, odds ratio; CI, confidence interval.

Table 2 Multivariate Regression Analysis Showing Clinical Characteristics for Prediction of AEH/EC

Variables	OR	95% CI	Criterion	p Value
Age	1.12	1.02–1.21	≥45 years	0.01
Anovulatory pattern of bleeding	3.4	1.27–8.94	–	0.009
BMI ≥30 kg/m^2	2.46	1.02–5.94		0.04
Diabetes = yes	3.00	1.28–7.61		0.02

Note: Using stepwise regression analysis, variables not included in the model: duration of AUB, endometrial thickness, family history of breast carcinoma, family history of colon cancer, which showed significant association in univariate analysis.

Abbreviations: OR, odds ratio; CI, confidence interval; BMI, body mass index.

Table 3 Sensitivity, Specificity, PPV, NPV, LR+, LR−, Pre- and Post-Test Probability for Each Score of Our Risk-Scoring Model

Cut-Off Score	Sensitivity (%)	Specificity (%)	PPV (%)	NPV (%)	LR+	LR−	Pre-Test Probability (%)	Post-Test Probability (%)
≥0	100	0	6	–	–	–	6	0
≥1	100	33.1	8.7	100	–	0	6	0
≥2	100	44.4	10.2	100	–	0	6	0
≥3	96.4	46.6	10.3	99.5	–	0.07	6	0.4
≥4	92.9	78.2	21.3	99.4	–	0.09	6	0.5
≥5	85.7	87.6	30.6	98.9	–	0.16	6	1.03
≥6	82.1	91.9	39.2	98.7	–	0.19	6	1.22
≥7	64.3	96.6	54.6	97.6	–	0.36	6	2.3
≥8	53.6	98.2	65.5	97.07	–	0.47	6	2.92
≥9	25	98.6	53.2	95.36	–	0.76	6	4.6
>9	0	100	–	94	–	1	6	6
–	–	–	–	–	–	–	––	–
≥0	100	0	6	–	1	–	6	6
≥1	100	33.1	8.7	100	1.49	–	6	8.7
≥2	100	44.4	10.2	100	1.79	–	6	10.2
≥3	96.4	46.6	10.3	99.5	1.80	–	6	10.3
≥4	92.9	78.2	21.3	99.4	4.26	–	6	21.3
≥5	85.7	87.6	30.6	98.9	6.91	–	6	30.6
≥6	82.1	91.9	39.2	98.7	10.13	–	6	39.2
≥7	64.3	96.6	54.6	97.6	18.91	–	6	54.6
≥8	53.6	98.2	65.5	97.07	29.77	–	6	65.5
≥9	25	98.6	53.2	95.36	17.85	–	6	53.2
>9	0	100	–	94	–	–	6	0

Note: Values highlighted in bold indicate the intersection of the sensitivity and specificity curves against the cut-off mentioned.

Figure 2 Receiver operating characteristics curve for the risk-scoring model PAD30, with an area under the curve (AUC) of 0.848 (95% CI 0.75–0.93; p<0.048).

Figure 3 Risk assessment pathway for management of premenopausal women with abnormal uterine bleeding.