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Author response to: Improving the existing diagnostic strategy by accounting for characteristics of the women in the diagnostic work up for postmenopausal bleeding
Author(s) -
Opmeer BC,
Van Doorn HC,
Heintz APM,
Burger CW,
Bossuyt PMM,
Mol BWJ
Publication year - 2007
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.2007.01305.x
Subject(s) - erasmus+ , obstetrics and gynaecology , biostatistics , medicine , obstetrics , epidemiology , family medicine , medical education , pregnancy , history , genetics , the renaissance , biology , art history
OBJECTIVESThe aim of this study was to evaluate whether the efficiency of the current diagnostic work up following postmenopausal bleeding could be improved by diagnostic strategies that take into account characteristics of the women in addition to the currently recommended transvaginal measurement of endometrial thickness to determine for subsequent histological assessment.DESIGNMulticenter, prospective cohort study.SETTINGA university hospital and seven teaching hospitals in the Netherlands.SAMPLEConsecutive women not using hormone replacement therapy, presenting with postmenopausal bleeding.METHODSFive hundred and forty women underwent transvaginal sonography, and in case of endometrial thickness (double layer) above 4 mm, subsequent endometrial sampling was performed. Presence of carcinoma was ruled out by the absence of abnormalities in histological specimen or by an uneventful follow up of at least 6 months.MAIN OUTCOME MEASURESProbability of endometrial carcinoma was estimated by multivariable logistic regression models. For each diagnostic strategy, we calculated diagnostic accuracy (area under receiver operating characteristic curve [AUC]), negative predictive value (NPV) and the number of diagnostic procedures.RESULTSA strategy with transvaginal sonography alone with a fixed threshold incorrectly classified 0.7% of the women as nonmalignant (NPV: 99.3% [98.5-100%]), with 97% sensitivity and 56% specificity. A strategy integrating characteristics of the women with transvaginal sonography could result in less false reassurances (NPV: 99.6% [99.2-100%]), with only marginal decrease in diagnostic procedures, or a minor increase in false reassurances (NPV: 99.0% [98.3-100%]), with a substantial reduction (15-20%) in the procedures. AUCs associated with these strategies could improve from 0.76 (0.73-0.79) for transvaginal sonography alone to 0.90 (0.87-0.93) for the integrated strategy.CONCLUSIONTaking into account the characteristics of the women could increase the efficiency of the diagnostic work up for postmenopausal bleeding.