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Endometrial Cancer: Sensitivity and Specificity

Introduction: Adenocarcinoma of the endometrium occurs generally in 2 types, with type I being the most common, hormone-sensitive, and having a better prognosis. Overall, ~70% of patients present in Stage I because of abnormal uterine bleeding.

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Tags: Gynecologic Neoplasm Tag this Diagnosis.

Prevalence

Population / CalculatorPrevalence Comments / Study / Link
Postmenopausal Women with Abnormal Uterine Bleeding 12% "5-20%". From UpToDate (http://www.utdol.com/online/content/topic.do?topicKey=gyne_onc/9015)
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The sensitivity and specificity of findings for Endometrial Cancer are listed below. See the left navigation bar to change the display.

Sensitive and Specific Findings

Finding SensitivitySpecificity Comments, Study
Endometrial Biopsy Edit 99.6%98%

In postmenopausal women. Using the Pipelle device, which has been shown to be the best. Sensitivity in premenopausal women is lower at 91%.

Study: Cancer 2000 Oct 15;89(8):1765-72. PMID 11042572

Specific Findings

Finding SensitivitySpecificity Comments, Study
Age Edit 26.9%96.7%

>=70 years, in patients with abnormal vaginal bleeding

Study: Gynecol Oncol. 1995 Mar;56(3):376-81 PMID: 7705671

History of Estrogen Use Edit 15.4%96%

Study: Gynecol Oncol. 1995 Mar;56(3):376-81 PMID: 7705671

Diabetes Edit 15.4%94%

Study: Gynecol Oncol. 1995 Mar;56(3):376-81 PMID: 7705671

Nulliparity Edit 28.8%87.4%

Study: Gynecol Oncol. 1995 Mar;56(3):376-81 PMID: 7705671

Sensitive Findings

Finding SensitivitySpecificity Comments, Study
Trans-Vaginal Ultrasound Edit 95.9%51.1%

Endometrial thickness >4mm. As thickness increases (especially >15-20mm) the likelihood of cancer increases. (Note that this is in postmenopausal women).

Study: Acta Obstet Gynecol Scand 2002 Sep;81(9):799-816. PMID 12225294

Postmenopausal Edit 90.4%25.2%

Study: Gynecol Oncol. 1995 Mar;56(3):376-81 PMID: 7705671

Vaginal Bleeding Edit Sensitivity = 90%

i.e. abnormal uterine bleeding

Study: UpToDate http://www.utdol.com./online/content/topic.do?topicKey=gyne_onc/9015

Dilatation and Curettage Edit Sensitivity = 89%

Hysteroscopically guided biopsies had greater sensitivity.

Study: Acta Obstet Gynecol Scand 2001 Dec;80(12):1131-6. PMID 11846711

Poorly Diagnostic Findings

Finding SensitivitySpecificity Comments, Study
ThinPrep Pap Smear Edit Sensitivity = 65%

Specificity, stage not specified. Sensitivity of traditional Pap smear was 39% in this study.

Study: Cancer. 2002 Dec 25;96(6):338-43. PMID 12478681

Hysteroscopy Edit Sensitivity = 65%

Alone, without biopsies.

Study: UpToDate article does not specify a reference for this study.

http://www.utdol.com/online/content/topic.do?topicKey=gen_gyne/27128

Traditional Pap Smear Edit Sensitivity = 48%

For Stage I. No specificity provided. Sensitivity increases to 86% for stages II+.

Study: Acta Cytol. 2001 Jul-Aug;45(4):555-60. PMID 11480718