Endometrial Cancer: Likelihood Ratios

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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Prevalence

Population / Calculator	Prevalence	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 likelihood ratios of findings for Endometrial Cancer are listed below. See the left navigation bar to change the display.

Pre-Test Probability (Prevalence): %.	Post-Test Probability (Predictive Value): %.	Switch to display mode.
Note that calculating probabilities from more than one** finding is inherently inaccurate because findings are not independent. (For example, using two positive findings that share a common pathogenesis is likely to overestimate the true probability.)

Good Positive and Negative Likelihood Ratios
Finding	Result	+LR	-LR
[ + ] Endometrial Biopsy	+ 0 -	49.8	0
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
[ + ] Trans-Vaginal Ultrasound	+ 0 -	7.3	0.1
Study: no study specified.
[ + ] Trans-Vaginal Ultrasound	+ 0 -	2	0.1
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

Good Negative Likelihood Ratio
Finding	Result	+LR	-LR
[ + ] Postmenopausal	+ 0 -	1.2	0.4
Study: Gynecol Oncol. 1995 Mar;56(3):376-81 PMID: 7705671

Poorly Diagnostic Findings
Finding	Result	+LR	-LR
[ + ] Vaginal Bleeding		Sensitivity = 90%
i.e. abnormal uterine bleeding Study: UpToDate http://www.utdol.com./online/content/topic.do?topicKey=gyne_onc/9015
[ + ] Dilatation and Curettage		Sensitivity = 89%
Hysteroscopically guided biopsies had greater sensitivity. Study: Acta Obstet Gynecol Scand 2001 Dec;80(12):1131-6. PMID 11846711
[ + ] ThinPrep Pap Smear		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		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		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

Good Positive Likelihood Ratio
Finding	Result	+LR	-LR
[ + ] Age	+ 0 -	8.2	0.8
>=70 years, in patients with abnormal vaginal bleeding Study: Gynecol Oncol. 1995 Mar;56(3):376-81 PMID: 7705671
[ + ] History of Estrogen Use	+ 0 -	3.9	0.9
Study: Gynecol Oncol. 1995 Mar;56(3):376-81 PMID: 7705671
[ + ] Diabetes	+ 0 -	2.6	0.9
Study: Gynecol Oncol. 1995 Mar;56(3):376-81 PMID: 7705671
[ + ] Nulliparity	+ 0 -	2.3	0.8
Study: Gynecol Oncol. 1995 Mar;56(3):376-81 PMID: 7705671