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.

Good Positive and Negative Likelihood Ratios

Finding	+LR	-LR	Comments, Study
Endometrial Biopsy	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 Duplicate	7.3	0.1	Study: no study specified.
Trans-Vaginal Ultrasound Duplicate	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

Postmenopausal

1.2

0.4

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

Good Positive Likelihood Ratio

Finding	+LR	-LR	Comments, Study
Age	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	3.9	0.9	Study: Gynecol Oncol. 1995 Mar;56(3):376-81 PMID: 7705671
Diabetes	2.6	0.9	Study: Gynecol Oncol. 1995 Mar;56(3):376-81 PMID: 7705671
Nulliparity	2.3	0.8	Study: Gynecol Oncol. 1995 Mar;56(3):376-81 PMID: 7705671

Poorly Diagnostic Findings

Finding	+LR	-LR	Comments, Study
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