Age-associated with endometrial intraepithelial neoplasia and endometrial carcinoma in patients with abnormal uterine bleeding
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Abstract
Objective: To determine the age cut-off for endometrial biopsy in women with abnormal uterine bleeding to detect endometrial intraepithelial neoplasia and endometrial carcinoma in patients with abnormal uterine bleeding.
Methods: A total of 1384 women presenting with abnormal uterine bleeding underwent endometrial biopsy at Maharat Nakhon Ratchasima Hospital between July 1, 2021, and June 30, 2023. This retrospective cohort study collected age and other risk factors of endometrial intraepithelial neoplasia and endometrial carcinoma, then calculated sensitivity, specificity, negative likelihood ratio, area under the curve(AUC) of each age cut-off and conducted multivariable logistic regression.
Results: The age group ≥45 years showed a moderate impact negative likelihood ratio (0.14, 95% CI 0.07 - 0.31) and higher area under the curve (0.91) compared to other age groups, with a sensitivity of 94.17% and a specificity of 41.06%. The risk factors including age ≥45 years, nulliparity, menopause status, diabetes mellitus, polycystic ovarian syndrome, endometrial thickness of 4 and 7mm or thicker were significantly associated with endometrial intraepithelial neoplasia and endometrial carcinoma.
Conclusion: Consider endometrial biopsy for screening of endometrial intraepithelial neoplasia and endometrial carcinoma in women aged 45 or older with abnormal uterine bleeding or those under 45 with risk factors such as nulliparity, diabetes mellitus, menopausal status, polycystic ovarian syndrome, and endometrial thickness of 4 and 7 mm or thicker.
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