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@article{Eriksson:2020:10.1002/uog.21950,
author = {Eriksson, LSE and Epstein, E and Testa, AC and Fischerova, D and Valentin, L and Sladkevicius, P and Franchi, D and Frühauf, F and Fruscio, R and Haak, LA and Opolskiene, G and Mascilini, F and Alcazar, JL and Van, Holsbeke C and Chiappa, V and Bourne, T and Lindqvist, PG and Van, Calster B and Timmerman, D and Verbakel, JY and Van, den Bosch T and Wynants, L},
doi = {10.1002/uog.21950},
journal = {Ultrasound in Obstetrics and Gynecology},
pages = {443--452},
title = {An ultrasound-based risk model to predict lymph node metastases before surgery in women with endometrial cancer: a model development study.},
url = {http://dx.doi.org/10.1002/uog.21950},
volume = {56},
year = {2020}
}

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TY  - JOUR
AB  - OBJECTIVES: To develop a pre-operative risk model using endometrial biopsy results, clinical and ultrasound variables to predict the individual risk of lymph node metastases in women with endometrial cancer. METHODS: A mixed effects logistic regression model was developed on 1501 prospectively included women with endometrial cancer subjected to transvaginal ultrasound examination before surgery. Missing data, including missing lymph node status, was imputed. Discrimination, calibration and clinical utility were evaluated using leave-center-out cross-validation. The predictive performance was compared with risk classification from endometrial biopsy alone (high-risk = endometrioid cancer grade 3/non-endometrioid cancer) or combined endometrial biopsy and ultrasound (high-risk = endometrioid cancer grade 3/non-endometrioid cancer/deep myometrial invasion/cervical stromal invasion/extrauterine spread). RESULTS: Lymphadenectomy was performed in 691 women, of which 127 had lymph node metastases. The model included the predictors age, duration of abnormal bleeding, endometrial biopsy result, tumor extension and tumor size according to ultrasound and "undefined tumor with an unmeasurable endometrium". The model's AUC was 0.73 (95% CI 0.68 to 0.78), calibration slope 1.06 (95% CI 0.79 to 1.34) and calibration intercept 0.06 (95% CI 0.15 to 0.27). Using risk thresholds for lymph node metastases 5% vs. 20% the model had sensitivity 98% vs. 48% and specificity 11% vs. 80%. The model had higher sensitivity and specificity than high-risk according to endometrial biopsy alone (50% vs. 35% and 80% vs. 77%) or combined endometrial biopsy and ultrasound (80% vs. 75% and 53% vs. 52%). The model's clinical utility was higher than that of endometrial biopsy alone or combined endometrial biopsy and ultrasound at any given risk threshold. CONCLUSIONS: Based on endometrial biopsy results, clinical and ultrasound characteristics, the individual risk of lymph node metastases in wo
AU  - Eriksson,LSE
AU  - Epstein,E
AU  - Testa,AC
AU  - Fischerova,D
AU  - Valentin,L
AU  - Sladkevicius,P
AU  - Franchi,D
AU  - Frühauf,F
AU  - Fruscio,R
AU  - Haak,LA
AU  - Opolskiene,G
AU  - Mascilini,F
AU  - Alcazar,JL
AU  - Van,Holsbeke C
AU  - Chiappa,V
AU  - Bourne,T
AU  - Lindqvist,PG
AU  - Van,Calster B
AU  - Timmerman,D
AU  - Verbakel,JY
AU  - Van,den Bosch T
AU  - Wynants,L
DO  - 10.1002/uog.21950
EP  - 452
PY  - 2020///
SN  - 0960-7692
SP  - 443
TI  - An ultrasound-based risk model to predict lymph node metastases before surgery in women with endometrial cancer: a model development study.
T2  - Ultrasound in Obstetrics and Gynecology
UR  - http://dx.doi.org/10.1002/uog.21950
UR  - https://www.ncbi.nlm.nih.gov/pubmed/31840873
UR  - http://hdl.handle.net/10044/1/76397
VL  - 56
ER  -

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