A predictive model for benign and malignant endometrial lesions in postmenopausal women based on clinical and ultrasound characteristics
Objective:To explore the clinical and ultrasound characteristics of benign and malignant endometrial lesions in postmenopausal women.Methods:A total of 430 patients with postmenopausal endometrial lesions treated in Obstetrics and Gynecology Hospital of Tongji University from June 2019 to February 2024 were retrospectively screened,340 patients of whom recruited from June 2019 to January 2023 served as the modeling group,and were divided into benign group(n=204)and malignant group(n=136)with pathological diagnosis as the gold standard.The differences in clinical and ultrasonographic characteristics between the two groups were analyzed and a prediction model was established.The model differentiation was assessed using the consistency index(C-index).Ninety patients recruited from February 2023 to February 2024 were used as the external validation group,and those were also divided into benign group(n=50)and malignant group(n=40).Results:Univariate analysis in the modeling group showed that,clinically,patients in the malignant group were older,had a higher percentage of BMI＞24 kg/m2,a higher incidence of hypertension and vaginal bleeding,and longer duration of menopause(P＜0.05).In terms of ultrasonographic signs,patients in the malignant group had a higher percentage of＞8 mm of endometrial thickness(ET),a lower percentage of homogeneous endometrial echogenicity,fewer cystic structure,a higher percentage of irregular or interrupted endometrio-myometrial junction,higher blood flow score,and higher proportion of multiple blood vessels supplying blood(P＜0.05).Multivariate analysis results showed that vaginal bleeding,＞8 mm of ET,cystic structure,irregular or interrupted endometrial-myometrial junction,blood supply score and blood supply pattern were independent influencing factors for the differentiation of the two groups(P＜0.05),and a regression model was established accordingly.The C-index of the model was 0.926(P＜0.05),and the sensitivity,specificity and accuracy of the model in predicting endometrial cancer were 91.42％,85.40％and 87.26％respectively.The C-index after model validation was 0.894,with 93.90％,75.00％and 83.30％of sensitivity,specificity and accuracy,respectively.Conclusions:The benign or malignant endometrial lesions of postmenopausal women have some ultrasound characteristics,and the multivariate analysis showed that vaginal bleeding,＞8 mm of ET,cystic structure,irregular or interrupted endometrio-myometrial junction,blood supply score and blood supply pattern can be used as the reliable indices to comprehensively judge the two kinds of lesions.The established prediction model has high diagnostic efficacy and good differentiation of external validation with certain clinical value.
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