Cargando…

Risk of Pre-Malignancy or Malignancy in Postmenopausal Endometrial Polyps: A CHAID Decision Tree Analysis

Background and aims: Postmenopausal endometrial polyps are commonly managed by surgical resection; however, expectant management may be considered for some women due to the presence of medical co-morbidities, failed hysteroscopies or patient’s preference. This study aimed to identify patient charact...

Descripción completa

Detalles Bibliográficos
Autores principales: Wong, Michael, Thanatsis, Nikolaos, Nardelli, Federica, Amin, Tejal, Jurkovic, Davor
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8232598/
https://www.ncbi.nlm.nih.gov/pubmed/34203810
http://dx.doi.org/10.3390/diagnostics11061094
_version_ 1783713668824825856
author Wong, Michael
Thanatsis, Nikolaos
Nardelli, Federica
Amin, Tejal
Jurkovic, Davor
author_facet Wong, Michael
Thanatsis, Nikolaos
Nardelli, Federica
Amin, Tejal
Jurkovic, Davor
author_sort Wong, Michael
collection PubMed
description Background and aims: Postmenopausal endometrial polyps are commonly managed by surgical resection; however, expectant management may be considered for some women due to the presence of medical co-morbidities, failed hysteroscopies or patient’s preference. This study aimed to identify patient characteristics and ultrasound morphological features of polyps that could aid in the prediction of underlying pre-malignancy or malignancy in postmenopausal polyps. Methods: Women with consecutive postmenopausal polyps diagnosed on ultrasound and removed surgically were recruited between October 2015 to October 2018 prospectively. Polyps were defined on ultrasound as focal lesions with a regular outline, surrounded by normal endometrium. On Doppler examination, there was either a single feeder vessel or no detectable vascularity. Polyps were classified histologically as benign (including hyperplasia without atypia), pre-malignant (atypical hyperplasia), or malignant. A Chi-squared automatic interaction detection (CHAID) decision tree analysis was performed with a range of demographic, clinical, and ultrasound variables as independent, and the presence of pre-malignancy or malignancy in polyps as dependent variables. A 10-fold cross-validation method was used to estimate the model’s misclassification risk. Results: There were 240 women included, 181 of whom presented with postmenopausal bleeding. Their median age was 60 (range of 45–94); 18/240 (7.5%) women were diagnosed with pre-malignant or malignant polyps. In our decision tree model, the polyp mean diameter (≤13 mm or >13 mm) on ultrasound was the most important predictor of pre-malignancy or malignancy. If the tree was allowed to grow, the patient’s body mass index (BMI) and cystic/solid appearance of the polyp classified women further into low-risk (≤5%), intermediate-risk (>5%–≤20%), or high-risk (>20%) groups. Conclusions: Our decision tree model may serve as a guide to counsel women on the benefits and risks of surgery for postmenopausal endometrial polyps. It may also assist clinicians in prioritizing women for surgery according to their risk of malignancy.
format Online
Article
Text
id pubmed-8232598
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-82325982021-06-26 Risk of Pre-Malignancy or Malignancy in Postmenopausal Endometrial Polyps: A CHAID Decision Tree Analysis Wong, Michael Thanatsis, Nikolaos Nardelli, Federica Amin, Tejal Jurkovic, Davor Diagnostics (Basel) Article Background and aims: Postmenopausal endometrial polyps are commonly managed by surgical resection; however, expectant management may be considered for some women due to the presence of medical co-morbidities, failed hysteroscopies or patient’s preference. This study aimed to identify patient characteristics and ultrasound morphological features of polyps that could aid in the prediction of underlying pre-malignancy or malignancy in postmenopausal polyps. Methods: Women with consecutive postmenopausal polyps diagnosed on ultrasound and removed surgically were recruited between October 2015 to October 2018 prospectively. Polyps were defined on ultrasound as focal lesions with a regular outline, surrounded by normal endometrium. On Doppler examination, there was either a single feeder vessel or no detectable vascularity. Polyps were classified histologically as benign (including hyperplasia without atypia), pre-malignant (atypical hyperplasia), or malignant. A Chi-squared automatic interaction detection (CHAID) decision tree analysis was performed with a range of demographic, clinical, and ultrasound variables as independent, and the presence of pre-malignancy or malignancy in polyps as dependent variables. A 10-fold cross-validation method was used to estimate the model’s misclassification risk. Results: There were 240 women included, 181 of whom presented with postmenopausal bleeding. Their median age was 60 (range of 45–94); 18/240 (7.5%) women were diagnosed with pre-malignant or malignant polyps. In our decision tree model, the polyp mean diameter (≤13 mm or >13 mm) on ultrasound was the most important predictor of pre-malignancy or malignancy. If the tree was allowed to grow, the patient’s body mass index (BMI) and cystic/solid appearance of the polyp classified women further into low-risk (≤5%), intermediate-risk (>5%–≤20%), or high-risk (>20%) groups. Conclusions: Our decision tree model may serve as a guide to counsel women on the benefits and risks of surgery for postmenopausal endometrial polyps. It may also assist clinicians in prioritizing women for surgery according to their risk of malignancy. MDPI 2021-06-15 /pmc/articles/PMC8232598/ /pubmed/34203810 http://dx.doi.org/10.3390/diagnostics11061094 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Wong, Michael
Thanatsis, Nikolaos
Nardelli, Federica
Amin, Tejal
Jurkovic, Davor
Risk of Pre-Malignancy or Malignancy in Postmenopausal Endometrial Polyps: A CHAID Decision Tree Analysis
title Risk of Pre-Malignancy or Malignancy in Postmenopausal Endometrial Polyps: A CHAID Decision Tree Analysis
title_full Risk of Pre-Malignancy or Malignancy in Postmenopausal Endometrial Polyps: A CHAID Decision Tree Analysis
title_fullStr Risk of Pre-Malignancy or Malignancy in Postmenopausal Endometrial Polyps: A CHAID Decision Tree Analysis
title_full_unstemmed Risk of Pre-Malignancy or Malignancy in Postmenopausal Endometrial Polyps: A CHAID Decision Tree Analysis
title_short Risk of Pre-Malignancy or Malignancy in Postmenopausal Endometrial Polyps: A CHAID Decision Tree Analysis
title_sort risk of pre-malignancy or malignancy in postmenopausal endometrial polyps: a chaid decision tree analysis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8232598/
https://www.ncbi.nlm.nih.gov/pubmed/34203810
http://dx.doi.org/10.3390/diagnostics11061094
work_keys_str_mv AT wongmichael riskofpremalignancyormalignancyinpostmenopausalendometrialpolypsachaiddecisiontreeanalysis
AT thanatsisnikolaos riskofpremalignancyormalignancyinpostmenopausalendometrialpolypsachaiddecisiontreeanalysis
AT nardellifederica riskofpremalignancyormalignancyinpostmenopausalendometrialpolypsachaiddecisiontreeanalysis
AT amintejal riskofpremalignancyormalignancyinpostmenopausalendometrialpolypsachaiddecisiontreeanalysis
AT jurkovicdavor riskofpremalignancyormalignancyinpostmenopausalendometrialpolypsachaiddecisiontreeanalysis