Risk Assessment of Endometrial Hyperplasia and Endometrial Cancer

Endometrial Cancer Clinical Trial

Official title:

Risk Assessment of Endometrial Hyperplasia and Endometrial Cancer: Development and Validation of Clinical-ultrasound Based Scoring System(A Cross Sectional -Validation Study)

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT04995731
• Other study ID #: AssiutNT
• Status: Recruiting
• Start date: September 1, 2021
• Est. completion date: July 2024

Study information

• Verified date: August 2022
• Source: Assiut University
• Contact: Norhan T Sayed, Masters
• Phone: +201032747426
• Email: norhantareq[@]yahoo.com
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

Abnormal uterine bleeding (AUB) represents common diagnostic challenge in everyday gynecological practice. However, abnormal bleeding is a common symptom of many benign diseases and only indicates the presence of EC in 9% of postmenopausal women and 1% to 2% of premenopausal women, suggesting that many women at low risk undergo unnecessary invasive procedures to rule out cancer. The aim of the study is to create a risk-scoring model of endometrial hyperplasia and endometrial cancer.

Description:

Approximately 90% of endometrial cancer (EC) cases are preceded by AUB in premenopausal or perimenopausal women or post-menopausal bleeding (PMB).Transvaginal ultrasonography(TVS) has become the first step diagnostic tool of AUB. The main advantage of ultrasound imaging is that it has high accuracy for the preoperative classification of intra and extra uterine lesions, both benign and malignant. If increased endometrial thickness (ET) is found in women with PMB, the risk of EC increases. However, in women with type II EC, ET below 3-4 mm might also be found. Because of these limitations, ET should not be the only factor for cancer risk estimation in women with AUB.

Three-dimensional sonography and blood flow vascular indices improve the diagnostic precision of the sonographic estimation of endometrial lesions. Several scoring systems using different ultrasound image characteristics were proposed to estimate the risk of EC in women with AUB including the recently proposed system" Risk of Endometrial Cancer scoring model "(REC).

Existing guidelines recommend considering clinical risk factors such as BMI, age, obesity, type II diabetes, polycystic ovary syndrome(PCOS) and use of unopposed estrogen when evaluating AUB. However, only few clinical risk prediction models have been developed.

Despite the important role of ultrasound imaging in assessment of endometrial lesions, one wonders if clinical variables can improve the diagnostic performance of risk prediction models.

The aim of the study is to create a risk-scoring model of endometrial hyperplasia and endometrial cancer using patient clinical characteristics and ultrasound image characteristics among women with abnormal uterine bleeding, and to validate the diagnostic performance of our model and to compare it's predictive value with the recently proposed REC score for EC risk stratification.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 328
• Est. completion date: July 2024
• Est. primary completion date: July 2023
• Accepts healthy volunteers: No
• Gender: Female
• Age group: 40 Years and older

Eligibility

Inclusion Criteria:

women =40 years with pre- or perimenopausal AUB or PMB presenting to Women's Health Hospital, Department of Obstetrics and Gynecology, Faculty of medicine, Assiut University, Assiut, Egypt.

Exclusion Criteria:

• Women with a vaginal bleeding arising from a cervical, vaginal or vulvar disease.

• Patients with cervical cancer or uterine metastases.

• History of prior hysterectomy, prior pelvic radiation, endometrial sampling within the past 3 months.

• Presence of existing pregnancy.

• Women with inadequate endometrial sampling or with no histopathological diagnosis.

Related Conditions & MeSH terms

• Endometrial Cancer
• Endometrial Hyperplasia
• Endometrial Neoplasms
• Hyperplasia

Intervention

Behavioral:
• Information about clinical risk factors for endometrial cancer and endometrial hyperplasia (EH)
Bleeding type, age, race, parity, early menarche or late menopause, body mass index, body composition, hypertension, type II diabetes, anovulation, polycystic ovary syndrome and smoking history. Other epidemiologic risk factors including tamoxifen exposure, history of breast cancer, current hormone therapy use, anticoagulant use, oral contraception use, family history of endometrial, breast or colon cancer.

Procedure:
• transvaginal ultrasound examination
All patients will undergo a standard transvaginal ultrasound examination followed by power Doppler endometrial vascularity assessment. After ultrasound examination, all patients will undergo endometrial sampling either through hysteroscopy or dilatation and curettage operation (D, C) or will have histopathological evaluation of biopsy specimens obtained by hysterectomy. Histopathological evaluation will serve as a gold standard for the ?nal diagnosis.

Locations

Country	Name	City	State
Egypt	Assiut University	Assiut

Sponsors (1)

Lead Sponsor	Collaborator
Assiut University

Country where clinical trial is conducted

Egypt, 

References & Publications (9)

Burbos N, Musonda P, Duncan TJ, Crocker SG, Morris EP, Nieto JJ. Estimating the risk of endometrial cancer in symptomatic postmenopausal women: a novel clinical prediction model based on patients' characteristics. Int J Gynecol Cancer. 2011 Apr;21(3):500-6. doi: 10.1097/IGC.0b013e31820c4cd6. — View Citation

Clarke MA, Long BJ, Del Mar Morillo A, Arbyn M, Bakkum-Gamez JN, Wentzensen N. Association of Endometrial Cancer Risk With Postmenopausal Bleeding in Women: A Systematic Review and Meta-analysis. JAMA Intern Med. 2018 Sep 1;178(9):1210-1222. doi: 10.1001/jamainternmed.2018.2820. — View Citation

Du J, Li Y, Lv S, Wang Q, Sun C, Dong X, He M, Ulain Q, Yuan Y, Tuo X, Batchu N, Song Q, Li Q. Endometrial sampling devices for early diagnosis of endometrial lesions. J Cancer Res Clin Oncol. 2016 Dec;142(12):2515-2522. Epub 2016 Aug 11. Review. — View Citation

Dueholm M, Hjorth IM. Structured imaging technique in the gynecologic office for the diagnosis of abnormal uterine bleeding. Best Pract Res Clin Obstet Gynaecol. 2017 Apr;40:23-43. doi: 10.1016/j.bpobgyn.2016.09.010. Epub 2016 Oct 1. Review. — View Citation

Dueholm M, Hjorth IMD, Dahl K, Pedersen LK, Ørtoft G. Identification of endometrial cancers and atypical hyperplasia: Development and validation of a simplified system for ultrasound scoring of endometrial pattern. Maturitas. 2019 May;123:15-24. doi: 10.1016/j.maturitas.2019.01.017. Epub 2019 Feb 1. — View Citation

Gull B, Karlsson B, Milsom I, Granberg S. Can ultrasound replace dilation and curettage? A longitudinal evaluation of postmenopausal bleeding and transvaginal sonographic measurement of the endometrium as predictors of endometrial cancer. Am J Obstet Gynecol. 2003 Feb;188(2):401-8. — View Citation

Matteson KA, Robison K, Jacoby VL. Opportunities for Early Detection of Endometrial Cancer in Women With Postmenopausal Bleeding. JAMA Intern Med. 2018 Sep 1;178(9):1222-1223. doi: 10.1001/jamainternmed.2018.2819. — View Citation

Pennant ME, Mehta R, Moody P, Hackett G, Prentice A, Sharp SJ, Lakshman R. Premenopausal abnormal uterine bleeding and risk of endometrial cancer. BJOG. 2017 Feb;124(3):404-411. doi: 10.1111/1471-0528.14385. Epub 2016 Oct 20. Review. — View Citation

Szubert S, Szpurek D, Wójtowicz A, Zywica P, Stukan M, Sajdak S, Jablonski S, Wicherek L, Moszynski R. Performance of Selected Models for Predicting Malignancy in Ovarian Tumors in Relation to the Degree of Diagnostic Uncertainty by Subjective Assessment With Ultrasound. J Ultrasound Med. 2020 May;39(5):939-947. doi: 10.1002/jum.15178. Epub 2019 Nov 29. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	prevalence of endometrial cancer, endometrial hyperplasia	Magnitude and prevalence of endometrial cancer, endometrial hyperplasia using a practical clinical-ultrasound based scoring system.	3 years
Secondary	prevalence of endometrial benign lesions	calculate absolute risks (prevalent risk) of endometrial benign lesions.	3 years