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Predicting Pre-Malignant and Malignant Endometrial Conditions Among Postmenopausal Filipino Women Based on Ultrasound Measurement of Ovarian Volume

Cheryl T. Tiuseco, MD; Nephtali M. Gorgonio, MD, FPOGS
Department of Obstetrics and Gynecology, Cardinal Santos Medical Center

Backgound: Clinical studies showed a correlation between postmenopausal women with large ovaries and endometrial cancer. Considering the different average ovarian volumes among various races, it is prudent to identify the most valid ovarian volume among symptomatic menopausal women in our population and classify their probability of having a benign or malignant endometrium.

Objective: To determine the relation of ovarian volume measurements using a reference value generated by an ROC curve with endometrial tissue biopsy diagnosis of pre-malignant and malignant endometrium among Filipino postmenopausal women.

Methodology: Fifty menopausal women with vaginal bleeding were included in a six-year review from January 2008 to December 2013. All had transvaginal ultrasonography and underwent endometrial sampling. A receiver operating characteristic (ROC) curve was generated and the most valid ovarian volume was obtained. The ROC curve – generated ovarian volume was used as the cut-off value and was correlated with histopathologic diagnoses.

Results: Among the fifty patients, 30 with benign endometrium had an ovarian volume of <3.51 ml, and 10 patients had an ovarian volume of > 3.51 ml. Among the 10 patients with malignant endometrium, 9 had an ovarian volume of > 3.51 ml, and one had an ovarian volume of < 3.51 ml. The sensitivity of predicting endometrial cancer using ovarian volume of > 3.51 ml as cut-off is 90% (95% CI 55.46 % to 98.34%), while the specificity is 75% (95% CI of 58.80% to 87.29%). Using the chi-square test, it showed a significant association between ovarian volume of > 3.51 ml and malignant endometrium (P=0.0001).

Conclusion: The ROC curve-generated cut-off value of > 3.51 ml for Filipino postmenopausal women may serve as a useful diagnostic tool for classifying patients with pre-malignant and malignant endometrial conditions.