{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T13:08:51Z","timestamp":1791896931708,"version":"4.3.4"},"reference-count":26,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,3,4]],"date-time":"2024-03-04T00:00:00Z","timestamp":1709510400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To assess the ability of the International Endometrial Tumor Analysis (IETA)\u20101 polynomial regression model to estimate the risk of endometrial cancer\u00a0(EC) and other intracavitary uterine pathology in women without abnormal uterine bleeding.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective study, in which we validated the IETA\u20101 model on the IETA\u20103 study cohort (<jats:italic>n<\/jats:italic>\u2009=\u20091745). The IETA\u20103 study is a prospective observational multicenter study. It includes women without vaginal bleeding who underwent a standardized transvaginal ultrasound examination in one of seven ultrasound centers between January 2011 and December 2018. The ultrasonography was performed either as part of a routine gynecological examination, during follow\u2010up of non\u2010endometrial pathology, in the work\u2010up before fertility treatment or before treatment for uterine prolapse or ovarian pathology. Ultrasonographic findings were described using IETA terminology and were compared with histology, or with results of clinical and ultrasound follow\u2010up of at least 1\u2009year if endometrial sampling was not performed. The IETA\u20101 model, which was created using data from patients with abnormal uterine bleeding, predicts four histological outcomes: (1) EC or endometrial intraepithelial neoplasia (EIN); (2) endometrial polyp or intracavitary myoma; (3)\u00a0proliferative or secretory endometrium, endometritis, or endometrial hyperplasia without atypia; and (4) endometrial atrophy. The predictors in the model are age, body mass index and seven ultrasound variables (visibility of the endometrium, endometrial thickness, color score, cysts in the endometrium, non\u2010uniform echogenicity of the endometrium, presence of a bright edge, presence of a single dominant vessel). We analyzed the discriminative ability of the model (area under the receiver\u2010operating\u2010characteristics curve (AUC); polytomous discrimination index (PDI)) and evaluated calibration of its risk estimates (observed\/expected ratio).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The median age of the women in the IETA\u20103 cohort was 51 (range, 20\u201385)\u2009years and 51% (887\/1745) of the women were postmenopausal. Histology showed EC or EIN in 29 (2%) women, endometrial polyps or intracavitary myomas in 1094 (63%), proliferative or secretory endometrium, endometritis, or hyperplasia without atypia in 144 (8%) and endometrial atrophy in 265 (15%) women. The endometrial sample had insufficient material in five (0.3%) cases. In 208 (12%) women who did not undergo endometrial sampling but were followed up for at least 1\u2009year without clinical or ultrasound signs of endometrial malignancy, the outcome was classified as benign. The IETA\u20101 model had an AUC of 0.81 (95% CI, 0.73\u20130.89, <jats:italic>n<\/jats:italic>\u2009=\u20091745) for discrimination between malignant (EC or EIN) and benign endometrium, and the observed\/expected ratio for EC or EIN was 0.51 (95% CI, 0.32\u20130.82). The model was able to categorize the four histological outcomes with considerable accuracy: the PDI of the model was 0.68 (95% CI, 0.62\u20130.73) (<jats:italic>n<\/jats:italic>\u2009=\u20091532). The IETA\u20101 model discriminated very well between endometrial atrophy and all other intracavitary uterine conditions, with an AUC of 0.96 (95% CI, 0.95\u20130.98). Including only patients in whom the endometrium was measurable (<jats:italic>n<\/jats:italic>\u2009=\u20091689), the model's AUC was 0.83 (95% CI, 0.75\u20130.91), compared with 0.62 (95% CI, 0.52\u20130.73) when using endometrial thickness alone to predict malignancy (difference in AUC, 0.21; 95% CI, 0.08\u20130.32). In postmenopausal women with measurable endometrial thickness (<jats:italic>n<\/jats:italic>\u2009=\u2009848), the IETA\u20101 model gave an AUC of 0.81 (95% CI, 0.71\u20130.91), while endometrial thickness alone gave an AUC of 0.70 (95% CI, 0.60\u20130.81) (difference in AUC, 0.11; 95% CI, 0.01\u20130.20).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The IETA\u20101 model discriminates well between benign and malignant conditions in the uterine cavity in patients without abnormal bleeding, but it overestimates the risk of malignancy. It also discriminates well between the four histological outcome categories. \u00a9 2023 International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.27530","type":"journal-article","created":{"date-parts":[[2023,11,6]],"date-time":"2023-11-06T06:17:24Z","timestamp":1699251444000},"page":"556-563","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Estimating risk of endometrial malignancy and other intracavitary uterine pathology in women without abnormal uterine bleeding using <scp>IETA<\/scp>\u20101 multinomial regression model: validation study"],"prefix":"10.1002","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4945-8867","authenticated-orcid":false,"given":"R.","family":"Heremans","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology University Hospitals Leuven  Leuven Belgium"},{"name":"Department of Development and Regeneration KU Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3037-122X","authenticated-orcid":false,"given":"L.","family":"Wynants","sequence":"additional","affiliation":[{"name":"Department of Development and Regeneration KU Leuven  Leuven Belgium"},{"name":"Department of Epidemiology, CAPHRI Care and Public Health Research Institute Maastricht University  Maastricht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3830-6414","authenticated-orcid":false,"given":"L.","family":"Valentin","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Sk\u00e5ne University Hospital Malm\u00f6 and Department of Clinical Sciences Malm\u00f6 Lund University  Malm\u00f6 Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3839-6779","authenticated-orcid":false,"given":"F. P. G.","family":"Leone","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Clinical Sciences Institute Luigi Sacco  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5095-6981","authenticated-orcid":false,"given":"M. A.","family":"Pascual","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproduction Hospital Universitario Dexeus  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5688-2194","authenticated-orcid":false,"given":"R.","family":"Fruscio","sequence":"additional","affiliation":[{"name":"UOC Gynecology, Department of Medicine and Surgery University of Milan\u2010Bicocca, Fondazione IRCCS San Gerardo dei Tontori  Monza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2217-8726","authenticated-orcid":false,"given":"A. C.","family":"Testa","sequence":"additional","affiliation":[{"name":"Dipartimento Scienze della Salute della Donna, del Bambino e di Sanit\u00e0 Pubblica Fondazione Policlinico Universitatio A Gemelli, IRCCS  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6587-2622","authenticated-orcid":false,"given":"F.","family":"Buonomo","sequence":"additional","affiliation":[{"name":"Institute for Maternal and Child Health, IRCCS Burlo Garofolo  Trieste Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1359-7155","authenticated-orcid":false,"given":"S.","family":"Guerriero","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Cagliari, Policlinico Universitario Duilio Casula  Monserrato, Cagliari Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2298-7785","authenticated-orcid":false,"given":"E.","family":"Epstein","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education, Karolinska Institutet, and Department of Obstetrics and Gynecology S\u00f6dersjukhuset  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1421-6059","authenticated-orcid":false,"given":"T.","family":"Bourne","sequence":"additional","affiliation":[{"name":"Department of Development and Regeneration KU Leuven  Leuven Belgium"},{"name":"Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital Imperial College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3707-6645","authenticated-orcid":false,"given":"D.","family":"Timmerman","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University Hospitals Leuven  Leuven Belgium"},{"name":"Department of Development and Regeneration KU Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6777-5036","authenticated-orcid":false,"given":"T.","family":"Van den Bosch","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University Hospitals Leuven  Leuven Belgium"},{"name":"Department of Development and Regeneration KU Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the IETA Consortium","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,3,4]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.27.6.1491"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.21106\/ijma.294"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.24910"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.22109"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.7487"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.4104"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1159\/000522524"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.2196\/medinform.3251"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-019-1466-7"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g7594"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.1704"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/jcu.22631"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-018-4885-3"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.5468\/ogs.2019.62.4.273"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2001.111088"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2014.03.025"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2015.07.023"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1080\/09513590.2020.1843621"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2022.07.043"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(10)70268-0"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.12306"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-016-4054-5"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2023.03.012"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0959-8049(00)00356-7"},{"issue":"181","key":"e_1_2_8_26_1","first-page":"e1","article-title":"Is there a survival advantage in diagnosing endometrial cancer in asymptomatic postmenopausal patients? 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