{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T10:09:37Z","timestamp":1784887777966,"version":"3.55.0"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T00:00:00Z","timestamp":1764892800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Endometrial atypical hyperplasia (EAH) and endometrial cancer (EC) are increasingly detected in asymptomatic postmenopausal women. This often leads to delayed treatment. Risk stratification remains challenging, and single-factor models may not accurately identify high-risk individuals. This study aimed to develop and validate a multivariable prediction model for identifying EAH or EC in asymptomatic postmenopausal women.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study included asymptomatic postmenopausal women with endometrial pathology records from the Third Affiliated Hospital of Sun Yat-sen University, China (2021\u20132024). Candidate risk factors included demographics, clinical characteristics, and hematological parameters. The primary outcome was a composite of histologically-confirmed EAH or EC. Multivariable Poisson regression with robust variance was then employed to identify independent risk factors for this composite outcome. Risk - stratified models were developed by calculating predicted probabilities for key combinations of risk factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 928 patients [median age: 59 years, IQR (interquartile range): 55\u201365; median BMI: 23.4 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ], the overall prevalence of EAH and EC was 2.59% (24\/928). Key independent risk factors included endometrial thickness (EMT) &amp;gt; 8 mm [vs. \u2264 4 mm: adjusted Relative Risks (aRR) = 11.34, 95% confidence interval (95% CI): 4.35\u201339.56;\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001], diabetes (aRR = 2.54, 95% CI: 1.12\u20135.78;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.026), and platelet count per 10\n                      <jats:sup>9<\/jats:sup>\n                      \/L increase (aRR = 1.01, 95% CI: 1.01\u20131.02;\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001). EMT &amp;gt; 8 mm was the strongest predictor, with the highest aRR. In the stratified analysis, the combination of EMT &amp;gt; 8 mm and diabetes was associated with the highest observed prevalence (33.33%). The risk-stratified model demonstrated clinical utility: using a \u2265 5% risk threshold, biopsy would be recommended for 17% of patients (sensitivity 70.8%, specificity 84.4%); at a \u2265 10% threshold, biopsy would be recommended for 4.3% of patients (requiring 3.64 biopsies per true positive case).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The risk of EAH and EC among asymptomatic postmenopausal women varies significantly based on clinical factors. This risk-stratified modeling approach delivers individualized risk estimates to inform endometrial biopsy decisions, facilitating personalized patient management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2025.1707883","type":"journal-article","created":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T05:13:35Z","timestamp":1764911615000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["A risk-stratified model for predicting endometrial atypical hyperplasia and cancer to guide biopsy decisions in asymptomatic postmenopausal women"],"prefix":"10.3389","volume":"12","author":[{"given":"Shanshan","family":"Wu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xu","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suhan","family":"Lai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaohui","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Wan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,12,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"3093","DOI":"10.1097\/CM9.0000000000003442","article-title":"Comparative analysis of cancer statistics in China and the United States in 2024.","volume":"137","author":"Wu","year":"2024","journal-title":"Chin Med J"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e1002081","DOI":"10.1371\/journal.pmed.1002081","article-title":"Duration of adulthood overweight, obesity, and cancer risk in the women\u2019s health initiative: a longitudinal study from the United States.","volume":"13","author":"Arnold","year":"2016","journal-title":"PLoS Med"},{"key":"B3","doi-asserted-by":"publisher","first-page":"229","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: globocan estimates of incidence and mortality worldwide for 36 cancers in 185 countries.","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J Clin"},{"key":"B4","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1111\/ajo.13472","article-title":"Can a higher endometrial thickness threshold exclude endometrial cancer and atypical hyperplasia in asymptomatic postmenopausal women? 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