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ePoster
EP517 Cost-effective improvement in endometrial cancer diagnosis by the incorporation of molecular analysis: prospective pilot study
  1. S Fernandez-Gonzalez1,2,
  2. M Amoros2,3,
  3. SM Arroyuelo2,3,
  4. D Barazi2,4,
  5. M Cararach2,5,
  6. J Fernandez2,6,
  7. L Fernandez de Castillo1,2,
  8. L Jofre2,4,
  9. L Pallares2,6,
  10. M Palau2,5,
  11. MJ Rodriguez-Domingo2,7,
  12. L Santos2,7,
  13. X Sanz8,
  14. ME Fernandez-Montoli1,2,
  15. G Tena2,5 and
  16. J Ponce1,2
  1. 1Gynecology, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona
  2. 2Gerencia Territorial Metropolitana Sur del Instituto Catalán de la Salud (ICS), Barcelona
  3. 3Gynecology, ASSIR Gava, Gava
  4. 4Gynecology, ASSIR Castelldefels, Castelldefels
  5. 5Gynecology, Hospital de Viladecans, Viladecans
  6. 6ASSIR Prat de Llobregat, El Prat de Llobregat
  7. 7Gynecology, ASSIR Viladecans, Viladecans
  8. 8Health Department, Institut Catala d'Oncologia, Hospitalet de Llobregat, Barcelona, Spain

Abstract

Introduction/Background The histopathology remains the gold standard to diagnose endometrial cancer (EC) from endometrial biopsy. Molecular tests have recently emerged as a useful tool to classify EC according to its prognosis. However, there is currently no published protocol that includes molecular diagnosis of postmenopausal women with abnormal uterine bleeding (AUB). We hypothesized that the incorporation of a molecular test in the management of postmenopausal women with AUB improves the cost-efectiveness of the diagnostic process.

Methodology We present a prospective study performed in postmenopausal women who presented AUB between 2009–2014. Seven centers recruited the patients. Three of them follow the classical diagnosis algorithm (group 1) and four centers follow the one that incorporates a molecular test (Gynecâ-Dx) performed on the remnants of aspirates (group 2). In group 2, when both the endometrial biopsy and the molecular test were negative, the consequent explorations were considered as ‘out of procotol’. Clinical data, number of biopsies, ultrasounds, hysteroscopies and visits were compared between groups. In addition, the sensitivity (S), specificity (E), positive and negative predictive values (PPV and NPV) of the molecular test were calculated.

Results 94 patients were recruited. 51 vs 43 women were included in the classical and the molecular algorithm respectively. There were no differences in age, BMI, parity, use of tamoxifen or hormonal treatment. The detailed outcomes of explorations between classical vs molecular group are shown in table 1. 324 vs 229 explorations were performed respectively (table 2). In the molecular group, 92 explorations were considered ‘out of protocol’. The test validations showed a 100% S, 92.5% E, 50% PPV and 100% NPV.

Conclusion According to our results, the incorporation of a molecular test for diagnosing EC in postmenopausal women who complained with AUB reduces the number of explorations. Consequently, the molecular algorithm might be more cost-effective than conventional algorithms.

Disclosure Nothing to disclose.

Abstract EP517 Figure 1
Abstract EP517 Figure 1

Diagnostic algorithms of abnormal uterine bleeding

Abstract EP517 Figure 2
Abstract EP517 Figure 2

Outcomes of the molecular test (GynEC®-DX)

View this table:
Abstract EP517 Table 1

Outcomes

View this table:
Abstract EP517 Table 2

Number of explorations

https://doi.org/10.1136/ijgc-2019-ESGO.575

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