scholarly journals Characterization of patients that can continue conservative treatment for adenomyosis

2021 ◽  
Author(s):  
Chiho Miyagawa ◽  
Kosuke Murakami ◽  
Takako Tobiume ◽  
Takafumi Nonogaki ◽  
Noriomi Matsumura
Keyword(s):  
Clinical Trials ◽  
Conservative Treatment ◽  
Decision Tree ◽  
Age At Diagnosis ◽  
University Hospital ◽  
Red Cross ◽  
Decision Tree Analysis ◽  
Tree Analysis ◽  
Age Of Diagnosis

AbstractIntroductionHistorically, hysterectomy has been the radical treatment for adenomyosis. However, some patients do not wish to hysterectomy. Nevertheless, patients often required hysterectomy during the course of conservative treatment, but the factors involved remain unknown. The purpose of this study was to determine which patients can continue conservative treatment for adenomyosis.Materials and MethodsWe selected women diagnosed with adenomyosis and provided with conservative treatment at the Kindai University Hospital and Osaka Red Cross Hospital. Age at diagnosis, parity, uterine size, subtype of adenomyosis, type of conservative treatment, and timing of hysterectomy for cases with difficulty continuing conservative treatment were examined retrospectively.ResultsA total of 885 patients were diagnosed with adenomyosis, and 124 started conservative treatment. Conservative treatment was continued in 96 patients (77.4%) and hysterectomy was required in 28 patients (22.6%). The cumulative hysterectomy rate was 32.4%, and all women had hysterectomy within 63 months. In the decision tree analysis, 82% (23/28) of women aged 46 years or younger were able to continue conservative treatment when parity was zero or one. If parity was two and over, 95% (20/21) of those aged 39 years and older had hysterectomy.ConclusionsPatients that continue conservative treatment for approximately 5 years are more likely to have successful preservation of the uterus. Multipara and higher age of diagnosis are factors that contribute to hysterectomy after conservative treatment. Parity and age at diagnosis may be stratifying factor in future clinical trials on hormone therapy.

scholarly journals Characterization of patients that can continue conservative treatment for adenomyosis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chiho Miyagawa ◽  
Kosuke Murakami ◽  
Takako Tobiume ◽  
Takafumi Nonogaki ◽  
Noriomi Matsumura
Keyword(s):  
Clinical Trials ◽  
Conservative Treatment ◽  
Hormone Therapy ◽  
Classification Tree ◽  
Age At Diagnosis ◽  
University Hospital ◽  
Red Cross ◽  
Radical Treatment

Abstract Background Historically, hysterectomy has been the radical treatment for adenomyosis. Although, some patients may not want to have their uterus removed, patients often have to no choice but to request hysterectomy during conservative treatment. The factors necessitating these hysterectomies remain unknown. The purpose of this study was to determine which patients can continue conservative treatment for adenomyosis. Methods We selected women diagnosed with adenomyosis and provided with conservative treatment at the Kindai University Hospital and Osaka Red Cross Hospital in Osaka Japan from 2008 to 2017. Age at diagnosis, parity, uterine size, subtype of adenomyosis, type of conservative treatment, and timing of hysterectomy for cases with difficulty continuing conservative treatment were examined retrospectively. Results A total of 885 patients were diagnosed with adenomyosis, and 124 started conservative treatment. Conservative treatment was continued in 96 patients (77.4%) and hysterectomy was required in 28 patients (22.6%). The cumulative hysterectomy rate was 32.4%, and all women had hysterectomy within 63 months. In the classification tree, 82% (23/28) of women aged 46 years or younger were able to continue conservative treatment when parity was zero or one. In those with parity two and over, 95% (20/21) of those aged 39 years and older had hysterectomy. Conclusions Patients who continue conservative treatment for approximately 5 years are more likely to have successful preservation of the uterus. Multiparity and higher age at diagnosis are factors that contribute to hysterectomy after conservative treatment. Parity and age at diagnosis may be stratifying factors in future clinical trials of hormone therapy.

scholarly journals Fast nutritional characterization of different pigmented rice grains using a combination of NMR and decision tree analysis

2019 ◽  
Vol 17 (1) ◽  
pp. 128-136 ◽  
Author(s):  
Hongying Du ◽  
Yinqiang Huo ◽  
Huili Liu ◽  
Ghulam Mustafa Kamal ◽  
Jiaren Yang ◽  
...  
Keyword(s):  
Decision Tree ◽  
Decision Tree Analysis ◽  
Tree Analysis ◽  
Pigmented Rice ◽  
Rice Grains

scholarly journals Risk of Pre-Malignancy or Malignancy in Postmenopausal Endometrial Polyps: A CHAID Decision Tree Analysis

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 1094
Author(s):  
Michael Wong ◽  
Nikolaos Thanatsis ◽  
Federica Nardelli ◽  
Tejal Amin ◽  
Davor Jurkovic
Keyword(s):  
Decision Tree ◽  
Expectant Management ◽  
Decision Tree Model ◽  
Decision Tree Analysis ◽  
Focal Lesions ◽  
Tree Model ◽  
Normal Endometrium ◽  
Endometrial Polyps ◽  
Tree Analysis ◽  
Interaction Detection

Background and aims: Postmenopausal endometrial polyps are commonly managed by surgical resection; however, expectant management may be considered for some women due to the presence of medical co-morbidities, failed hysteroscopies or patient’s preference. This study aimed to identify patient characteristics and ultrasound morphological features of polyps that could aid in the prediction of underlying pre-malignancy or malignancy in postmenopausal polyps. Methods: Women with consecutive postmenopausal polyps diagnosed on ultrasound and removed surgically were recruited between October 2015 to October 2018 prospectively. Polyps were defined on ultrasound as focal lesions with a regular outline, surrounded by normal endometrium. On Doppler examination, there was either a single feeder vessel or no detectable vascularity. Polyps were classified histologically as benign (including hyperplasia without atypia), pre-malignant (atypical hyperplasia), or malignant. A Chi-squared automatic interaction detection (CHAID) decision tree analysis was performed with a range of demographic, clinical, and ultrasound variables as independent, and the presence of pre-malignancy or malignancy in polyps as dependent variables. A 10-fold cross-validation method was used to estimate the model’s misclassification risk. Results: There were 240 women included, 181 of whom presented with postmenopausal bleeding. Their median age was 60 (range of 45–94); 18/240 (7.5%) women were diagnosed with pre-malignant or malignant polyps. In our decision tree model, the polyp mean diameter (≤13 mm or >13 mm) on ultrasound was the most important predictor of pre-malignancy or malignancy. If the tree was allowed to grow, the patient’s body mass index (BMI) and cystic/solid appearance of the polyp classified women further into low-risk (≤5%), intermediate-risk (>5%–≤20%), or high-risk (>20%) groups. Conclusions: Our decision tree model may serve as a guide to counsel women on the benefits and risks of surgery for postmenopausal endometrial polyps. It may also assist clinicians in prioritizing women for surgery according to their risk of malignancy.

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