@article{article_1240705, title={Assessment of Clinical Utility in Decision Curve Analysis for an Individualized Risk Prediction Model of Endometrial Cancer}, journal={Türk Jinekolojik Onkoloji Dergisi}, volume={23}, pages={9–24}, year={2023}, author={Köksal, Oğuz Kaan and Erdemoğlu, Evrim and Öztürk, Volkan and Bozkurt, Kemal and Turan, İlyas}, keywords={Karar Eğrisi Analizi, Endometrium Kanseri, Bireyselleştirilmiş Risk Tahmin Modeli}, abstract={Background: There is a need for a personalized risk assessment method (IRPM) for women with abnormal uterine bleeding. Management of abnormal vaginal bleeding is based on diagnostic test results with positive/negative predictive values for a cut-off value. Patient has no contribution on the threshold to act for biopsy or not. Aim of present study was to develop a calibrated model with discriminative ability in which the patient can contribute to decision process. Methods: A cross-sectional one-gate design cohort study was planned to extract data of patients older than 35 years-old. All had index test (endometrial thickness measurement) and reference test (D&C under general anesthesia). Target was histopathological report according to WHO 2014 as benign or pre/cancer. Primary outcome was to develop a useful clinical IRPM and to compare net benefit of IRPM and models mimicking current guidelines for various thresholds of disease in decision curve analysis. Secondary outcomes were to analyse discriminative properties, the number of unnecessary biopsies and missed cases at various thresholds. Findings: IRPM consisting of symptom status, endometrial thickness and age was the best risk predicting method for pre-/endometrium cancer. IRPM had a higher net benefit than guidelines and to biopsy all or not at entire range of clinical threshold probabilities. IRPM had a good discrimination slope and can also decrease number of missed cases. Models mimicking current guidelines were only useful above a threshold of 3% and below this threshold, it is found to be harmful. Interpretation: IRPM doesn’t need any additional costs or time-consuming analysis. IRPM may aid patient to contribute to decision of further investigation. Clinical usefulness of IRPM is superior to models mimicking current practice. Value of diagnostic discriminatory cut-offs of guidelines is lower than expected in a heterogenous group of patients. Funding: No funding}, number={1}, publisher={Türk Jinekolojik Onkoloji Derneği}