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Clinical Utility of the REM Score in Stratifying Endometrial Malignancy Risk: Insights From a Tertiary Care Centre in
K M Ashika1,2, D Jayalakshmi2, P Veena2
1HIBA Women's Clinic, Tirunelveli, India.
Objective:
To evaluate the performance of the risk of endometrial malignancy (REM) scoring system using its existing cut-off value (0.3185) in stratifying risk for endometrial malignancy and to determine an optimal cut-off value in a tertiary care setting in South India.
Methods:
This cross-sectional diagnostic accuracy study enrolled 220 women aged 40-80 years who underwent surgical interventions for abnormal uterine bleeding (AUB), postmenopausal bleeding (PMB), or ultrasonographic abnormalities. Data on clinical, ultrasonographic, and biochemical parameters (including HE4 levels) were collected, and REM scores were calculated. Histopathological outcomes served as the gold standard for assessing performance.
Results:
The median REM score was significantly higher in women with malignancy (0.5581, IQR: 0.3442-0.7489) compared to those without (0.1709, IQR: 0.0993-0.3628, p < 0.001). At the existing cut-off value (0.3185), the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 79.6%, 72.67%, 51.65%, and 90.7%, respectively. An optimal cut-off value of 0.3348 demonstrated improved sensitivity and specificity in the study population.
Conclusion:
The REM scoring system effectively stratifies patients at high risk for endometrial malignancy. Adjusting the cut-off value for this population may further enhance its diagnostic utility.
