Narjes Karmous, Hanene Jemli, Abdelwahab Masmoudi, Badreddine Bouguerra, Aymen Mabrouk, Anis Ben Dhaou, Abdennour Karmous
This exploratory evaluation suggests that gamified online telehealth learning may support health science students' engagement and motivation in online telehealth courses. Participants identified more challenging elements, narrative-driven interactions and interactive features as key opportunities to enhance the GENIE module. These preliminary findings can inform the future development and evaluation of gamified approaches in health science education.
BACKGROUND: Abnormal uterine bleeding (AUB) in premenopausal women is frequent, yet distinguishing benign from malignant causes remains clinically challenging. Endometrial thickness (ET) measured by transvaginal ultrasound (TVUS) is well established in postmenopausal bleeding but less validated in premenopausal women due to cyclical variations. This study aimed to assess the diagnostic accuracy and prognostic value of ET, supplemented by Kaplan-Meier survival analysis, in predicting endometrial malignancy among premenopausal women with AUB.
METHODS: We conducted a retrospective observational study including premenopausal women presenting with AUB at Charles Nicolle Hospital, Tunis, Tunisia (2016-2024). All underwent TVUS followed by endometrial sampling (hysteroscopy or curettage) and definitive histological confirmation on hysterectomy specimens. Sonographic features were described using International Endometrial Tumor Analysis (IETA) criteria. Diagnostic performance of ET was evaluated using receiver operating characteristic (ROC) curve analysis. Kaplan-Meir survival analysis was applied to time-to-consultation and time-to-diagnosis, not survival outcomes.
RESULTS: ROC analysis identified ET as the strongest predictor of endometrial malignancy (AUC = 0.842, p < 0.001). An optimal cutoff of >9 mm achieved 69.2% sensitivity, 87.1% specificity, and a negative predictive value of 97.7%, effectively ruling out malignancy in patients with ET ≤9 mm. Although the positive predictive value was modest (26.5%), ET reliably stratified risk for further invasive evaluation. Kaplan-Meier analysis demonstrated that ET >9 mm was associated with earlier consultation (mean 27.7 vs. 70.3 months, p < 0.0001) and shorter time-to-diagnosis (median 12 months vs. not reached, p < 0.0001), reflecting a more aggressive clinical course.
CONCLUSIONS: ET >9 mm is a robust, non-invasive potential prognostic marker in premenopausal AUB, identifying high-risk women requiring urgent evaluation while safely excluding malignancy in low-risk patients.