Is the Use of Endometrial Thickness as Diagnostic Triage Reliable to Diagnose Endometrial Cancer for Patients Who are Black?

Transvaginal ultrasonography triage is not reliable among adults who are Black and are at risk for endometrial cancer, according to a recent study. Tissue biopsy is recommended to avoid misdiagnosis.

Poor performance of the transvaginal ultrasonography triage strategy in adults may be a contributor to racial disparity between individuals who are Black and individuals who are White in endometrial cancer diagnosis. Doll and colleagues examined the false-negative probability using ultrasonography-measured endometrial thickness thresholds as triage for endometrial cancer diagnosis. Further, they assessed whether any known risk factors of endometrial cancer modify endometrial thickness triage performance.

The retrospective diagnostic study included a total of 1494 individuals, with 210 being diagnosed with endometrial cancer. The most common presenting diagnoses within 30 days of ultrasonography were: fibroids (n = 1167 [78.1%]), vaginal bleeding (1067 [71.4%]), and pelvic pain (857 [57.4%]).

When looking at the application of endometrial thickness threshold, the researchers found that when applying the less than 5-mm endometrial thickness threshold, there was an 11.4% probability that someone with endometrial cancer would be classified as not having the disease. At the 4-mm threshold, it was 9.5%, and at the 3-mm threshold, it was 3.8%.

Further, the false-negative probability at the 5-mm threshold was similar among the following endometrial cancer risk factor groups: postmenopausal bleeding (12.4%; 95% CI, 7.8%-18.5%), BMI greater than 40 (9.3%; 95% CI, 3.1%-20.3%); and age 50 years or older (12.8%; 95% CI, 8.4%-18.5%).

In patients with fibroids, false-negative probability with ultrasonography was similar (11.8%; 95% CI, 6.9%-18.4%) but higher in the setting of reported partial visibility (26.1%; 95% CI, 10.2%-48.4%) and pelvic pain (14.5%; 95% CI, 7.7%-23.9%).

“In this diagnostic study, among patients [who are Black] who underwent hysterectomy, a significant proportion of those with [endometrial cancer] had [endometrial thickness] below the range of diagnostic thresholds for detection. Classic risk factors for [endometrial cancer] (postmenopausal bleeding, age, and body mass index) did not result in improved performance of the [endometrial thickness] triage thresholds,” the researchers concluded. “These findings suggest that the transvaginal ultrasonography triage strategy is not reliable among [adults who are] Black at risk for [endometrial cancer]. In the presence of postmenopausal bleeding, tissue sampling is strongly recommended.”

Reference:

Doll KM, Pike M, Alson J, et al. Endometrial thickness as diagnostic triage for endometrial cancer among black individuals. JAMA Oncol. 2024;10(8):1068-1076. doi:10.1001/jamaoncol.2024.1891