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. 2024 Aug 1;10(8):1068-1076.
doi: 10.1001/jamaoncol.2024.1891.

Endometrial Thickness as Diagnostic Triage for Endometrial Cancer Among Black Individuals

Kemi M Doll  1 , Mindy Pike  1 , Julianna Alson  1 , Patrice Williams  1 , Erin Carey  2 , Til Stürmer  3 , Mollie Wood  3 , Erica E Marsh  4 , Ronit Katz  1 , Whitney R Robinson  4   5
Affiliations

Endometrial Thickness as Diagnostic Triage for Endometrial Cancer Among Black Individuals

Kemi M Doll et al. JAMA Oncol. .

Erratum in

  • Correction to Open Access.
    [No authors listed] [No authors listed] JAMA Oncol. 2025 Mar 1;11(3):354. doi: 10.1001/jamaoncol.2024.6781. JAMA Oncol. 2025. PMID: 39847349 Free PMC article. No abstract available.

Abstract

Importance: Poor performance of the transvaginal ultrasonography triage strategy has been suggested as a contributor to racial disparity between Black individuals and White individuals in endometrial cancer (EC) stage at diagnosis in population-level simulation analyses.

Objectives: To examine the false-negative probability using ultrasonography-measured endometrial thickness (ET) thresholds as triage for EC diagnosis among Black individuals and assess whether known risk factors of EC modify ET triage performance.

Design, setting, and participants: This retrospective diagnostic study of merged abstracted electronic health record data and secondary administrative data (January 1, 2014, to December 31, 2020) from the Guidelines for Transvaginal Ultrasound in the Detection of Early Endometrial Cancer sample assessed Black individuals who underwent hysterectomy in a 10-hospital academic-affiliated health care system and affiliated outpatient practices. Data analysis was performed from January 31, 2023, to November 30, 2023.

Exposure: Pelvic ultrasonography within 24 months before hysterectomy.

Main outcome and measures: Ultrasonography performed before hysterectomy as well as demographic and clinical data on symptom presentation, endometrial characterization, and final EC diagnosis were abstracted. Endometrial thickness thresholds were examined for accuracy in ruling out EC diagnosis by using sensitivity, specificity, and negative predictive value. False-negative probability was defined as 1 - sensitivity. Accuracy measures were stratified by risk factors for EC and by factors hypothesized to influence ET measurement quality.

Results: A total of 1494 individuals with a uterus (median [IQR] age, 46.1 [41.1-54.0] years) comprised the sample, and 210 had EC. Fibroids (1167 [78.1%]), vaginal bleeding (1067 [71.4%]), and pelvic pain (857 [57.4%]) were the most common presenting diagnoses within 30 days of ultrasonography. Applying the less than 5-mm ET threshold, there was an 11.4% probability that someone with EC would be classified as not having EC (n = 24). At the 4-mm (cumulative) threshold, the probability was 9.5%, and at 3 mm, it was 3.8%. False-negative probability at the 5-mm threshold was similar among EC risk factor groups: postmenopausal bleeding (12.4%; 95% CI, 7.8%-18.5%), body mass index 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%). False-negative probability was also similar among those with fibroids on ultrasonography (11.8%; 95% CI, 6.9%-18.4%) but higher in the setting of reported partial ET visibility (26.1%; 95% CI, 10.2%-48.4%) and pelvic pain (14.5%; 95% CI, 7.7%-23.9%).

Conclusion and relevance: These findings suggest that the transvaginal ultrasonography triage strategy is not reliable among Black adults at risk for EC. In the presence of postmenopausal bleeding, tissue sampling is strongly recommended.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Carey reported receiving personal fees for providing expert witness testimony; personal fees for consulting from Asensus Surgical; personal fees from Violet Medical; nonfinancial support from grants 1R43HD112277-01, 1R43HD114347-0, 1R43HD115467-01, and 1R44HD112245-01A1; and personal fees from Eximis as a Data and Safety Monitoring Board member outside the submitted work; in addition, Dr Carey reported having 2 patents pending (PCT/US2020/055816 and PCT/US23/16013 for pelvic pain). Dr Stürmer reported receiving a grant from the National Institute on Agin (R01AG056479) outside the submitted work and holding stock in Novartis, Roche, and Novo Nordisk. Dr Wood reported receiving grants from University of Washington during the conduct of the study. Dr Marsh reported receiving consulting fees from University of Washington during the conduct of the study. Dr Robinson reported receiving honorarium from the National Institutes of Health and American Cancer Society; consulting for Victoria’s Secret Global Fund for Women’s Cancers Rising Innovator Research Grant, in Partnership with Pelotonia & American Association for Cancer Research; and receiving personal fees from the University of Pennsylvania and University of Wisconsin School of Medicine outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. False-Negative Probability of Endometrial Thickness Measurement for Endometrial Cancer Diagnostic Triage Among Black Individuals
BMI indicates body mass index (calculated as weight in kilograms divided by height in meters squared).
See this image and copyright information in PMC

References

    1. Clarke MA, Long BJ, Del Mar Morillo A, Arbyn M, Bakkum-Gamez JN, Wentzensen N. Association of endometrial cancer risk with postmenopausal bleeding in women: a systematic review and meta-analysis. JAMA Intern Med. 2018;178(9):1210-1222. doi:10.1001/jamainternmed.2018.2820 - DOI - PMC - PubMed
    1. Burke WM, Orr J, Leitao M, et al. ; SGO Clinical Practice Endometrial Cancer Working Group; Society of Gynecologic Oncology Clinical Practice Committee . Endometrial cancer: a review and current management strategies: part I. Gynecol Oncol. 2014;134(2):385-392. doi:10.1016/j.ygyno.2014.05.018 - DOI - PubMed
    1. ACOG Committee Opinion No . ACOG Committee Opinion No. 734: the role of transvaginal ultrasonography in evaluating the endometrium of women with postmenopausal bleeding. Obstet Gynecol. 2018;131(5):e124-e129. doi:10.1097/AOG.0000000000002631 - DOI - PubMed
    1. Long B, Clarke MA, Morillo ADM, Wentzensen N, Bakkum-Gamez JN. Ultrasound detection of endometrial cancer in women with postmenopausal bleeding: systematic review and meta-analysis. Gynecol Oncol. 2020;157(3):624-633. doi:10.1016/j.ygyno.2020.01.032 - DOI - PubMed
    1. Doll KM, Khor S, Odem-Davis K, et al. . Role of bleeding recognition and evaluation in Black-White disparities in endometrial cancer. Am J Obstet Gynecol. 2018;219(6):593.e1-593.e14. doi:10.1016/j.ajog.2018.09.040 - DOI - PubMed