CONCERNS about the reliability of transvaginal ultrasonography in diagnosing endometrial cancer (EC) among Black females have been raised in a recent study, suggesting this may contribute to racial disparities in cancer stage at diagnosis.
The study, conducted at a 10-hospital academic-affiliated health care system, analysed data from 1,494 Black individuals who underwent hysterectomy between January 2014–December 2020 (median [interquartile] age: 46.1 [41.1–54.0] years). Researchers examined the performance of ultrasonography-measured endometrial thickness (ET) thresholds in detecting EC.
Common diagnoses within 30 days of ultrasonography included fibroids (78.1%), vaginal bleeding (71.4%), and pelvic pain (57.4%). A total of 210 patients had EC. Findings showed that, when using a 5-mm ET threshold, there was an 11.4% chance that a patient with EC would be misclassified as cancer-free. Lowering the threshold to 4 mm reduced this probability to 9.5%, and further lowering it to 3 mm reduced it to 3.8. The false-negative probability at the 5 mm threshold remained similar across various risk groups: post-menopausal bleeding (12.4%; 95% CI: 7.8–18.5%), body mass index >40 (9.3%; 95% CI: 3.1–20.3%); and age ≥50 years (12.8%; 95% CI: 8.4–18.5%). The study also found that the false-negative probability was particularly high among patients with partial visibility of the endometrium (26.1%) and those experiencing pelvic pain (14.5%).
The authors underscored the need for improved diagnostic strategies, particularly for Black females, who were already at a higher risk of being diagnosed with advanced stages of EC. They recommended that, in cases of post-menopausal bleeding, tissue sampling should be strongly considered over reliance on ultrasonography alone.
This research calls for a re-evaluation of current diagnostic guidelines and highlights the importance of considering individual patient risk factors and symptom presentations. Addressing these diagnostic shortcomings is essential for reducing racial disparities in EC diagnosis and improving overall patient outcomes.
Ada Enesco, EMJ
Reference
Doll KM et al. Endometrial thickness as diagnostic triage for endometrial cancer among Black individuals. JAMA Oncol. 2024;DOI:10.1001/jamaoncol.2024.1891.
