Endometrial Thickness in Triage for Endometrial Cancer Among Black Women

In a study reported in JAMA Oncology, Kemi Doll, MD, MSCR, and colleagues found that ultrasonography-measured endometrial thickness was not reliable in triage for diagnosing endometrial cancer among Black women.

Study Details

The retrospective U.S. multicenter study focused on data from 1,494 women who underwent pelvic ultrasonography within 24 months before undergoing hysterectomy. Endometrial thickness thresholds were examined for accuracy in ruling out a diagnosis of endometrial cancer using sensitivity, specificity, and negative predictive value. Accuracy measures were stratified by endometrial cancer risk factors as well as factors hypothesized to influence endometrial thickness measurement quality.

Key Findings

Among the 1,494 women included in the analysis, 210 had endometrial cancer. Fibroids (78.1%), vaginal bleeding (71.4%), and pelvic pain (57.4%) were the most common presenting diagnoses within 30 days of ultrasonography.

According to endometrial thickness thresholds, the probabilities that patients with endometrial cancer would be classified as not having endometrial cancer were 11.4% at 5 mm, 9.5% at 4 mm, and 3.8% at 3 mm.

The probabilities of false-negative findings at the 5-mm threshold were similar among endometrial cancer risk factor groups, including patients with postmenopausal bleeding (12.4%, 95% confidence interval [CI] = 7.8%–18.5%), those with a body mass index of > 40 kg/m² (9.3%, 95% CI = 3.1%–20.3%), and those aged ≥ 50 years (12.8%, 95% CI = 8.4%–18.5%). False-negative probabilities were 11.8% (95% CI = 6.9%–18.4%) among patients with fibroids, 14.5% (95% CI = 7.7%–23.9%) among those with pelvic pain, and 26.1% (95% CI = 10.2%–48.4%) among cases of reported partial endometrial thickness visibility.

The investigators concluded: “These findings suggest that the transvaginal ultrasonography triage strategy is not reliable among Black adults at risk for endometrial cancer. In the presence of postmenopausal bleeding, tissue sampling is strongly recommended.”

Dr. Doll, of the Department of Obstetrics & Gynecology, University of Washington School of Medicine, Seattle, is the corresponding author of the JAMA Oncology article.

Disclosure: The study was supported by Kuni Discovery Grants for Cancer Research and the National Institutes of Health. For full disclosures of the study authors, visit jamanetwork.com.