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TOPLINE:
The transvaginal ultrasonography triage strategy is unreliable for diagnosing endometrial cancer in high-risk Black women, with a significant risk for false-negative results at different endometrial thickness thresholds.
METHODOLOGY:
- Poor performance of transvaginal ultrasonography-measured endometrial thickness as a diagnostic triage strategy for endometrial cancer may contribute to racial disparity in stage at diagnosis between Black and White women.
- Researchers assessed the false-negative probability using transvaginal ultrasonography-measured endometrial thickness thresholds as triage for endometrial cancer in 1494 Black women (median age, 46 years) who underwent hysterectomy.
- The researchers focused on endometrial thickness measurements recorded within 24 months before hysterectomy, as well as demographic and clinical data.
- The endometrial thickness thresholds were defined as < 3 mm, < 4 mm, and < 5 mm, with the rest grouped as ≥ 5 mm, consistent with guidelines.
- A total of 210 women had endometrial cancer. The most common presenting symptoms were fibroids (78%), vaginal bleeding (71%), and pelvic pain (57%).
TAKEAWAY:
- Twenty-four cases of endometrial cancer were below the 5-mm endometrial thickness threshold that would trigger biopsy, resulting overall in 11.4% of endometrial cancer cases potentially missed.
- The false-negative probability was 9.5% (20 cases) at the < 4-mm threshold and 3.8% (8 cases) at the < 3-mm threshold.
- Classic risk factors for endometrial cancer (postmenopausal bleeding, age ≥ 50 years, and BMI > 40) did not result in improved performance of the endometrial thickness triage strategy.
- False-negative probability was also similar among those with fibroids (12%) but higher in the setting of partial endometrial thickness visibility (26%) and pelvic pain (15%).
IN PRACTICE:
This study reveals a “concerning error rate for a triage strategy that would terminate further workup and provide false reassurance to both patients and physicians.” The results contribute to “an increasing body of work questioning the wisdom of the (transvaginal ultrasonography) triage strategy. It may be the case that the (transvaginal ultrasonography) triage for endometrial biopsy is no longer a preferred strategy in the setting of increasing endometrial cancer rates for all. For Black patients with concerning symptoms, tissue biopsy is recommended to avoid misdiagnosis of endometrial cancer,” the researchers concluded.
SOURCE:
The study, with first author Kemi M. Doll, MD, Fred Hutchinson Cancer Center, University of Washington, Seattle, was published online in JAMA Oncology.
LIMITATIONS:
The study did not include cases where transvaginal ultrasonography reports omitted endometrial thickness measurements or reported nonvisible endometrial thickness, possibly underestimating the failure rate of the transvaginal ultrasonography triage strategy.
The sample did not include endometrial cancer cases that were not treated with hysterectomy, which may occur in young women with grade 1 endometrial cancer, those medically incapable of undergoing surgery, and those with disease so advanced that surgery is no longer an option.
DISCLOSURES:
Funding was provided by Kuni Discovery Grants for Cancer Research: Advancing Innovation and by a grant from the National Institutes of Health. Dr. Doll reported receiving investigator-initiated research grants from the Patient Centered Outcomes Research Institute, American Association of Cancer Research, and Merck.
A version of this article first appeared on Medscape.com.
TOPLINE:
The transvaginal ultrasonography triage strategy is unreliable for diagnosing endometrial cancer in high-risk Black women, with a significant risk for false-negative results at different endometrial thickness thresholds.
METHODOLOGY:
- Poor performance of transvaginal ultrasonography-measured endometrial thickness as a diagnostic triage strategy for endometrial cancer may contribute to racial disparity in stage at diagnosis between Black and White women.
- Researchers assessed the false-negative probability using transvaginal ultrasonography-measured endometrial thickness thresholds as triage for endometrial cancer in 1494 Black women (median age, 46 years) who underwent hysterectomy.
- The researchers focused on endometrial thickness measurements recorded within 24 months before hysterectomy, as well as demographic and clinical data.
- The endometrial thickness thresholds were defined as < 3 mm, < 4 mm, and < 5 mm, with the rest grouped as ≥ 5 mm, consistent with guidelines.
- A total of 210 women had endometrial cancer. The most common presenting symptoms were fibroids (78%), vaginal bleeding (71%), and pelvic pain (57%).
TAKEAWAY:
- Twenty-four cases of endometrial cancer were below the 5-mm endometrial thickness threshold that would trigger biopsy, resulting overall in 11.4% of endometrial cancer cases potentially missed.
- The false-negative probability was 9.5% (20 cases) at the < 4-mm threshold and 3.8% (8 cases) at the < 3-mm threshold.
- Classic risk factors for endometrial cancer (postmenopausal bleeding, age ≥ 50 years, and BMI > 40) did not result in improved performance of the endometrial thickness triage strategy.
- False-negative probability was also similar among those with fibroids (12%) but higher in the setting of partial endometrial thickness visibility (26%) and pelvic pain (15%).
IN PRACTICE:
This study reveals a “concerning error rate for a triage strategy that would terminate further workup and provide false reassurance to both patients and physicians.” The results contribute to “an increasing body of work questioning the wisdom of the (transvaginal ultrasonography) triage strategy. It may be the case that the (transvaginal ultrasonography) triage for endometrial biopsy is no longer a preferred strategy in the setting of increasing endometrial cancer rates for all. For Black patients with concerning symptoms, tissue biopsy is recommended to avoid misdiagnosis of endometrial cancer,” the researchers concluded.
SOURCE:
The study, with first author Kemi M. Doll, MD, Fred Hutchinson Cancer Center, University of Washington, Seattle, was published online in JAMA Oncology.
LIMITATIONS:
The study did not include cases where transvaginal ultrasonography reports omitted endometrial thickness measurements or reported nonvisible endometrial thickness, possibly underestimating the failure rate of the transvaginal ultrasonography triage strategy.
The sample did not include endometrial cancer cases that were not treated with hysterectomy, which may occur in young women with grade 1 endometrial cancer, those medically incapable of undergoing surgery, and those with disease so advanced that surgery is no longer an option.
DISCLOSURES:
Funding was provided by Kuni Discovery Grants for Cancer Research: Advancing Innovation and by a grant from the National Institutes of Health. Dr. Doll reported receiving investigator-initiated research grants from the Patient Centered Outcomes Research Institute, American Association of Cancer Research, and Merck.
A version of this article first appeared on Medscape.com.
TOPLINE:
The transvaginal ultrasonography triage strategy is unreliable for diagnosing endometrial cancer in high-risk Black women, with a significant risk for false-negative results at different endometrial thickness thresholds.
METHODOLOGY:
- Poor performance of transvaginal ultrasonography-measured endometrial thickness as a diagnostic triage strategy for endometrial cancer may contribute to racial disparity in stage at diagnosis between Black and White women.
- Researchers assessed the false-negative probability using transvaginal ultrasonography-measured endometrial thickness thresholds as triage for endometrial cancer in 1494 Black women (median age, 46 years) who underwent hysterectomy.
- The researchers focused on endometrial thickness measurements recorded within 24 months before hysterectomy, as well as demographic and clinical data.
- The endometrial thickness thresholds were defined as < 3 mm, < 4 mm, and < 5 mm, with the rest grouped as ≥ 5 mm, consistent with guidelines.
- A total of 210 women had endometrial cancer. The most common presenting symptoms were fibroids (78%), vaginal bleeding (71%), and pelvic pain (57%).
TAKEAWAY:
- Twenty-four cases of endometrial cancer were below the 5-mm endometrial thickness threshold that would trigger biopsy, resulting overall in 11.4% of endometrial cancer cases potentially missed.
- The false-negative probability was 9.5% (20 cases) at the < 4-mm threshold and 3.8% (8 cases) at the < 3-mm threshold.
- Classic risk factors for endometrial cancer (postmenopausal bleeding, age ≥ 50 years, and BMI > 40) did not result in improved performance of the endometrial thickness triage strategy.
- False-negative probability was also similar among those with fibroids (12%) but higher in the setting of partial endometrial thickness visibility (26%) and pelvic pain (15%).
IN PRACTICE:
This study reveals a “concerning error rate for a triage strategy that would terminate further workup and provide false reassurance to both patients and physicians.” The results contribute to “an increasing body of work questioning the wisdom of the (transvaginal ultrasonography) triage strategy. It may be the case that the (transvaginal ultrasonography) triage for endometrial biopsy is no longer a preferred strategy in the setting of increasing endometrial cancer rates for all. For Black patients with concerning symptoms, tissue biopsy is recommended to avoid misdiagnosis of endometrial cancer,” the researchers concluded.
SOURCE:
The study, with first author Kemi M. Doll, MD, Fred Hutchinson Cancer Center, University of Washington, Seattle, was published online in JAMA Oncology.
LIMITATIONS:
The study did not include cases where transvaginal ultrasonography reports omitted endometrial thickness measurements or reported nonvisible endometrial thickness, possibly underestimating the failure rate of the transvaginal ultrasonography triage strategy.
The sample did not include endometrial cancer cases that were not treated with hysterectomy, which may occur in young women with grade 1 endometrial cancer, those medically incapable of undergoing surgery, and those with disease so advanced that surgery is no longer an option.
DISCLOSURES:
Funding was provided by Kuni Discovery Grants for Cancer Research: Advancing Innovation and by a grant from the National Institutes of Health. Dr. Doll reported receiving investigator-initiated research grants from the Patient Centered Outcomes Research Institute, American Association of Cancer Research, and Merck.
A version of this article first appeared on Medscape.com.