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Study Finds Transvaginal Ultrasound Unreliable for Detecting Endometrial Cancer in Black Patients

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Utilizing a threshold of less than 5 mm of ultrasound-measured endometrial thickness, the authors of a new study noted an 11.4 percent false-negative probability for endometrial cancer in Black patients.

Emerging research reveals a significant percentage of false-negative results with transvaginal ultrasound (TVUS) in Black individuals with endometrial cancer.

For the retrospective study, recently published in JAMA Oncology, the researchers reviewed data from the electronic medical records of 1,494 Black individuals who had hysterectomy procedures within a multicenter academic health-care system. According to the study, 210 patients had endometrial cancer.

For patients who had less than 5 mm of TVUS-measured endometrial thickness (ET), the study authors noted an 11.4 percent probability of false negative findings for endometrial cancer. They also found a 9.5 percent probability of false negatives for endometrial cancer when employing a 4 mm threshold for ET.

Study Finds Transvaginal Ultrasound Unreliable for Detecting Endometrial Cancer in Black Patients

For patients who had less than 5 mm of TVUS-measured endometrial thickness (ET), the study authors noted an 11.4 percent probability of false negative findings for endometrial cancer. (Image courtesy of Adobe Stock.)

“This is a concerning error rate for a triage strategy that would terminate further workup and provide false reassurance to both patients and physicians. This result contributes to an increasing body of work questioning the wisdom of the TVUS triage strategy. It may be the case that the TVUS triage for endometrial biopsy is no longer a preferred strategy in the setting of increasing EC rates for all,” wrote lead study author Kemi M. Doll, M.D., MSCR, who is affiliated with the Department of Obstetrics and Gynecology at the Fred Hutchinson Cancer Center at the University of Washington in Seattle, and colleagues.

The study authors also found similar trends with false-negative probability at the 5 mm ET threshold for women who had risk factors for endometrial cancer.

For patients with postmenopausal bleeding, the researchers noted a 12.4 percent false-negative probability at the 5 mm ET threshold. The presence of fibroids on ultrasound, a body mass index > 40 and being 50 years of age or older were also associated with 11.8 percent, 9.3 percent and 12.8 percent false-negative probabilities, respectively, at the 5 mm ET threshold, according to the researchers.

Three Key Takeaways

1. High false-negative rates with TVUS. The study reveals significant false-negative rates for endometrial cancer in Black individuals using transvaginal ultrasound (TVUS) with both 5 mm and 4 mm endometrial thickness (ET) thresholds, raising concerns about the reliability of TVUS for triage in this population.

2. Risk factors and false negatives. Certain risk factors for endometrial cancer such as postmenopausal bleeding, the presence of fibroids, higher body mass index (BMI > 40), and older age (≥ 50 years) were also associated with elevated false-negative probabilities with TVUS.

3. Reconsideration of TVUS triage strategy. Given the concerning error rates, the study contributes to growing evidence that the TVUS triage strategy for endometrial biopsy may no longer be suitable.

The study authors pointed out that pelvic pain and partial ET visibility were associated with the highest false-positive probabilities (14.5 percent and 26.1 percent probability respectively) at the 5 mm ET threshold.

“Fibroids were also associated with lower ET visibility. However, the difference in false-negative probability when stratified by fibroids alone was small, suggesting other mediators of this association,” explained Doll and colleagues. “Individuals experiencing pelvic pain had higher false-negative probabilities — a potential sign that increased discomfort with the vaginal ultrasonography probe might lead to a shorter, lower-quality study as technicians seek to minimize harm.”

(Editor’s note: For related content, see “Emerging SPECT/CT Agent Gets FDA Fast Track Designation for Superficial Peritoneal Endometriosis,” “Transvaginal Ultrasound or MRI: Which is More Effective in Evaluating Endometrial Cancer?” and “What a Transvaginal Ultrasound Study Reveals About Fibroid Prevalence in Minority Women.”)

In regard to study limitations, the authors acknowledged the exclusion of patients with non-visible ETs, those who did not have an ET measurement on their ultrasound reports, and patients who did not have a hysterectomy for endometrial cancer.

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