Health
This cancer screening approach is not trustworthy for black women
Top line:
Transvaginal ultrasound triage strategies are less reliable for diagnosing endometrial cancer in high-risk black women, with different endometrial thickness thresholds carrying a substantial risk of false-negative results.
methodology:
- The poor performance of endometrial thickness measured by transvaginal ultrasound as a diagnostic triage strategy for endometrial cancer may contribute to racial disparities in stage at diagnosis between black and white women.
- The researchers assessed the probability of false-negative results using thresholds for endometrial thickness measured by transvaginal ultrasound to triage endometrial cancer among 1,494 black women (median age, 46 years) who underwent hysterectomy.
- The researchers focused on endometrial thickness measurements recorded within 24 months prior to hysterectomy, as well as demographic and clinical data.
- Endometrial thickness thresholds were defined as < 3 mm, < 4 mm, < 5 mm according to guidelines, with the remainder grouped as ≥ 5 mm.
- A total of 210 women had endometrial cancer. The most common symptoms were uterine fibroids (78%), vaginal bleeding (71%), and pelvic pain (57%).
remove:
- Twenty-four cases of endometrial cancer were below the 5 mm endometrial thickness threshold that would require a biopsy, so overall, 11.4% of endometrial cancer cases would have been missed.
- The false-negative probability was 9.5% (20 cases) for the <4 mm threshold and 3.8% (8 cases) for the <3 mm threshold.
- Classic risk factors for endometrial cancer (postmenopausal bleeding, age ≥ 50 years, BMI > 40) did not improve the performance of the endometrial thickness triage strategy.
- The rate of false-negative results was similar in patients with uterine fibroids (12%) but was higher in the setting of partial endometrial thickening visibility (26%) and pelvic pain (15%).
in fact:
The study reveals “a concerning error rate of triage strategies that discourage further testing and provide a false sense of security to both patients and physicians.” The findings contribute to a growing body of research questioning the wisdom of the (transvaginal ultrasound) triage strategy. Triage for (transvaginal ultrasound) endometrial biopsy may no longer be the preferred strategy in the context of rising endometrial cancer incidence in all patients. For black patients with concerning symptoms, tissue biopsy is recommended to avoid misdiagnosis of endometrial cancer,” the researchers concluded.
sauce:
The study was led by lead author Kemi M. Doll, MD, PhD, of the Fred Hutchinson Cancer Center at the University of Washington in Seattle. online June 27, 2024, JAMA Oncology.
Limitations:
This study did not include cases in which endometrial thickness measurements were omitted in the transvaginal ultrasound reports or endometrial thickness was reported as invisible, so the failure rate of the transvaginal ultrasound triage strategy may be underestimated.
This sample does not include endometrial cancer cases who did not undergo hysterectomy, which may occur among young women with grade 1 endometrial cancer, women who are medically inoperable, or women with advanced disease where surgery is no longer an option.
Disclosure:
Funding was provided by grants from Kuni Discovery Grants for Cancer Research: Advancing Innovation and the National Institutes of Health. Doll reported receiving investigator-initiated research grants from the Patient Centered Outcomes Research Institute, the American Association of Cancer Research, and Merck & Co., Inc.
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Sources 2/ https://www.medscape.com/viewarticle/transvaginal-ultrasound-often-misses-endometrial-cancer-2024a1000d6l The mention sources can contact us to remove/changing this article |
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