A recent study found that current transvaginal ultrasonography triage strategies may not be useful for accurately diagnosing endometrial cancer among Black patients at risk for the malignancy.

The retrospective diagnostic study—published by Doll et al in JAMA Oncology—merged abstracted electronic health record data and secondary administrative data collected from 1,494 Black individuals with a uterus between January 1, 2014, and December 31, 2020. A data analysis was conducted from January 31, 2023, to November 30, 2023. Patients included in the analysis had a median age of 46.1 years.

Of the total 1,494 Black patients included in the study population, 210 were diagnosed with endometrial cancer. The most common presenting diagnoses within 30 days of ultrasonography included fibroids (in 78.1% of patients), vaginal bleeding (in 71.4%), and pelvic pain (in 57.4%).

Using endometrial thickness as a threshold for diagnosis, a 3-mm threshold would have resulted in a false-negative probability (missed endometrial cancer diagnoses) of 3.8%; a 4-mm threshold would have resulted in a false-negative probability of 9.5%; and a 5-mm threshold would have resulted in a false-negative probability of 11.4%. These rates indicate significant disparities in diagnostic accuracy among Black patients when applying endometrial thickness thresholds derived from research conducted in predominantly White populations.

The findings suggested that common endometrial cancer risk factors such as postmenopausal bleeding, age, and high body mass index did not improve the diagnostic reliability of endometrial thickness thresholds for Black women. Black women more frequently presented with complicating factors such as fibroids and nonendometrioid types of endometrial cancer.

The research questioned the generalized application of transvaginal ultrasonography for endometrial cancer triage across racial groups, and highlighted the need for further investigation to establish more accurate and equitable diagnostic methods. The findings also underscore the necessity to reevaluate current guidelines and develop diagnostic approaches tailored to address racial disparities in gynecological health. Such changes are crucial for improving healthcare outcomes and ensuring equity in the diagnosis and treatment of endometrial cancer among Black women.

Conflict of interest disclosures can be found in the study.