P14.10: Factors associated with inconsistency in visibility of the endometrial echo on transvaginal ultrasound of postmenopausal women

Rotenberg, O.; Escobar, Pamela; Fridman, Dmitry; Dar, P.

doi:10.1002/uog.18140

Cited by 2 publications

(5 citation statements)

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“…We used the definitions of Black and White race as social constructs with substantial health consequences secondary to differential exposure to interpersonal, institutional, structural, and internalized racism across generations, with self-reported race as the most accurate measurement of group belonging. We defined the parameters of the simulation using national cancer registry data, population-based cohorts of women with PMB, and published TVUS measurements of ET among women with and without EC from several retrospective cohort studies . Our steps for cohort creation mirror those from a prior publication and are reproduced here.…”

Section: Methodsmentioning

confidence: 99%

“…In addition, the visibility of the endometrium (required to have an accurate measurement) on TVUS was assigned based on fibroid history given the potential of fibroids to distort the endometrium, thereby causing an inability to visualize and measure the thickness. Endometrial visibility was assigned as visible or not visible based on published estimations of the proportion of visible endometrium during TVUS measurement of women with and without fibroids . For Black women, we used ET visibility estimates that were reported directly by the presence or absence of fibroids in a study of 440 women of whom 85% were Black race or Hispanic ethnicity .…”

Section: Methodsmentioning

confidence: 99%

“…Endometrial visibility was assigned as visible or not visible based on published estimations of the proportion of visible endometrium during TVUS measurement of women with and without fibroids . For Black women, we used ET visibility estimates that were reported directly by the presence or absence of fibroids in a study of 440 women of whom 85% were Black race or Hispanic ethnicity . For White women, the proportion of nonvisible ET in women without fibroids was averaged from 3 studies of the 4 population-based investigations that reported this parameter, and we then used the same decrement of visibility (13.1%) in the presence of fibroids to estimate visibility in the setting of fibroids.…”

Section: Methodsmentioning

confidence: 99%

“…These data, however, may be suboptimal sources from which to base guidelines for US Black women. The presence of uterine fibroids can distort the endometrial cavity, resulting in poor visualization of the endometrium—a key component of the TVUS strategy . Nonendometrioid cancers can be focal lesions that are less likely to cause the global hypertrophy of the endometrium that is captured in the ET measurement .…”

Section: Introductionmentioning

confidence: 99%

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Estimated Performance of Transvaginal Ultrasonography for Evaluation of Postmenopausal Bleeding in a Simulated Cohort of Black and White Women in the US

et al. 2021

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IMPORTANCEBlack women in the US with endometrial cancer (EC) are more likely to be diagnosed with advanced-stage disease independent of insured status and histologic type. The most common way of diagnosing EC at early stages is through screening of people with postmenopausal bleeding to detect endometrial thickness (ET). This approach may disproportionately underperform in Black women secondary to a higher prevalence of fibroids and nonendometrioid EC in this population, both of which affect the quality of ET measurement.OBJECTIVE To compare the performance of recommended transvaginal ultrasonography (TVUS) ET thresholds as a screening method to prompt endometrial biopsy by race in a simulated cohort of symptomatic women. DESIGN, SETTING, AND PARTICIPANTSIn a simulated retrospective cohort study, based on data from Surveillance, Epidemiology, and End Results (SEER) national cancer registry 2012-2016; the US census; and published estimates of ET distribution and fibroid prevalence, diagnostic test characteristics of the 3-mm or more, 4-mm or more, and 5-mm or more ET thresholds for biopsy to capture EC diagnoses were calculated. The simulated cohort was constructed from February 2, 2020 (date of access to SEER data), to August 31, 2020. Analysis occurred from September 30, 2020, to March 30, 2021, including the primary analysis and the sensitivity calculations. MAIN OUTCOMES AND MEASURESThe main outcome measured was accuracy of the TVUS ET threshold to accurately identify cases of EC, measured by sensitivity, negative predictive value, and area under the curve (AUC).RESULTS A total of 367 073 simulated Black and White women with postmenopausal bleeding were evaluated, including 36 708 with EC. Among Black women, the currently recommended 4-mm or greater ET threshold prompted biopsy for fewer than half of EC cases (sensitivity, 47.5%; 95% CI, 46.0%-49.0%); of women referred for biopsy, 13.1% were EC cases (positive predictive value, 13.1%; 95% CI, 12.5%-13.6%). The AUC for the 4-mm or more threshold was 0.57 (95% CI, 0.56-0.57). In contrast, among the White women, the 4-mm or more threshold led to biopsy for most with EC (sensitivity, 87.9%; 95% CI, 87.6%-88.3%). Of those referred for biopsy, 14.6% had EC (positive predictive value, 14.6%; 95% CI, 14.4%-14.7%); AUC was 0.73 (95% CI, 0.73-0.74). The same variations held for the 3-mm or more and 5-mm or more ET thresholds: sensitivity, positive predictive value, and AUC were consistently lower for Black women than White women. CONCLUSIONS AND RELEVANCEThe findings of this simulated cohort study suggest that use of ET as measured by TVUS to determine the need for EC diagnostic testing in symptomatic women may exacerbate racial disparities in EC stage at diagnosis. In simulated data, TVUS ET screening missed almost 5 times more cases of EC among Black women vs White women owing to the greater prevalence of fibroids and nonendometrioid histologic type in Black women.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Estimated Performance of Transvaginal Ultrasonography for Evaluation of Postmenopausal Bleeding in a Simulated Cohort of Black and White Women in the US

et al. 2021

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“…Compared with white women, black women are three times more likely to have uterine fibroids [50]. Furthermore, TVS can be unreliable in the assessment of high-risk non-endometrioid endometrial tumours [51,52]. Endometrioid EC commonly presents with a thickened endometrium, which is visible on TVS.…”

Section: Disparities In Endometrial Cancer Diagnosismentioning

confidence: 99%

Racioethnic Disparities in Endometrial Cancer Outcomes

Illah,

Adeeko,

Olaitan

et al. 2024

Diagnostics

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Black women are twice as likely to die from endometrial cancer (EC) compared with white women. This represents one of the worst racioethnic disparities amongst all cancers globally. Compared with white women, black women are more likely to be diagnosed with advanced EC, have more barriers to accessing care and experience increased delays in obtaining an EC diagnosis and commencing treatment. Histological and molecular differences place black women at higher risk of being diagnosed with more aggressive EC subtypes that carry less favourable outcomes. Furthermore, EC diagnostic pathways are less reliable in black women, and black women are less likely to receive evidence-based treatment for EC. This racioethnic disparity in EC outcomes exists both in the UK and US, despite differences in healthcare systems. This review methodically describes the key factors along the patient journey that contribute to the disparity in black women and proposes multifaceted approaches to lessen these gaps.

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P14.10: Factors associated with inconsistency in visibility of the endometrial echo on transvaginal ultrasound of postmenopausal women

Cited by 2 publications

References 0 publications

Estimated Performance of Transvaginal Ultrasonography for Evaluation of Postmenopausal Bleeding in a Simulated Cohort of Black and White Women in the US

Estimated Performance of Transvaginal Ultrasonography for Evaluation of Postmenopausal Bleeding in a Simulated Cohort of Black and White Women in the US

Racioethnic Disparities in Endometrial Cancer Outcomes

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