Transvaginal Ultrasonography Triage Unreliable for Endometrial Cancer Diagnosis in High-Risk Black Women

แนวคิดหลัก

Transvaginal ultrasonography-based endometrial thickness triage strategy has a significant risk of false-negative results for endometrial cancer diagnosis in high-risk Black women.

บทคัดย่อ

The study assessed the performance of transvaginal ultrasonography-measured endometrial thickness as a diagnostic triage strategy for endometrial cancer in 1,494 Black women who underwent hysterectomy. The researchers focused on endometrial thickness measurements recorded within 24 months before hysterectomy, as well as demographic and clinical data.

The key findings are:

• 210 women had endometrial cancer, with the most common presenting symptoms being fibroids (78%), vaginal bleeding (71%), and pelvic pain (57%).
• 24 cases of endometrial cancer were below the 5-mm endometrial thickness threshold that would trigger biopsy, resulting 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 did not improve the performance of the endometrial thickness triage strategy.
• False-negative probability was also higher in the setting of partial endometrial thickness visibility (26%) and pelvic pain (15%).

The researchers concluded that the transvaginal ultrasonography triage strategy is unreliable for diagnosing endometrial cancer in high-risk Black women, with a significant risk for false-negative results. They recommend tissue biopsy for Black patients with concerning symptoms to avoid misdiagnosis of endometrial cancer.

สถิติ

24 cases of endometrial cancer were below the 5-mm endometrial thickness threshold that would trigger biopsy, resulting 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.
False-negative probability was higher in the setting of partial endometrial thickness visibility (26%) and pelvic pain (15%).

คำพูด

"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.'"
"For Black patients with concerning symptoms, tissue biopsy is recommended to avoid misdiagnosis of endometrial cancer."

ข้อมูลเชิงลึกที่สำคัญจาก

This Cancer Screening Approach Is Unreliable in Black Women

by Megan Brooks ที่ www.medscape.com 07-17-2024

https://www.medscape.com/viewarticle/transvaginal-ultrasound-often-misses-endometrial-cancer-2024a1000d6l

สอบถามเพิ่มเติม

What alternative screening methods or diagnostic approaches could be more reliable for detecting endometrial cancer in high-risk Black women?

In high-risk Black women, alternative screening methods or diagnostic approaches that could be more reliable for detecting endometrial cancer include:

Endometrial Biopsy: Direct sampling of the endometrial tissue can provide a more accurate diagnosis compared to relying solely on transvaginal ultrasonography-measured endometrial thickness.
MRI Imaging: Magnetic Resonance Imaging (MRI) can offer detailed images of the endometrium, aiding in the detection of abnormalities that may indicate endometrial cancer.
Hysteroscopy: This procedure allows for direct visualization of the endometrium and can help in identifying suspicious areas for biopsy.
Biomarker Testing: Utilizing biomarkers such as CA-125 or HE4 in conjunction with imaging techniques can enhance the accuracy of endometrial cancer detection.

How do the findings of this study compare to the performance of transvaginal ultrasonography in diagnosing endometrial cancer in other racial/ethnic groups?

The findings of this study highlight the unreliability of transvaginal ultrasonography as a diagnostic triage strategy for endometrial cancer, particularly in high-risk Black women. While this study focused on Black women, similar issues with false-negative results and missed diagnoses may also exist in other racial/ethnic groups. However, the impact of these findings may vary based on the prevalence of endometrial cancer and the distribution of risk factors across different populations. Further research is needed to assess the performance of transvaginal ultrasonography in diagnosing endometrial cancer in diverse racial/ethnic groups to determine if similar disparities exist.

What are the potential underlying biological or socioeconomic factors that may contribute to the observed racial disparities in endometrial cancer diagnosis and outcomes?

The observed racial disparities in endometrial cancer diagnosis and outcomes among Black women may be influenced by various biological and socioeconomic factors, including:

Genetic Variations: Differences in genetic predispositions to endometrial cancer among racial groups may impact disease incidence and progression.
Access to Healthcare: Limited access to quality healthcare services, including screening and diagnostic tools, can lead to delays in diagnosis and poorer outcomes.
Health Literacy: Disparities in health literacy and awareness of endometrial cancer symptoms and risk factors may contribute to delayed diagnosis in Black women.
Socioeconomic Status: Socioeconomic factors such as income, education level, and insurance coverage can affect the timeliness of seeking medical care and receiving appropriate diagnostic evaluations.
Implicit Bias: Healthcare provider biases and systemic racism within the healthcare system may result in disparities in the quality of care and treatment offered to Black women with endometrial cancer.

Addressing these complex interplay of factors is crucial in reducing racial disparities in endometrial cancer diagnosis and improving outcomes for Black women.