ImportancePoor performance of the transvaginal ultrasonography triage strategy has been suggested as a contributor to racial disparity between Black individuals and White individuals in endometrial cancer (EC) stage at diagnosis in population-level simulation analyses.ObjectivesTo examine the false-negative probability using ultrasonography-measured endometrial thickness (ET) thresholds as triage for EC diagnosis among Black individuals and assess whether known risk factors of EC modify ET triage performance.Design, Setting, and ParticipantsThis retrospective diagnostic study of merged abstracted electronic health record data and secondary administrative data (January 1, 2014, to December 31, 2020) from the Guidelines for Transvaginal Ultrasound in the Detection of Early Endometrial Cancer sample assessed Black individuals who underwent hysterectomy in a 10-hospital academic-affiliated health care system and affiliated outpatient practices. Data analysis was performed from January 31, 2023, to November 30, 2023.ExposurePelvic ultrasonography within 24 months before hysterectomy.Main Outcome and MeasuresUltrasonography performed before hysterectomy as well as demographic and clinical data on symptom presentation, endometrial characterization, and final EC diagnosis were abstracted. Endometrial thickness thresholds were examined for accuracy in ruling out EC diagnosis by using sensitivity, specificity, and negative predictive value. False-negative probability was defined as 1 − sensitivity. Accuracy measures were stratified by risk factors for EC and by factors hypothesized to influence ET measurement quality.ResultsA total of 1494 individuals with a uterus (median [IQR] age, 46.1 [41.1-54.0] years) comprised the sample, and 210 had EC. Fibroids (1167 [78.1%]), vaginal bleeding (1067 [71.4%]), and pelvic pain (857 [57.4%]) were the most common presenting diagnoses within 30 days of ultrasonography. Applying the less than 5-mm ET threshold, there was an 11.4% probability that someone with EC would be classified as not having EC (n = 24). At the 4-mm (cumulative) threshold, the probability was 9.5%, and at 3 mm, it was 3.8%. False-negative probability at the 5-mm threshold was similar among EC risk factor groups: postmenopausal bleeding (12.4%; 95% CI, 7.8%-18.5%), body mass index greater than 40 (9.3%; 95% CI, 3.1%-20.3%); and age 50 years or older (12.8%; 95% CI, 8.4%-18.5%). False-negative probability was also similar among those with fibroids on ultrasonography (11.8%; 95% CI, 6.9%-18.4%) but higher in the setting of reported partial ET visibility (26.1%; 95% CI, 10.2%-48.4%) and pelvic pain (14.5%; 95% CI, 7.7%-23.9%).Conclusion and RelevanceThese findings suggest that the transvaginal ultrasonography triage strategy is not reliable among Black adults at risk for EC. In the presence of postmenopausal bleeding, tissue sampling is strongly recommended.

中文翻译：

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子宫内膜厚度作为黑人子宫内膜癌的诊断分诊


重要性在人群水平模拟分析中，经阴道超声检查分诊策略的不良表现被认为是造成子宫内膜癌 (EC) 阶段黑人和白人之间种族差异的一个因素。目的使用超声检查测量的结果检查假阴性概率子宫内膜厚度（ET）阈值作为黑人个体中 EC 诊断的分类，并评估已知的 EC 危险因素是否会改变 ET 分类性能。设计、设置和参与者这项回顾性诊断研究合并了抽象电子健康记录数据和二级管理数据（1 月 1 日） ，2014年至2020年12月31日）来自《经阴道超声检测早期子宫内膜癌指南》样本评估了在由10家医院组成的学术附属医疗保健系统和附属门诊诊所接受子宫切除术的黑人个体。数据分析于2023年1月31日至2023年11月30日进行。子宫切除术前24个月内进行盆腔超声检查。主要结果和措施子宫切除术前进行的超声检查以及有关症状表现、子宫内膜特征和最终EC诊断的人口统计学和临床​​数据抽象的。使用敏感性、特异性和阴性预测值检查子宫内膜厚度阈值排除 EC 诊断的准确性。假阴性概率定义为 1 − 灵敏度。根据 EC 风险因素和假设影响 ET 测量质量的因素对准确度测量进行分层。结果样本共有 1494 名有子宫的个体（中位 [IQR] 年龄，46.1 [41.1-54.0] 岁），其中 210 人患有 EC 。肌瘤（1167 [78。超声检查 30 天内最常见的诊断是阴道出血 (1067 [71.4%]) 和盆腔疼痛 (857 [57.4%])。应用小于 5 毫米的 ET 阈值，患有 EC 的人有 11.4% 的概率被归类为不患有 EC (n = 24)。在 4 毫米（累积）阈值处，概率为 9.5%，在 3 毫米处，概率为 3.8%。 EC 危险因素组中 5 毫米阈值的假阴性概率相似：绝经后出血（12.4%；95% CI，7.8%-18.5%）、体重指数大于 40（9.3%；95% CI，3.1） %-20.3%);年龄为 50 岁或以上（12.8%；95% CI，8.4%-18.5%）。超声检查显示肌瘤的假阴性概率也相似（11.8%；95% CI，6.9%-18.4%），但在报告部分 ET 可见性的情况下假阴性概率较高（26.1%；95% CI，10.2%-48.4%） ）和盆腔疼痛（14.5%；95% CI，7.7%-23.9%）。结论和相关性这些研究结果表明，经阴道超声检查分类策略在有 EC 风险的黑人成人中并不可靠。如果存在绝经后出血，强烈建议进行组织取样。