{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T16:19:15Z","timestamp":1792685955048,"version":"4.5.0"},"reference-count":17,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Oncol"],"published-print":{"date-parts":[[2024,8,1]]},"abstract":"<jats:sec id=\"ab-coi240024-4\"><jats:title>Importance<\/jats:title><jats:p>Poor 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.<\/jats:p><\/jats:sec><jats:sec id=\"ab-coi240024-5\"><jats:title>Objectives<\/jats:title><jats:p>To 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.<\/jats:p><\/jats:sec><jats:sec id=\"ab-coi240024-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This 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.<\/jats:p><\/jats:sec><jats:sec id=\"ab-coi240024-7\"><jats:title>Exposure<\/jats:title><jats:p>Pelvic ultrasonography within 24 months before hysterectomy.<\/jats:p><\/jats:sec><jats:sec id=\"ab-coi240024-8\"><jats:title>Main Outcome and Measures<\/jats:title><jats:p>Ultrasonography 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\u2009\u2212\u2009sensitivity. Accuracy measures were stratified by risk factors for EC and by factors hypothesized to influence ET measurement quality.<\/jats:p><\/jats:sec><jats:sec id=\"ab-coi240024-9\"><jats:title>Results<\/jats:title><jats:p>A 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\u2009=\u200924). 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%).<\/jats:p><\/jats:sec><jats:sec id=\"ab-coi240024-10\"><jats:title>Conclusion and Relevance<\/jats:title><jats:p>These 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.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamaoncol.2024.1891","type":"journal-article","created":{"date-parts":[[2024,6,27]],"date-time":"2024-06-27T17:36:05Z","timestamp":1719509765000},"page":"1068","source":"Crossref","is-referenced-by-count":39,"title":["Endometrial Thickness as Diagnostic Triage for Endometrial Cancer Among Black Individuals"],"prefix":"10.1001","volume":"10","author":[{"given":"Kemi M.","family":"Doll","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Fred Hutchinson Cancer Center, University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mindy","family":"Pike","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Fred Hutchinson Cancer Center, University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julianna","family":"Alson","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Fred Hutchinson Cancer Center, University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrice","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Fred Hutchinson Cancer Center, University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Carey","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Til","family":"St\u00fcrmer","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mollie","family":"Wood","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica E.","family":"Marsh","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, School of Medicine, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronit","family":"Katz","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Fred Hutchinson Cancer Center, University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Whitney R.","family":"Robinson","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, School of Medicine, University of Michigan, Ann Arbor"},{"name":"Department of Obstetrics and Gynecology, School of Medicine, Duke University, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"9","key":"coi240024r1","doi-asserted-by":"publisher","first-page":"1210","DOI":"10.1001\/jamainternmed.2018.2820","article-title":"Association of endometrial cancer risk with postmenopausal bleeding in women: a systematic review and meta-analysis.","volume":"178","author":"Clarke","year":"2018","journal-title":"JAMA Intern Med"},{"issue":"2","key":"coi240024r2","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1016\/j.ygyno.2014.05.018","article-title":"Endometrial cancer: a review and current management strategies: part I.","volume":"134","author":"Burke","year":"2014","journal-title":"Gynecol Oncol"},{"issue":"5","key":"coi240024r3","doi-asserted-by":"publisher","first-page":"e124","DOI":"10.1097\/AOG.0000000000002631","article-title":"ACOG Committee Opinion No. 734: the role of transvaginal ultrasonography in evaluating the endometrium of women with postmenopausal bleeding.","volume":"131","author":"ACOG Committee Opinion No","year":"2018","journal-title":"Obstet Gynecol"},{"issue":"3","key":"coi240024r4","doi-asserted-by":"publisher","first-page":"624","DOI":"10.1016\/j.ygyno.2020.01.032","article-title":"Ultrasound detection of endometrial cancer in women with postmenopausal bleeding: systematic review and meta-analysis.","volume":"157","author":"Long","year":"2020","journal-title":"Gynecol Oncol"},{"issue":"6","key":"coi240024r5","doi-asserted-by":"publisher","first-page":"593.e1","DOI":"10.1016\/j.ajog.2018.09.040","article-title":"Role of bleeding recognition and evaluation in Black-White disparities in endometrial cancer.","volume":"219","author":"Doll","year":"2018","journal-title":"Am J Obstet Gynecol"},{"issue":"5","key":"coi240024r6","doi-asserted-by":"publisher","first-page":"e204954","DOI":"10.1001\/jamanetworkopen.2020.4954","article-title":"Assessment of prediagnostic experiences of black women with endometrial cancer in the United States.","volume":"3","author":"Doll","year":"2020","journal-title":"JAMA Netw Open"},{"issue":"8","key":"coi240024r7","doi-asserted-by":"publisher","first-page":"1158","DOI":"10.1001\/jamaoncol.2021.1700","article-title":"Estimated performance of transvaginal ultrasonography for evaluation of postmenopausal bleeding in a simulated cohort of Black and White women in the US.","volume":"7","author":"Doll","year":"2021","journal-title":"JAMA Oncol"},{"issue":"4","key":"coi240024r8","doi-asserted-by":"publisher","first-page":"549.e1","DOI":"10.1016\/j.ajog.2020.03.032","article-title":"Risk assessment of endometrial cancer and endometrial intraepithelial neoplasia in women with abnormal bleeding and implications for clinical management algorithms.","volume":"223","author":"Clarke","year":"2020","journal-title":"Am J Obstet Gynecol"},{"issue":"5","key":"coi240024r9","doi-asserted-by":"publisher","first-page":"598.e1","DOI":"10.1016\/j.ajog.2016.06.006","article-title":"Body mass index trumps age in decision for endometrial biopsy: cohort study of symptomatic premenopausal women.","volume":"215","author":"Wise","year":"2016","journal-title":"Am J Obstet Gynecol"},{"issue":"22","key":"coi240024r11","doi-asserted-by":"publisher","first-page":"1895","DOI":"10.1200\/JCO.19.00151","article-title":"Hysterectomy-corrected uterine corpus cancer incidence trends and differences in relative survival reveal racial disparities and rising rates of nonendometrioid cancers.","volume":"37","author":"Clarke","year":"2019","journal-title":"J Clin Oncol"},{"issue":"3","key":"coi240024r12","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1016\/j.ajog.2016.12.023","article-title":"Untangling the Black-White mortality gap in endometrial cancer: a cohort simulation.","volume":"216","author":"Doll","year":"2017","journal-title":"Am J Obstet Gynecol"},{"issue":"1-2","key":"coi240024r13","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/0021-9681(79)90012-2","article-title":"Bias in analytic research.","volume":"32","author":"Sackett","year":"1979","journal-title":"J Chronic Dis"},{"issue":"5","key":"coi240024r14","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1097\/01.ede.0000135174.63482.43","article-title":"A structural approach to selection bias.","volume":"15","author":"Hern\u00e1n","year":"2004","journal-title":"Epidemiology"},{"issue":"3","key":"coi240024r15","doi-asserted-by":"crossref","first-page":"47","DOI":"10.2307\/3002000","article-title":"Limitations of the application of fourfold table analysis to hospital data.","volume":"2","author":"Berkson","year":"1946","journal-title":"Biometrics"},{"issue":"8","key":"coi240024r16","doi-asserted-by":"crossref","first-page":"1765","DOI":"10.1002\/1097-0142(20001015)89:8<1765::AID-CNCR17>3.0.CO;2-F","article-title":"The accuracy of endometrial sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia: a meta-analysis.","volume":"89","author":"Dijkhuizen","year":"2000","journal-title":"Cancer"},{"issue":"33","key":"coi240024r17","doi-asserted-by":"crossref","first-page":"3828","DOI":"10.1200\/JCO.22.00266","article-title":"A simple cervicovaginal epigenetic test for screening and rapid triage of women with suspected endometrial cancer: validation in several cohort and case\/control sets.","volume":"40","author":"Herzog","year":"2022","journal-title":"J Clin Oncol"},{"key":"coi240024r10","volume-title":"Release 18","author":"Stata Statistical Software","year":"2023"}],"container-title":["JAMA Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamaoncology\/articlepdf\/2820528\/jamaoncology_doll_2024_oi_240024_1737571097.3113.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,23]],"date-time":"2025-01-23T16:00:37Z","timestamp":1737648037000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamaoncology\/fullarticle\/2820528"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,1]]},"references-count":17,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2024,8,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamaoncol.2024.1891","relation":{},"ISSN":["2374-2437"],"issn-type":[{"value":"2374-2437","type":"print"}],"subject":[],"published":{"date-parts":[[2024,8,1]]}}}