Prospective study of racial differences in sonographic evaluation in suspected cases of endometrial neoplasia

Black women have twice the endometrial cancer mortality of White women, and studies suggest that differences in ultrasound diagnostic accuracy contribute to this disparity. A prospective study of 1833 women aged 50 and older at risk of endometrial neoplasia who underwent endometrial evaluation between 2014 and 2022 at Montefiore Medical Center (Bronx, NY) evaluated racial and ethnical differences in the diagnostic performance of transvaginal ultrasound for detecting endometrial neoplasia. The mean age was 60.3 years (SD 8.1), most were postmenopausal (87.4%); 45.4% were Black, 38.5% were Hispanic, and 13.8% were White. Black women had significantly lower ultrasound completion rates than White women (76% versus 89%), primarily due to fibroids limiting endometrial visualization. Accuracy among completed scans was slightly lower for Black women than for White women (sensitivity 96.3% versus 100%; negative predictive value 97.9% versus 100%). The authors conclude that ultrasound completion rates were lower among Black women; nevertheless, transvaginal sonography demonstrated a 76% completion rate and retained excellent ability to exclude cancer in Black women.