Sensitivity of transvaginal ultrasound screening for endometrial cancer in postmenopausal women: a case-control study within the UKCTOCS cohort.

Area of Science:

• Gynecologic Oncology
• Diagnostic Imaging
• Preventive Medicine

Background:

• Rising global incidence of endometrial cancer linked to obesity, declining fertility, and an aging population.
• Transvaginal ultrasound (TVS) is a potential screening tool, but large-scale data are limited.
• This study reports TVS screening performance in a substantial cohort of postmenopausal women.

Purpose of the Study:

• To evaluate the performance of TVS for endometrial cancer screening in postmenopausal women.
• To determine optimal endometrial thickness cutoffs for detecting endometrial cancer and atypical endometrial hyperplasia (AEH).
• To assess the utility of a risk-stratified screening approach.

Main Methods:

• Nested case-control study within the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS).
• Analysis of endometrial thickness and abnormalities from TVS in 48,230 postmenopausal women.
• Follow-up via national registries and questionnaires to identify endometrial cancer and AEH diagnoses within one year of TVS.

Main Results:

• An endometrial thickness cutoff of 5.15 mm yielded 80.5% sensitivity and 86.2% specificity for detecting endometrial cancer or AEH.
• Combining a 5 mm cutoff with endometrial abnormalities improved sensitivity to 85.3% and specificity to 80.4%.
• A logistic regression model identified a high-risk group (25% of the population) accounting for 39.5% of cases; a 6.75 mm cutoff in this group achieved 84.3% sensitivity and 89.9% specificity.

Conclusions:

• TVS demonstrates good sensitivity for endometrial cancer screening in postmenopausal women.
• Screening higher-risk populations can decrease diagnostic procedures and false positives.
• Findings are valuable for managing postmenopausal women with increased endometrial thickness detected incidentally.