Risk Factors Impacting Endometrial Thickness Visibility and Information Availability in Black Patients

Background: Black patients experience worse endometrial cancer outcomes compared to white patients. Endometrial thickness (ET) measures from transvaginal ultrasound (TVUS) are used in diagnostic triage to determine if further endometrial tissue sampling is needed. However, recent work suggests that TVUS may disproportionately underdiagnose Black patients and those over 60 years old, contributing to Black patients' lower survival. Our study aimed to identify risk factors that impact ET measurement quality [visibility, missing data] from TVUS and result in nondiagnostic TVUS results. Methods: A retrospective analysis was conducted in a cohort of Black patients undergoing hysterectomy from 2014 to 2020. ET visibility documentation was categorized as visible or "compromised" (partially visible or nonvisible). The presence or absence of endometrial information was also assessed. Results: Of 2,705 patients with ultrasound information, 78% (N = 1,838) had documented ET visibility. Of those with visibility, 1,301 (71%) had complete ET visibility. Among those with compromised visibility (n = 537), 271 (50.5%) had partially visible ET, while 266 (49.5%) had nonvisible ET. Significant risk factors associated with compromised visibility included an enlarged uterus (OR: 2.89, 95% CI: 2.32-3.61) and fibroids (OR: 3.78, 95% CI: 1.94-7.39). Of 2,032 patients with ultrasound reports, 9.5% (N = 194) lacked endometrial information. Fibroids (OR: 1.81, 95% CI: 1.19-2.76) and enlarged uterus (OR: 2.61, 95% CI: 1.53-4.45) were also significantly associated with missing endometrial information. Conclusion: These findings suggest that a substantial proportion of TVUS examinations may not yield definitive data for diagnostic triage in Black women, potentially contributing to diagnostic delays and worse survival. Improved diagnostic approaches are needed in this population.