In a simulated cohort of symptomatic women, the performance of suggested transvaginal ultrasonography (TVUS) ET thresholds as a screening technique to trigger endometrial biopsy was compared by race.

Design, Environment, and Participants Based on data from the Surveillance, Epidemiology, and End Results (SEER) national cancer registry from 2012 to 2016, the US census, and published estimates of ET distribution and fibroid prevalence, diagnostic test characteristics of the 3-mm or more, 4-mm or more, and 5-mm or more ET thresholds for biopsy to capture EC diagnoses were calculated in a simulated retrospective cohort study. The simulated cohort was built between February 2, 2020, and August 31, 2020. The major analysis and sensitivity calculations took place between September 30, 2020, and March 30, 2021. The key result examined was the sensitivity, negative predictive value, and area under the curve (AUC) of the TVUS ET threshold in identifying instances of EC. 


A total of 367,073 simulated Black and White postmenopausal bleeding women were evaluated, including 36,708 with EC. The current suggested 4-mm or larger ET threshold induced biopsy for less than half of EC cases among Black women (sensitivity, 47.5%; 95% CI, 46.0% -49.0%); of women referred for biopsy, 13.1% were EC cases (positive predictive value, 13.1%; 95% CI, 12.5% -13.6% ). For the 4-mm or greater criteria, the AUC was 0.57. (95% CI, 0.56-0.57). In contrast, for the majority of White women with EC, a 4-mm or greater threshold resulted in a biopsy (sensitivity, 87.9%; 95% CI, 87.6% -88.3% ). EC was found in 14.6% of individuals submitted for biopsy (positive predictive value, 14.6%; 95% CI, 14.4% -14.7%); AUC was 0.73. (95% CI, 0.73-0.74). The same differences were seen for the 3-mm or greater and 5-mm or greater ET thresholds: sensitivity, positive predictive value, and AUC were consistently lower in Black women than in White women.