将子宫内膜厚度作为黑人子宫内膜癌的诊断分流标准。

IF 28.4 1区 医学 Q1 Biochemistry, Genetics and Molecular Biology
Kemi M Doll, Mindy Pike, Julianna Alson, Patrice Williams, Erin Carey, Til Stürmer, Mollie Wood, Erica E Marsh, Ronit Katz, Whitney R Robinson
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引用次数: 0

摘要

重要性:经阴道超声波检查分流策略效果不佳被认为是导致黑人与白人在人群水平模拟分析中子宫内膜癌(EC)诊断阶段种族差异的一个因素:目的:研究使用超声波测量的子宫内膜厚度(ET)阈值作为黑人EC诊断分流的假阴性概率,并评估EC的已知风险因素是否会改变ET分流效果:这项回顾性诊断研究对《经阴道超声检测早期子宫内膜癌指南》抽取的电子健康记录数据和二级管理数据(2014 年 1 月 1 日至 2020 年 12 月 31 日)进行了合并,评估了在一家 10 家医院的学术附属医疗系统和附属门诊诊所接受子宫切除术的黑人患者。数据分析时间为 2023 年 1 月 31 日至 2023 年 11 月 30 日:主要结果和测量指标:摘录了子宫切除术前进行的超声检查以及有关症状表现、子宫内膜特征和最终EC诊断的人口统计学和临床数据。通过灵敏度、特异性和阴性预测值检查子宫内膜厚度阈值在排除EC诊断方面的准确性。假阴性概率定义为 1 - 敏感性。根据EC的风险因素和假定影响ET测量质量的因素对准确性进行了分层:样本中共有 1494 名子宫患者(中位数[IQR]年龄为 46.1 [41.1-54.0] 岁),其中 210 人患有子宫内膜异位症。子宫肌瘤(1167 [78.1%])、阴道出血(1067 [71.4%])和盆腔疼痛(857 [57.4%])是超声检查后 30 天内最常见的诊断症状。以ET小于5毫米为界限,有11.4%的EC患者会被归类为非EC(n = 24)。以 4 毫米(累积)为阈值,概率为 9.5%,以 3 毫米为阈值,概率为 3.8%。在 5 毫米阈值下,EC 风险因素组的假阴性概率相似:绝经后出血(12.4%;95% CI,7.8%-18.5%)、体重指数大于 40(9.3%;95% CI,3.1%-20.3%)和 50 岁或以上(12.8%;95% CI,8.4%-18.5%)。超声检查发现子宫肌瘤的患者的假阴性概率也相似(11.8%;95% CI,6.9%-18.4%),但报告部分ET可见度(26.1%;95% CI,10.2%-48.4%)和盆腔疼痛(14.5%;95% CI,7.7%-23.9%)的患者的假阴性概率更高:这些研究结果表明,经阴道超声波检查分流策略在高危黑人成人中并不可靠。如果出现绝经后出血,强烈建议进行组织采样。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Endometrial Thickness as Diagnostic Triage for Endometrial Cancer Among Black Individuals.

Importance: 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.

Objectives: 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.

Design, setting, and participants: 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.

Exposure: Pelvic ultrasonography within 24 months before hysterectomy.

Main outcome and measures: 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 - sensitivity. Accuracy measures were stratified by risk factors for EC and by factors hypothesized to influence ET measurement quality.

Results: 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 = 24). 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%).

Conclusion and relevance: 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.

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来源期刊
Jama Oncology
Jama Oncology Medicine-Oncology
CiteScore
37.50
自引率
1.80%
发文量
423
期刊介绍: At JAMA Oncology, our primary goal is to contribute to the advancement of oncology research and enhance patient care. As a leading journal in the field, we strive to publish influential original research, opinions, and reviews that push the boundaries of oncology science. Our mission is to serve as the definitive resource for scientists, clinicians, and trainees in oncology globally. Through our innovative and timely scientific and educational content, we aim to provide a comprehensive understanding of cancer pathogenesis and the latest treatment advancements to our readers. We are dedicated to effectively disseminating the findings of significant clinical research, major scientific breakthroughs, actionable discoveries, and state-of-the-art treatment pathways to the oncology community. Our ultimate objective is to facilitate the translation of new knowledge into tangible clinical benefits for individuals living with and surviving cancer.
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