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Ultrasonographic evaluation of endometrial stripe thickness is insufficient to rule out uterine serous carcinoma

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Abstract

Purpose

Uterine serous carcinoma (USC) is a rare endometrial cancer representing less than 10% of uterine cancers but contributing to up to 50% of the mortality. Delay in diagnosis with this high-grade histology can have significant clinical impact. USC is known to arise in a background of endometrial atrophy. We investigated endometrial stripe (EMS) thickness in USC to evaluate current guidelines for postmenopausal bleeding in the context of this histology.

Methods

Retrospective chart review was conducted using ICD-9 and ICD-10 codes over an 18-year period. We included 139 patients with USC and compared characteristics of patients with EMS ≤ 4 mm and EMS > 4 mm. Chi-square or Fisher’s exact tests were used to compare proportions and two-tailed t-tests to compare means. A p-value of < 0.05 was considered statistically significant.

Results

Most patients were white, obese, and multiparous. Thirty-two (23%) had an EMS ≤ 4 mm; 107 (77%) had an EMS > 4 mm. There were no statistically significant differences in age at diagnosis or presenting symptoms between groups, and postmenopausal bleeding was the most common symptom in each group.

Conclusion

Nearly 25% of patients with USC initially evaluated with transvaginal ultrasound were found to have an EMS ≤ 4 mm. If transvaginal ultrasound is used to triage these patients, one in four women will potentially experience a delay in diagnosis that may impact their prognosis.

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Data availability

The datasets generated during and analyzed during the current study are not publicly available in order to maintain subject confidentiality.

Abbreviations

ACOG:

American College of Obstetricians and Gynecologists

EC:

Endometrial cancer

EMS:

Endometrial stripe

LMG:

Legacy Medical Group

OHSU:

Oregon Health and Science University

PMB:

Postmenopausal bleeding

REDCap:

Research Electronic Data Capture

SH:

Salem Health

TVUS:

Transvaginal ultrasound

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Acknowledgments

Support for this manuscript was provided in part by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, 800 Stanton L Young Boulevard, AAT-2400, Oklahoma City, OK, 73104, USA

    Jaime M. Kiff

  2. Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA

    Mercedes Williams-Weisenberger, Bharti Garg, Elizabeth G. Munro & Amanda S. Bruegl

  3. College of Medicine, Washington State University, Pullman, WA, USA

    Danielle Spellacy

Authors
  1. Jaime M. Kiff
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  4. Bharti Garg
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  6. Amanda S. Bruegl
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Contributions

JMK: Data curation, Writing—original draft, MW-W: Conceptualization, Methodology, Data curation, DS: Data curation, BG: Methodology, Formal analysis, EM: Writing—review & editing, AB: Conceptualization, Funding acquisition, Methodology, Writing—review & editing.

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Correspondence to Jaime M. Kiff.

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The authors have no financial or non-financial conflicts of interest to disclose.

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This study was conducted at Oregon Health and Science University in Portland, Oregon.

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Kiff, J.M., Williams-Weisenberger, M., Spellacy, D. et al. Ultrasonographic evaluation of endometrial stripe thickness is insufficient to rule out uterine serous carcinoma. Cancer Causes Control 34, 1133–1138 (2023). https://doi.org/10.1007/s10552-023-01759-y

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  • DOI: https://doi.org/10.1007/s10552-023-01759-y

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