Faculty mentor/PI email address
schnatz@rowan.edu
Keywords
Endometrial Cancer, Transvaginal Ultrasound, Endometrial Thickness, Racial Disparities, Diagnostic Sensitivity, Health Equity
Date of Presentation
5-6-2026 12:00 AM
Poster Abstract
Title: Evaluating the 4mm Endometrial Thickness Threshold: Racial Disparities in Ultrasound Sensitivity and Diagnostic Delay
Background: Current ACOG guidelines utilize a 4mm endometrial thickness (ET) threshold via transvaginal ultrasound (TVUS) to exclude malignancy in postmenopausal women. However, recent evidence suggests these standardized thresholds may not be equally effective across all racial cohorts. This systematic review evaluates the diagnostic performance of the 4mm threshold specifically in Black patients.
Methods: A systematic search of peer-reviewed literature was conducted to identify studies comparing TVUS sensitivity and clinical outcomes between racial groups. Data were extracted focusing on the diagnostic sensitivity of the 4mm threshold, the prevalence of confounding uterine factors, and the interval to diagnosis.
Results: Synthesis of the available data demonstrates a significant reduction in TVUS sensitivity among Black women when using the standard 4mm threshold. Findings indicate that sensitivity can fall as low as 47.5% in this population. This decreased accuracy is strongly correlated with a higher prevalence of uterine fibroids and varied histological presentations, which frequently obscure ultrasound findings and lead to significant diagnostic delays compared to other cohorts.
Conclusion: The findings of this review suggest that a universal 4mm ET threshold may be insufficient for the evaluation of symptomatic Black women. There is a critical need for individualized risk assessment and the consideration of lower diagnostic thresholds to ensure equitable cancer detection and reduce time-to-treatment in underrepresented populations.
Disciplines
Diagnosis | Medicine and Health Sciences | Population Health | Women's Health
Included in
Diagnosis Commons, Population Health Commons, Women's Health Commons
Evaluating the 4mm Endometrial Thickness Threshold: Racial Disparities in Ultrasound Sensitivity and Diagnostic Delay
Title: Evaluating the 4mm Endometrial Thickness Threshold: Racial Disparities in Ultrasound Sensitivity and Diagnostic Delay
Background: Current ACOG guidelines utilize a 4mm endometrial thickness (ET) threshold via transvaginal ultrasound (TVUS) to exclude malignancy in postmenopausal women. However, recent evidence suggests these standardized thresholds may not be equally effective across all racial cohorts. This systematic review evaluates the diagnostic performance of the 4mm threshold specifically in Black patients.
Methods: A systematic search of peer-reviewed literature was conducted to identify studies comparing TVUS sensitivity and clinical outcomes between racial groups. Data were extracted focusing on the diagnostic sensitivity of the 4mm threshold, the prevalence of confounding uterine factors, and the interval to diagnosis.
Results: Synthesis of the available data demonstrates a significant reduction in TVUS sensitivity among Black women when using the standard 4mm threshold. Findings indicate that sensitivity can fall as low as 47.5% in this population. This decreased accuracy is strongly correlated with a higher prevalence of uterine fibroids and varied histological presentations, which frequently obscure ultrasound findings and lead to significant diagnostic delays compared to other cohorts.
Conclusion: The findings of this review suggest that a universal 4mm ET threshold may be insufficient for the evaluation of symptomatic Black women. There is a critical need for individualized risk assessment and the consideration of lower diagnostic thresholds to ensure equitable cancer detection and reduce time-to-treatment in underrepresented populations.