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

PurposeUterine 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.MethodsRetrospective 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 & LE; 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.ResultsMost patients were white, obese, and multiparous. Thirty-two (23%) had an EMS & LE; 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.ConclusionNearly 25% of patients with USC initially evaluated with transvaginal ultrasound were found to have an EMS & LE; 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.

Automated summary

This study investigated the endometrial stripe thickness in patients with uterine serous carcinoma (USC) and evaluated the current guidelines for postmenopausal bleeding in this type of cancer. The study found that nearly 25% of USC patients had an endometrial stripe thickness less than 4 mm on transvaginal ultrasound, suggesting that using transvaginal ultrasound alone to triage these patients may result in a delay in diagnosis that can impact prognosis.