According to results from a large multicenter study of patients with postmenopausal bleeding, only two-thirds of patients with abnormal or inadequate transvaginal ultrasound received a timely endometrial sampling.

These results were first presented by Angela Nolin, MD, Duke University School of Medicine, Durham, North Carolina, at the 2025 Society of Gynecological Oncology Annual Meeting on Women’s Cancer.

Dr Nolin and coauthors explained, “A common [diagnostic strategy for postmenopausal bleeding] is transvaginal ultrasound (TVUS), followed by endometrial sampling if the endometrium exceeds 4 mm or is inadequately visualized.” The authors noted that fibroids, which affect TVUS efficacy are more common among non-Hispanic Black patients and that “racial differences in TVUS efficacy and timely receipt of indicated endometrial sampling could contribute to delays in diagnosis [of endometrial cancer].”

This study included a review of 6466 patients with postmenopausal bleeding who underwent a TVUS between 2013 and 2022. The results of the TVUS were categorized as endometrium visualized with a thickness of >4 mm (thick/biopsy indicated), inadequately visualized endometrium (inadequate/biopsy indicated), or endometrium visualized with a thickness of ≤4 mm (thin/biopsy not indicated). Guideline-concordant care, which is defined as a receipt of endometrial sampling within 3 months if a biopsy is indicated, was compared across the categories, patient race/ethnicity, and fibroid presence.

Of the 6466 patients (40.7% non-Hispanic White, 25.7% non-Hispanic Black, 15.4% Hispanic, 3% non-Hispanic Asian, 16% other/unknown), 13.2% of patients had an inadequate TVUS, 46.3% had a thick endometrium, and 40.5% had a thin endometrium. Among non-Hispanic White patients, 48% had fibroids, compared to 74% among non-Hispanic Black patients. Fibroids were present among 74.3% of all patients with an inadequate TVUS, 57.5% of all patients with a thick endometrium, and 49.4% of all patients with a thin endometrium. Of the patients with an inadequate TVUS, 50.5% received guidance-concordant care. Of all patients with a thick endometrium, 74.5% received guidance-concordant care. Study authors noted, “The higher prevalence of fibroids and subsequent inadequate TVUS in [non-Hispanic Black] patients was associated with a higher rate of failure to sample.” Care that was not guidance-concordant was significantly higher among non-Hispanic Black patients (23.1%) than among non-Hispanic White patients (14.7%; P < .001).

Dr Nolin et al, concluded, “A universal biopsy-based approach to postmenopausal bleeding should be considered.”

Source:

Nolin A, Atkins S, Brucker A, et al. Timely endometrial sampling after transvaginal ultrasound: Multi-institutional performance of ultrasound in menopausal bleeding assignment (PUMBA) study. Presented at the 2025 SGO Annual Meeting at Women’s Cancer. March 14-17, 2025; Seattle Washington. Abstract LBA 941012