EP20.06: Performance of ultrasound in women with postmenopausal or abnormal uterine bleeding in white and black ethnic groups: a retrospective cohort study

To assess whether there is a higher incidence of uninformative ultrasound in black women compared to white women presenting with postmenopausal or abnormal uterine bleeding. This was a retrospective cohort study of patients over the age of 45 seen in gynecology clinic with suspected endometrial cancer due to postmenopausal or abnormal bleeding. Cases were identified by searching referral and ultrasound records. Data was collected by retrospective review of clinical records. Demographic, clinical and ultrasound findings were recorded along with subsequent clinical outcomes. An endometrial thickness of 4mm was used as the cut-off for endometrial sampling in women with PMB. Women had a hysteroscopy if ultrasound scan was uninformative or endometrial pathology suspected on ultrasound. Fisher's exact test was used to compare the outcomes between the two groups. 302 patients were included in the study, 152 with documented black ethnicity and 150 white. Black patients had a significantly higher prevalence of fibroids compared to white patients (70%vs36%, p < 0.0001). The endometrial cavity was visible in 95% of scans in white women compared to 80% in black women (p = 0.0001). Of the scans where the endometrium was not visible, 93% of black women had fibroids compared to 57% of white women (p = 0.016). 103/152(68%) of black women had endometrial sampling compared to 85/150(57%) of white women (p = 0.057). 6 cancers were detected in white women (4%) and 3 in black women (2%)(p = 0.334). A higher proportion of black women had uninformative ultrasounds when presenting to our rapid access gynecology clinic compared to white women. Fibroids were more prevalent in the cohort of black patients in our study, and their presence can make the endometrium more challenging to assess. This resulted in a higher proportion of black women needing invasive testing. Alternative methods to investigate for suspected endometrial cancer may be more useful in black populations compared to ultrasound alone.