Tamoxifen and the endometrium: findings of pelvic ultrasound examination and endometrial biopsy in asymptomatic breast cancer patients.

Divisione di Oncologia Medica 1, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy.
Breast Cancer Research and Treatment (Impact Factor: 4.2). 01/1998; 47(1):41-6.
Source: PubMed

ABSTRACT The need for endometrial surveillance in breast cancer patients undergoing adjuvant treatment with tamoxifen is still controversial. In this study, 164 asymptomatic breast cancer patients (110 on treatment with tamoxifen, 20 mg/day, and 54 controls) were examined with pelvic ultrasound and endometrial biopsy. No differences in ultrasound and biopsy findings were observed in the pre- and perimenopausal group between patients treated with tamoxifen and controls. Postmenopausal patients on tamoxifen had a significantly thicker endometrium (mean+/-SD, 7.2+/-8.5 vs. 1.5+/-4.3 mm, p=0.00002) and significantly larger uterine volume (mean+/-SD, 63.2+/-39.9 vs. 43.7+/-38.8 cm3, p=0.0001) than controls. Fifty-four percent of patients on tamoxifen had an endometrial thickness > or = 5 mm, often with multiple irregular sonolucencies suggesting the presence of cysts. Ultrasound findings, however, did not correlate with the presence of endometrial abnormalities on biopsy, and no endometrial cancer or atypical hyperplasia were found. This lack of correlation makes questionable the use of routine sonography in asymptomatic breast cancer patients on tamoxifen. Obtaining routine endometrial samples, on the other hand, may be difficult in some patients because of cervical stenosis or refusal. Until the benefits of endometrial surveillance will be proved, asymptomatic patients should not be submitted routinely to ultrasound examination or biopsy, but encouraged to report promptly any abnormal vaginal bleeding.

1 Bookmark
  • [Show abstract] [Hide abstract]
    ABSTRACT: This review demonstrates the unique advantages of sonography in the oncologic setting. Although computed tomography, magnetic resonance imaging, and positron emission tomography-computed tomography are primary imaging modalities for evaluation of the oncologic patient, sonography is useful for evaluation of various conditions and clinical scenarios associated with cancer. The following article will illustrate the utility of sonography at a tertiary cancer center for diagnosis and problem solving.
    Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 01/2014; 33(1):9-22. DOI:10.7863/ultra.33.1.9 · 1.40 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective:To determine the role, timing and indications for endometrial hysteroscopic investigation in relation to the clinical, ultrasound and histological features of the endometrium during tamoxifen use.Methods:We performed an observational longitudinal cohort study (years 2007-2012) that investigated the endometria of 151 tamoxifen users with hysteroscopy and histology. For all patients, gynaecological history, years of adjuvant treatment, ultrasound endometrial thickness measurement and indications for hysteroscopy were recorded.Results:Hysteroscopic findings showed that 100% of patients referred for simple follow-up had no evidence of endometrial disease. We found a strong correlation between previous history of abnormal uterine bleeding (with or without endometrial thickening) and hysteroscopic suspicion of endometrial atypia that was confirmed by histology.Hysteroscopy had 83.3%-sensitivity, 99%-specificity, 83.3%-PPV and 99%-NPV in detecting endometrial atypia. No significant correlation was found between endometrial thickening to >5mm without bleeding and histological atypia. Similarly, the duration of treatment was not related to endometrial thickening and histological atypia.Endometrial stromal hyperplasia was detected by histology in 70.5% of patients with endometrial thickness measurements ranging from 5-10 mm. In contrast, no atypia was detected when endometrial thickness was <5mm.Ultrasound performed using a 5-mm cut-off threshold for endometrial thickness resulted in 100%-sensitivity, 15%-specificity, 4%-PPV and 100%-NPV in detecting endometrial atypia, while a 10-mm cut-off threshold resulted in 84%-sensitivity, 69%-specificity, 10%-PPV and 99%-NPV.Conclusion:Low-risk tamoxifen users do not require different endometrial surveillance than the general population. Hysteroscopy could play a fundamental role in determining the endometrial status of patients before the initiation of tamoxifen treatment and in assessing the endometrial status of patients when bleeding occurs.
    Endocrine Related Cancer 04/2013; 20(4). DOI:10.1530/ERC-13-0020 · 5.26 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The value of transvaginal ultrasound in gynaecological examinations is beyond dispute. But it is of particular forensic importance that the validity of this type of imaging with regard to the reliable detection of early-stage malignancy is properly understood. Vaginal ultrasound screening in asymptomatic patients for the early detection of endometrial carcinoma is not useful from a medical point of view, nor is it cost-efficient. However, even though the validity of transvaginal ultrasound for screening has currently not been proven, the method should still be an integral part of gynaecological examinations.
    Geburtshilfe und Frauenheilkunde 12/2012; 72(12):1088-1091. DOI:10.1055/s-0032-1328070 · 0.85 Impact Factor