Tamoxifen and the endometrium: findings of pelvic ultrasound examination and endometrial biopsy in asymptomatic breast cancer patients.
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.
- SourceAvailable from: Salvatore Gizzo[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 · 4.91 Impact Factor
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ABSTRACT: Cerebrovascular disorders are less common in pre-menopausal than post-menopausal women and in females than males. This protection may be due, in part at least, to direct effects of oestrogens on blood vessels. Oestrogen's vasodilatory mechanisms have been reported to be via the endothelium, vascular smooth muscle and extracellular matrix, depending on the vascular bed studied. Herein we investigated the vasoactive effects of oestrogen, oestrogen receptor (ER) and GPR30 agonists and selective ER modulators (SERMs) in the rat middle cerebral artery(MCA), an artery affected in focal ischaemia. MCAs isolated from male Sprague Dawley rats were mounted on a wire myograph. Concentration response curves were constructed to 17β-oestradiol, ERα agonist-PPT, ERβ agonist-DPN, GPR30 agonist-G1 and novel SERMs (LY362321 and LY2120310) in pre-constricted vessels, in the presence and absence of endothelium, blocking agents for nitric oxide synthase (L-NAME), classic ER antagonist (ICI182,780) or plasma membrane specific ERα (ERα-36) antibody. 17β-oestradiol induced rapid vasorelaxation of the MCA which was not affected by endothelium removal, L-NAME or ICI182,780. Vasorelaxation was mimicked by PPT, DPN and G1 but not by the SERMs. Using ERα-36 antibody, effects of oestrogen were partially blocked. PPT had a greater vasorelaxation, while DPN and G1 had a lesser effect than 17β-oestradiol. These findings indicate that activation of plasma membrane bound ERα, β and GPR30 elicits rapid, endothelial-nitric oxide-independent relaxation of the rat MCA.Neuroscience Research 05/2011; 71(1):78-84. DOI:10.1016/j.neures.2011.05.006 · 2.15 Impact Factor
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ABSTRACT: •This case report documents the in vivo process of malignant transformation in a patient with Cowden syndrome.•PTEN-driven oncogenesis may proceed through a stage of pre-invasive intra-epithelial neoplasm.•Our findings have important implications for preventive care and for pathologic sampling at the time of prophylactic surgery.02/2015; 12. DOI:10.1016/j.gore.2015.01.008