A randomized trial on the use of ultrasonography or office hysteroscopy for endometrial assessment in postmenopausal patients with breast cancer who were treated with tamoxifen.
OBJECTIVE
Our purpose was to compare the screening effectiveness and acceptability of transvaginal ultrasonography (with sonohysterography if endometrial thickness was >4 mm) with office hysteroscopy.


METHODS
This randomized crossover study comprised 53 consecutive asymptomatic (without vaginal bleeding) postmenopausal patients with breast cancer who had taken tamoxifen (20 or 40 mg/day) for at least 6 months.


RESULTS
Two patients had endometrial cancer (1 primary, 1 breast secondary), both detected only by transvaginal ultrasonography. Twenty-six patients had at least 1 polyp (total 47, all benign). The women who had polyps were not significantly different in their age, body mass, months of tamoxifen intake, or the cumulative dose. The sensitivity and specificity of transvaginal ultrasonography were 85% and 100%, respectively. The corresponding values for office hysteroscopy were 77% and 92%. It was significant that more patients preferred transvaginal ultrasonography to hysteroscopy (P < .001).


CONCLUSIONS
Transvaginal ultrasonography (plus sonohysterography) may be more effective and acceptable than office hysteroscopy for detecting endometrial abnormalities in women taking tamoxifen.
Department of Obstetrics and Gynecology, University Hospitals, Leuven, Belgium.
D
D
Timmerman
J
J
Deprest
T
T
Bourne
I
I
Van den Berghe
W P
WP
Collins
I
I
Vergote
D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D018592:Cross-Over Studies; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000379:methods*; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010824:Physicians' Offices; D017698:Postmenopause; D012680:Sensitivity and Specificity; D013223:Statistics as Topic; D013629:Tamoxifen / Q000627:therapeutic use*; D014463:Ultrasonography
D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen