Discrepancy between ultrasonography and hysteroscopy and histology of endometrium in postmenopausal breast cancer patients using tamoxifen.
BACKGROUND
The increased risk of endometrial carcinoma following the use of tamoxifen has stimulated studies on endometrial diagnostic screening methods. In tamoxifen users the endometrial thickening observed with transvaginal ultrasonography (TVU) frequently cannot be confirmed by hysteroscopy or histology.


OBJECTIVE
The aim was to investigate the relationship between TVU and hysteroscopic and histologic endometrial findings in postmenopausal patients using tamoxifen.


METHODS
Fifty-three asymptomatic postmenopausal tamoxifen-using breast cancer patients underwent a gynecological examination combined with TVU. Patients with an endometrial thickness of >5 mm were offered hysteroscopy and endometrial biopsy.


RESULTS
Thirty-one patients (58%) had an endometrial thickness of >5 mm with enhanced, inhomogeneous echogenicity. Hysteroscopy was performed in 22 patients and 3 underwent hysterectomy. Seven of 22 patients had endometrial polyps, histologically characterized by cystically dilated glands lined with atrophic epithelium and periglandular stromal condensation. Histology of the three hysterectomy specimens showed a similar picture of atrophic luminal epithelium, covering dilated glands lined with atrophic epithelium and surrounded by dense stroma, which resembled the histology of the endometrial polyps. In all three specimens the histologically measured endometrial thickness corresponded with that on TVU.


CONCLUSIONS
Tamoxifen can induce specific endometrial changes consisting of cystically dilated glands with periglandular stromal condensation while the overlying epithelium remains atrophic. The changes occur either in the endometrium itself or as a protrusion of the endometrium, i.e., as endometrial polyps. These findings explain the discrepancy between ultrasound, hysteroscopy, and histology. Due to the high number of false-positive findings, TVU is not an effective screening instrument in these patients.
Mourits
M J
MJ
Department of Gynecology, University Hospital Groningen, Groningen, 9713 GZ, The Netherlands.
Van der Zee
A G
AG
Willemse
P H
PH
Ten Hoor
K A
KA
Hollema
H
H
De Vries
E G
EG
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy*; D004717:Endometrium / Q000000981:diagnostic imaging* / Q000187:drug effects / Q000473:pathology*; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D008875:Middle Aged; D017698:Postmenopause; D013629:Tamoxifen / Q000627:therapeutic use*; D014463:Ultrasonography
D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen