Sonographic, hysteroscopic, and histologic evaluation of the endometrium in postmenopausal women with breast cancer receiving tamoxifen.
OBJECTIVE
To evaluate the estrogenic effects of tamoxifen on the endometrium in postmenopausal women with breast cancer.


METHODS
Consecutive study (Canadian Task Force classification II-2).


METHODS
University-affiliated hospital.


METHODS
Thirty-three women. Interventions. All patients underwent transvaginal sonography (TVS) and color flow Doppler of endometrial vessels, hysteroscopy, and, if necessary, endometrial biopsy or other operative hysteroscopic procedures.


RESULTS
In four women the endometrium was thin on TVS and atrophic at hysteroscopic assessment. In 29 women with thick endometrium on TVS, hysteroscopy and endometrial biopsy showed atrophy (11 patients), hyperplasia (5), polyps (11), and well-differentiated adenocarcinoma (2). The two endometrial cancers were present in women with uterine bleeding. In women with positive histologic findings, the endometrium was significantly thicker (p = 0.04) and duration of tamoxifen therapy longer than in those with negative findings, although this was not statistically significant (p = 0.067).


CONCLUSIONS
We believe regular assessment of the endometrium by TVS should be performed in postmenopausal patients at the start of the tamoxifen therapy, and hysteroscopy in women with a thick endometrium or postmenopausal bleeding. We believe that patients with thin endometrium on TVS at the beginning of tamoxifen therapy, who have no abnormal uterine bleeding should be screened with these examinations for 2 years.
Ceci
O
O
Istituto di Clinica Ostetrica e Ginecologica II, Universitá degli Studi di Bari Policlinico, Piazza Giulio Cesare, 11-70124 Bari Italy.
Bettocchi
S
S
Marello
F
F
Nappi
L
L
Chiechi
L M
LM
Laricchia
L
L
Masciandaro
A
A
D001706:Biopsy; D001943:Breast Neoplasms / Q000188:drug therapy*; D004717:Endometrium / Q000000981:diagnostic imaging / Q000473:pathology*; D004965:Estrogen Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D008875:Middle Aged; D017698:Postmenopause; D013629:Tamoxifen / Q000009:adverse effects / Q000627:therapeutic use*; D018615:Ultrasonography, Doppler, Color
D004965:Estrogen Antagonists; D013629:Tamoxifen