title: Endometrial evaluation with transvaginal US and hysterosonography in asymptomatic postmenopausal women with breast cancer receiving tamoxifen.
abstract: OBJECTIVE
  To determine performance characteristics of transvaginal ultrasonography (US) and hysterosonography for diagnosing endometrial abnormality in asymptomatic postmenopausal women with breast cancer receiving tamoxifen.
  
  
  METHODS
  The authors prospectively examined 138 women receiving tamoxifen by using transvaginal US, hysterosonography, and office hysteroscopy. The combined hysteroscopic-histopathologic diagnosis was the reference standard. Sensitivity, specificity, positive and negative predictive values, and likelihood ratios of transvaginal US and hysterosonography were calculated.
  
  
  RESULTS
  All 138 women underwent transvaginal US; 104, successful hysterosonography; and 117, successful hysteroscopy. Uterine abnormality was present in 47 (40.2%) of 117 women: 45 with polyps and two with submucosal fibroids. Receiver operating characteristic curve analysis revealed 6 mm to be the optimal endometrial thickness cutoff for diagnosing endometrial abnormalities. When a thickness greater than 6 mm or a focal endometrial finding was considered abnormal, transvaginal US had a sensitivity of 85.1% and a specificity of 55.7%. In 92 women who completed transvaginal US, hysterosonography, and hysteroscopy, hysterosonography was more specific (79.2%; P =.008) but not significantly more sensitive (89.7%; P =.508) than transvaginal US. When women with abnormal transvaginal US findings were further examined with hysterosonography, the sequential combination of transvaginal US and hysterosonography was more specific (77.1%) than transvaginal US alone (P <.001), without a significant decrease in sensitivity (78.7%; P =.25).
  
  
  CONCLUSIONS
  In asymptomatic postmenopausal women receiving tamoxifen, 6 mm is the optimal endometrial thickness cutoff for diagnosing endometrial abnormalities with transvaginal US. Further examination with hysterosonography can improve specificity by reducing the high false-positive rate of transvaginal US.
authors.affiliation: Department of Medical Imaging, Sunnybrook and Women's College Health Sciences Centre, 76 Grenville St, Toronto, Ontario, Canada M5S 1B2. katherine.fong@swchsc.on.ca
authors.forename: K
authors.initials: K
authors.lastname: Fong
authors.forename: R
authors.initials: R
authors.lastname: Kung
authors.forename: A
authors.initials: A
authors.lastname: Lytwyn
authors.forename: M
authors.initials: M
authors.lastname: Trudeau
authors.forename: W
authors.initials: W
authors.lastname: Chapman
authors.forename: P
authors.initials: P
authors.lastname: Nugent
authors.forename: P
authors.initials: P
authors.lastname: Glanc
authors.forename: L
authors.initials: L
authors.lastname: Manchul
authors.forename: D
authors.initials: D
authors.lastname: Szabunio
authors.forename: T
authors.initials: T
authors.lastname: Myhr
mesh_terms: D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy*; D004717:Endometrium / Q000000981:diagnostic imaging* / Q000187:drug effects*; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D010342:Patient Acceptance of Health Care; D017698:Postmenopause; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013629:Tamoxifen / Q000009:adverse effects*; D014463:Ultrasonography; D014599:Uterus / Q000000981:diagnostic imaging*
chemical_list: D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen