title: Saline infusion sonography and office hysteroscopy to assess endometrial morbidity associated with tamoxifen intake.
abstract: OBJECTIVE
  The objective of this study was to compare office feasibility, patient acceptance, and diagnostic accuracy of hysteroscopy (HYS) and saline infusion sonography (SIS) in breast cancer patients taking tamoxifen.
  
  
  METHODS
  Sixty-six asymptomatic postmenopausal women on tamoxifen for breast cancer underwent SIS, followed by outpatient HYS with endometrial biopsy. In all women an endometrial stripe over 4 mm was previously measured by transvaginal ultrasonography (TU). Histologic reports were matched with sonographic and hysteroscopic findings. After SIS and HYS, patients were asked to rate pelvic pain experienced during the two procedures on a 10 cm Visual Analog Scale (VAS).
  
  
  RESULTS
  SIS and HYS were not accomplished in 26 (39.3%) and 4 (6.0%) patients, respectively, due to cervical stenosis or patient intolerance. No adverse event was recorded after 40 SIS and 62 hysteroscopic procedures. Pathologic assessment reported 15 polyps (22.7%), 7 hyperplasias (10.5%), and 2 submucous myomas (3.0%). Sensitivity, specificity, and negative and positive predictive values of SIS in distinguishing between normal and abnormal endometrium were 85.7, 83.3, 93.7, and 66.0%, respectively, whereas HYS provided corresponding values of 100, 94.1, 97.8, and 100%, respectively. No significant difference was found between SIS and HYS in the subjective perception of pelvic pain (VAS scores 3.02 +/- 2.8 and 3.82 +/- 2.7, respectively).
  
  
  CONCLUSIONS
  Office hysteroscopy is a safe and conclusive diagnostic tool for endometrial investigation in menopausal women on tamoxifen. It exposes the patients to the same pelvic discomfort as SIS, but has a better feasibility rate and diagnostic accuracy.
authors.affiliation: Obstetrics and Gynecolgy Department, Lodi Hospital, via Savoia No. 1, 26900 Lodi, Italy. ostginlo@tiscalinet.it
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Garuti
authors.forename: Fulvia
authors.initials: F
authors.lastname: Cellani
authors.forename: Francesco
authors.initials: F
authors.lastname: Grossi
authors.forename: Monica
authors.initials: M
authors.lastname: Colonnelli
authors.forename: Giovanna
authors.initials: G
authors.lastname: Centinaio
authors.forename: Massimo
authors.initials: M
authors.lastname: Luerti
mesh_terms: D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy; D004717:Endometrium / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000473:pathology; D020847:Estrogen Receptor Modulators / Q000009:adverse effects*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000379:methods*; D008875:Middle Aged; D013629:Tamoxifen / Q000008:administration & dosage* / Q000627:therapeutic use; D014463:Ultrasonography
chemical_list: D018931:Antineoplastic Agents, Hormonal; D020847:Estrogen Receptor Modulators; D013629:Tamoxifen