Surveillance for endometrial cancer with transvaginal ultrasonography of breast cancer patients under tamoxifen treatment.
The association of endometrial thickness with the risk of developing endometrial cancer (EC) within 2 years was investigated in a consecutive cohort of 1205 breast cancer patients under tamoxifen treatment, undergoing transvaginal ultrasonography (TVUS) for follow-up purpose (asymptomatic, 1068) or for abnormal uterine bleeding (AUB, 137). Linkage with tumour registry allowed for the follow-up of 3184.3 person-years. According to underlying incidence, 1.85 EC cases were expected in the study cohort while 12 were observed (observed/expected ratio=6.49, 95% CI 3.35-11.33; asymptomatic=4.09, 95% CI 1.65-8.43, symptomatic=35.71, 95% CI 11.59-83.34). No EC was observed with thickness (half layer) <3 mm. Raising this threshold increased specificity with a substantial loss of sensitivity (>or=3, >or=4, >or=6, >or=9 mm; spec.=25.8, 44.5, 76.1, 91.5%, sens.=100, 91.6, 75.0, 66.6%). The presence of AUB was rather specific (88.94%) but poorly sensitive (41.67%). A combination of AUB presence/absence and thickness allowed the best accuracy (AUB + thickness >or=3, >or=4 or >or=5; sens.=100, 81.6 or 91.6%; spec.=22.8, 40.4, or 56.7%). Breast cancer patients under tamoxifen might be selected for further invasive assessment on the basis of AUB and endometrial thickness assessed at TVUS.
Ciatto
S
S
Centro per lo Studio e la Prevenzione Oncologica, Firenze, Italy. s.ciatto@cspo.it
Cecchini
S
S
Gervasi
G
G
Landini
A
A
Zappa
M
M
Crocetti
E
E
D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy*; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D016609:Neoplasms, Second Primary / Q000000981:diagnostic imaging*; D013629:Tamoxifen / Q000627:therapeutic use*; D014463:Ultrasonography / Q000379:methods*; D014621:Vagina
D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen