title: Hysteroscopically targeted biopsies compared with blind samplings in endometrial assessment of menopausal women taking tamoxifen for breast cancer.
abstract: OBJECTIVE
  To determine the validity of tissue sampling accomplished by hysteroscopically targeted or blind biopsies in the assessment of endometrial morbidity associated with tamoxifen treatment.
  
  
  METHODS
  Retrospective, unrandomized study (Canadian Task Force classification II-2).
  
  
  METHODS
  Public hospital.
  
  
  METHODS
  One hundred seventy-six menopausal women who had an endometrial stripe of more than 4 mm on transvaginal ultrasonography.
  
  
  METHODS
  Review of histopathologic reports of patients undergoing hysteroscopy followed by targeted (94 samplings) or blind (82 samplings) endometrial biopsies.
  
  
  RESULTS
  Histopathology was considered the reference test to assess endometrial morbidity, and correlates with hysteroscopic findings were made to evaluate the validity of the two sampling procedures. Overall, in 23 women (13.0%) tissue samples were insufficient for pathologic evaluation. Functional or atrophic endometrium and cystic atrophy were found in 51 (28.8%) and 37 patients (21.0%), respectively. Polyps, hyperplasias, and carcinomas were found in 38 (21.5%), 19 (10.7%), and 6 (3.3%), respectively. Blind biopsies failed to detect 5 of 5 polyps and 33 of 37 cystic atrophies, and in 34.1% of cases provided insufficient tissue for diagnosis; however, no hyperplasias or carcinomas were undetected. All specimens collected under vision were pathologically evaluable; 34 of 38 hysteroscopic reports of cystic atrophy were confirmed, and neither endometrial polyps nor hyperplasias and carcinomas were undetected. In distinguishing between normal and abnormal endometrium, hysteroscopy showed sensitivity and negative predictive value of 100% regardless of sampling modality. We found better specificity (80.0% vs 68.9%) and positive predictive value (68.9% vs 43.7%) for hysteroscopic diagnosis when tissue was collected under vision compared with blind sampling.
  
  
  CONCLUSIONS
  In women taking tamoxifen, endometrial evaluation performed by blind sampling is safe in excluding hyperplasias or carcinomas. For complete understanding of tamoxifen-associated morbidity, hysteroscopy with sampling under vision has better diagnostic compliance.
authors.affiliation: Department of Obstetrics and Gynecology, Lodi Hospital, Lodi, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Garuti
authors.forename: Fulvia
authors.initials: F
authors.lastname: Cellani
authors.forename: Monica
authors.initials: M
authors.lastname: Colonnelli
authors.forename: Delia
authors.initials: D
authors.lastname: Garzia
authors.forename: Cristina
authors.initials: C
authors.lastname: Gonfiantini
authors.forename: Massimo
authors.initials: M
authors.lastname: Luerti
mesh_terms: D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects* / Q000627:therapeutic use; D001284:Atrophy; D001707:Biopsy, Needle / Q000379:methods; D001943:Breast Neoplasms / Q000188:drug therapy*; D016889:Endometrial Neoplasms / Q000139:chemically induced / Q000473:pathology; D004717:Endometrium / Q000187:drug effects / Q000473:pathology*; D005260:Female; D006801:Humans; D006965:Hyperplasia; D015907:Hysteroscopy; D008875:Middle Aged; D011127:Polyps / Q000139:chemically induced / Q000473:pathology; D017698:Postmenopause; D011237:Predictive Value of Tests; D020845:Selective Estrogen Receptor Modulators / Q000009:adverse effects* / Q000627:therapeutic use; D012680:Sensitivity and Specificity; D013629:Tamoxifen / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D018931:Antineoplastic Agents, Hormonal; D020845:Selective Estrogen Receptor Modulators; D013629:Tamoxifen