Transvaginal sonographic and hysteroscopic findings in postmenopausal women receiving tamoxifen.

STUDY OBJECTIVE: To evaluate the effect of tamoxifen on the endometrium. DESIGN: Prospective study. SETTING: Department of Obstetrics and Gynecology of the University of Rome. PATIENTS: One hundred one postmenopausal women with breast cancer receiving tamoxifen 20 to 30 mg/day for at least 1 year; of these 78 were asymptomatic and 23 had vaginal bleeding. INTERVENTIONS: All patients underwent transvaginal color Doppler sonography. Those with endometrial thickness greater than 5 mm were advised to undergo hysteroscopy and if necessary endometrial biopsy. For women with endometrial thickness less than 5 mm, hysteroscopy was recommended only if irregular endometrial echotexture was observed. MEASUREMENTS AND MAIN RESULTS: Eleven (14%) asymptomatic patients and 1 (4.3%) with vaginal bleeding had endometrial thickness less than 5 mm (p = 0.4, NS). Women with vaginal bleeding had a significantly thicker endometrium than asymptomatic patients (15.8 +/- 7.5 vs 11.1 +/- 5.7 mm, p = 0.003). In the asymptomatic group 31 polyps, 15 atrophic endometria, and 6 hyperplasias were observed. Two endometrial cancers, 13 polyps, and 3 hyperplasias were detected in patients with vaginal bleeding. Hysteroscopy did not always allow endometrial biopsy, even in the presence of increased endometrial thickness with or without irregular surface. No statistical differences were found for mean pulsatility and resistance indexes of uterine and endometrial arteries between symptomatic and asymptomatic women, but these indexes were significantly lower compared with normal postmenopausal values. CONCLUSION: Women receiving tamoxifen, especially those who are asymptomatic, should be closely monitored by transvaginal sonography and hysteroscopy to detect endometrial pathologies.

Transvaginal Sonographic and Hysteroscopic Findings in Postmenopausal Women Receiving Tamoxifen

The effect of tamoxifen on the endometrium was assessed by transvaginal color Doppler sonography, hyteroscopy, and histology in 90 postmenopausal women, of whom 71 were asymptomatic and 19 had vaginal bleeding. All were treated with tamoxifen 20 to 30 mg/day for breast cancer for at least 1 year and all underwent transvaginal color Doppler sonography. Women with endometrial thickness greater than 5 mm and with vaginal bleeding were advised to undergo hysteroscopy and endometrial biopsy if necessary. In asymptomatic women with endometrial thickness of 5 mm or less, hysteroscopy was recommended if irregular endometrial echotexture was observed. Nine (12.7%) asymptomatic patients and 1 (5.3%) with vaginal bleeding had an endometrial width of 5 mm or less (p = 0.6, NS). Those with vaginal bleeding receiving tamoxifen had a significantly thicker endometrium than asymptomatic women (16.1 ± 7.7 vs 11.1 ± 5.7 mm, p = 0.003). A typical sonographic endometrial pattern with small hypoechoic cystic areas was reported in 83% of patients. In the asymptomatic group, 25 polyps, and 7 atrophic and 13 thickened endometria were observed at hysteroscopy. Two endometrial cancers, 11 polyps, and 1 atrophic and 4 thickened endometria were present in women with vaginal bleeding. Hysteroscopy did not always allow endometrial biopsy even if endometrial thickness with or without an irregular surface was observed. No statistical differences were revealed in the two tamoxifen groups for the mean pulsatility and resistance indexes of the uterine and endometrial arteries, which were otherwise significantly lower compared with normal postmenopausal values. Women receiving tamoxifen, especially asymptomatic women, should be closely monitored by transvaginal color Doppler ultrasonography and hysteroscopy to detect endometrial pathologies.

Endometrial evaluation in postmenopausal breast cancer patients receiving tamoxifen: an ultrasound, color flow Doppler, hysteroscopic and histological study.

The purpose of this study was to evaluate the effect of tamoxifen therapy on the endometrium by transvaginal color Doppler sonography, hysteroscopy and endometrial sampling. The study group (tamoxifen group) was composed of 38 asymptomatic postmenopausal women. All had been treated with tamoxifen (20-30 mg/day) for breast cancer for at least 1 year. The patients of the tamoxifen group underwent transvaginal color Doppler sonography, hysteroscopy and, if necessary, endometrial biopsy. Thirty asymptomatic postmenopausal women (control group) and 25 asymptomatic postmenopausal breast cancer patients not on tamoxifen therapy (no-tamoxifen group) served as the control groups. The endometrium was scanned by transvaginal ultrasound to evaluate thickness, echotexture, border and intraluminal fluid. Color and pulsed Doppler were used to evaluate the pulsatility (PI) and resistance (RI) indices of the uterine and endometrial arteries when possible. The patients receiving tamoxifen had a significantly thicker endometrium compared to the control groups. Endometrial pathology was observed in 61% (23/38) of cases and an endometrial thickness of "> or =" 10 mm was always associated with an endometrial lesion. Nineteen benign endometrial polyps were found, most of them having a typical sonographic endometrial pattern with regular borders and small hypoechoic cystic areas which we define as polypoid. Four endometrial hyperplasias, one of these atypical were observed. There were no endometrial cancers. The mean PI and RI of the uterine arteries in the tamoxifen group were 2.04 +/- 0.77 and 0.82 +/- 0.1, respectively and were significantly lower than those of the control group (2.93 +/- 0.9 and 0.93 +/- 0.06) and the no-tamoxifen group (2.53 +/- 0.7 and 0.89 +/- 0.1). The blood velocity changes were very similar to those described in postmenopausal women receiving estrogen replacement therapy. A correlation between the time of beginning tamoxifen therapy after menopause and development of endometrial pathology was observed: in patients who started therapy many years after the onset of menopause, the risk of developing endometrial pathology was higher than in those who began therapy a few years after the onset of menopause. Patients receiving tamoxifen, particularly those who start therapy many years after the onset of menopause, should be closely monitored by transvaginal ultrasound and color Doppler imaging to detect endometrial lesions.

Hysteroscopic Evaluation in Patients with Thickened Endometrium at Vaginal Ultrasound Examination

The purpose of this study was to evaluate the hysteroscopic appearance of the endometrium in cases with abnormal thickening (>8mm) evaluated by vaginal ultrasound. We considered postmenopausal patients who were asymptomatic and those with abnormal uterine bleeding (AUB). Hysteroscopy with endometrial biopsy revealed cancer, hyperplasia, polyps, and myoma in patients with AUB. In the asymptomatic group with increased endometrial thickening, hysteroscopy revealed hyperplasia, polyps and myoma. Our results show that vaginal ultrasound is a reliable method for evaluation of the endometrium in postmenopausal women. Hysteroscopic examination is required to assess the endometrial pathology, and to determine which patients will require biopsy or surgical intervention.