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The aim of this study is to evaluate the accuracy of hysteroscopy in detecting tamoxifen-associated endometrial morbidity. Ninety-eight menopausal breast cancer patients taking tamoxifen underwent hysteroscopy because of an endometrial thickness above 4mm measured by Transvaginal Ultrasonography. Thirty-one women recorded uterine bleeding while 67 were asymptomatic. Hysteroscopies with operative facilities were performed, mainly in out-patient setting. Hysteroscopic findings were matched with histopathology derived from various modalities of tissue collection as suction-curettage, oriented-streak curettage, hysteroscopically-targeted biopsies or polypectomies and hysterectomies. Accuracy of hysteroscopy to estimate a normal or abnormal endometrium was calculated. Abnormal endometrium was detected in 35 patients (64.5% in symptomatic and 22.3% in asymptomatic women, P < 0.001). We found six carcinomas, 18 polyps and 11 hyperplasias. Hysteroscopy showed sensitivity and specificity of 89.2 and 98.4%, respectively. By blind sampling, tissue collection was too scant to give a diagnosis in 29. 1% of patients and in 80.5% of patients in whom hysteroscopy showed cystic atrophy the pathologist failed to confirm this condition. Moreover, eight endometrial polyps (36.3%) detected by hysteroscopy were missed. Conversely, by tissue sampling under vision no inadequate specimen was sent to the pathologist and all hysteroscopies showing cystic atrophy and polyps were pathologically confirmed. From literature data, the detection-rate of endometrial pathology in tamoxifen users varies from the lowest to the highest prevalences whether blind or hysteroscopically-targeted modalities of tissue sampling were used, respectively. Hysteroscopy with targeted sampling appears to be the most effective method to assess the endometrial lining. In our experience it is safe, well tolerated and it should be considered the reference test to assess a thickened endometrium in women under tamoxifen.

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Background: Cesarean Scar Pregnancy (CSP) is a cause of severe maternal morbidity. Currently, no guideline for its management is shared. We assessed safety and effectiveness of Methotrexate (MTX) administration within the sub-chorionic space under hysteroscopic guidance, followed by resectoscopic placental removal. Methods: Five patients suffering from type 2 CSP underwent a sequential treatment based on hysteroscopic techniques. Pregnancy termination was firstly obtained by injection of 80 mg of MTX within the intervillous spaces of placental site. The intervention was performed in an office setting using a 16Fr hysteroscope. MTX was administered by a 17-gauge needle suitable for the operative channel of hysteroscope. Subsequently, based on the decline of Human Chorionic Gonadotropin β-subunit (β-HCG), we timed a placental removal using a 27-Fr resectoscope, under conscious sedation. Results: In all women a diagnosis of CSP was achieved between 6 and 8 gestational age weeks. Hysteroscopic MTX administration resulted easily, quickly, painlessly and uneventfully in all patients. A substantial decrease of β-HCG was obtained in all patients within 15 days from the MTX administration. After a mean time of 27 days from MTX a resectoscopic removal of CSP was carried-out without any recorded adverse outcome. After 30 days from surgery β-HCG returned to non-pregnant level and normal physical findings were found in all patients. Conclusions: Hysteroscopy-guided MTX sub-chorionic administration resulted safe and effective for CSP termination. It was followed by successful and uneventful resectoscopic placenta removal in all patients. When hysteroscopy facilities are available, this combined therapy can be an option to treat CSP.

Funding Acknowledgements Type of funding sources: None. Background The assessment of the ventricular myocardial substrate critically depends on the size of mapping electrodes, their orientation with respect to wavefront propagation, and interelectrode distance. Objective we conducted a dual-center study to evaluate the impact of microelectrode mapping in patients undergoing catheter ablation (CA) of ventricular tachycardia (VT). Methods We included 21 consecutive patients (median age, 68 [12], 95% male) with structural heart disease undergoing CA for electrical storm (n=14) or recurrent VT (n=7) using the QDOT Micro catheter and a multipolar catheter (PentaRay, n=9). The associations of peak-to-peak maximum standard bipolar (BVc) and minibipolar (PentaRay, BVp) with microbipolar (BVμMax) voltages were respectively tested in sinus rhythm with mixed effect models. Furthermore, we compared the features of standard bipolar (BE) and microbipolar (μBE) electrograms in sinus rhythm at sites of termination with radiofrequency energy. Results BVμMax was moderately associated with both BVc (β=0.85, p&lt;0.01) and BVp (β=0.56, p&lt;0.01). BVμMax was 0.98 (95% CI, 0.93-1.04, p&lt;0.01) mV larger than corresponding BVc, and 0.27 (95% CI, 0.16-0.37, p&lt;0.01) mV larger than matching BVp in sinus rhythm, with higher percentage differences in low voltage regions, leading to smaller endocardial dense scar (2.3 [2.7] vs. 12.1 [17] cm2, p&lt;0.01) and border zone (3.2 [7.4] vs. 4.8 [20.1] cm2, p=0.03) regions in microbipolar maps compared to standard bipolar maps. At sites of VT termination (n=14), μBE were of higher amplitude (0.9 [0.8] mV versus 0.4 [0.2] mV, p&lt;0.01), longer duration (117 [66] ms versus 74 [38] ms, p&lt;0.01), and with greater number of peaks (4 [2] versus 2 [1], p&lt;0.01) in sinus rhythm compared to BE. Conclusions Microelectrode mapping is more sensitive than standard bipolar mapping in the identification of viable myocytes in SR, and may facilitate recognition of targets for catheter ablation.