Hysteroscopically Targeted Biopsies Compared with Blind Samplings in Endometrial Assessment of Menopausal Women Taking Tamoxifen for Breast Cancer

Garuti, Giancarlo; Cellani, Fulvia; Colonnelli, Monica; Garzia, Delia; Gonfiantini, Cristina; Luerti, Massimo

doi:10.1016/s1074-3804(05)60013-8

Cited by 16 publications

(17 citation statements)

References 22 publications

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“…As shown by Garuti et al, blind endometrial sampling is safe in excluding hyperplasias and carcinomas, thus allowing it to be assumed that no cases were actually missed. 29 Although endometrial cancer or hyperplasia did not remain undetected in our study, this phenomenon has been described by others. Deckardt et al found 10 cases of undetected endometrial carcinoma among 1,286 patients who underwent hysteroscopy without biopsy, and in these cases the diagnosis was made by subsequent dilatation and curettage.…”

Section: Discussionsupporting

confidence: 81%

Hysteroscopy as a standard procedure for assessing endometrial lesions among postmenopausal women

et al. 2007

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CONTEXT AND OBJECTIVES: Endometrial cancer is the most prevalent type of malignant neoplasia of the genital tract. The objective of this study was to calculate the sensitivity, specificity, accuracy and positive and negative predictive values for diagnostic hysteroscopy, in comparison with histopathological tests, for all lesions of the endometrial cavity. DESIGN AND SETTING: Retrospective descriptive study at the public tertiary-level university hospital of Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. METHODS: Diagnostic hysteroscopy was indicated in the following instances: endometrial thickness > 4 mm in asymptomatic patients; postmenopausal bleeding; and irregular endometrium or endometrium difficult to assess from ultrasound, with or without vaginal bleeding. Ultrasound evaluations were carried out no more than three months prior to hysteroscopy. RESULTS: There were 510 patients, with a mean age of 61.1 ± 2.0 years and mean time elapsed since the menopause of 12.7 ± 2.5 years. Endometrial biopsies were performed on 293 patients (57.5%). Histopathological analysis showed that 18 patients presented endometrial carcinoma or typical or atypical hyperplasia, and none of them presented endometrial thickness of less than 8 mm. No significant differences were found between the median thicknesses of the various benign lesions (p > 0.05). In our data, the sensitivity, specificity, accuracy and positive and negative predictive values for cancer or hyperplasia were 94.4%, 97.0%, 96.8%, 68% and 99.6%, respectively. CONCLUSIONS: Our results suggest that hysteroscopy is valuable as a diagnostic tool for malignant/hyperplastic and benign lesions, except for submucous myomas, for which the sensitivity was only 52.6%.

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Section: Discussionsupporting

confidence: 81%

Hysteroscopy as a standard procedure for assessing endometrial lesions among postmenopausal women

et al. 2007

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“…However, this procedure may not be as well accepted by patients. In addition, endometrial biopsy sampling (in particular blind biopsy and biopsy of thin endometrium) in women receiving tamoxifen frequently yields insufficient tissue for diagnosis [25][26][27] . A study reported that 92% of biopsies showed insufficient material in 72 asymptomatic postmenopausal patients receiving tamoxifen and who had an endometrial thickness 1 5 mm [28] .…”

Section: Discussionmentioning

confidence: 99%

“…Endometrial polyps are the most common pathological consequence on the endometrium in women using tamoxifen [4,26] . Endometrial carcinomas arising from endometrial polyps have been described in women on tamoxifen as well as in the general population.…”

Section: Discussionmentioning

confidence: 99%

Surveillance for Endometrial Cancer in Women on Tamoxifen: The Role of Liquid-Based Endometrial Cytology – Cytohistological Correlation in a Population of 168 Women

Buccoliero¹,

Fambrini

Gheri³

et al. 2008

Gynecol Obstet Invest

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Aims: The aim of this study was to evaluate the utility of liquid-based cytology for endometrial surveillance in patients receiving tamoxifen. Methods: One hundred and sixty-eight women scheduled for hysteroscopy were enrolled in the study. The women sequentially underwent hysteroscopy, endometrial cytology and biopsy. Results: Endometrial biopsy only was inadequate in 112 (67%) patients, both endometrial biopsy and cytology were inadequate in 19 (11%) patients, endometrial cytology only was inadequate in 4 (2%) patients, and both endometrial biopsy and cytology were adequate in 33 (20%) patients. Overall, endometrial biopsy was inadequate in 131 (78%) patients and endometrial cytology in 23 (14%) patients. Endometrial cytology provided sufficient material for diagnosis more often than endometrial biopsy (p < 0.05). In the series of 33 patients (20%) in whom both endometrial cytology and biopsy were adequate, there was a 100% correlation between the endometrial cytology and biopsy results. Conclusions: For the first time, this study shows the diagnostic efficacy of liquid-based endometrial cytology in the follow-up of women receiving tamoxifen. It could be applied solely or in conjunction with ultrasonography.

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“…Cytohistologic correlation had been possible only in 94 cases (29%) of the study population, a fact that demands concern on the two techniques. Two hundred twenty-two biopsies (69%) were inadequate, a figure which is surprisingly high when compared to other similar studies (2) . It may be related to the prevalence of nonneoplastic or hyperplasic cases or due to the sequence of endometrial sampling: first the cytology and then the biopsy as hypothesized by the authors.…”

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confidence: 57%

Liquid-based endometrial cytology: its possible value in postmenopausal asymptomatic women

Marasinghe

Chintana²,

karunananda³

et al. 2007

Int J Gynecol Cancer

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Buccoliero AM et al. (1) should be credited for their study on liquid-based endometrial cytology in the management of a subpopulation of asymptomatic postmenopausal women. Their conclusion that liquidbased endometrial cytology may reduce unnecessary, more invasive, and expensive procedures is striking. However, they have obtained a specificity of 94% for endometrial cytology after categorizing the cases studied as nonpathologic and pathologic. If we were to categorize them as malignant and nonmalignant cytology, the resultant sensitivity would only be 83%. Cytohistologic correlation had been possible only in 94 cases (29%) of the study population, a fact that demands concern on the two techniques. Two hundred twenty-two biopsies (69%) were inadequate, a figure which is surprisingly high when compared to other similar studies (2) . It may be related to the prevalence of nonneoplastic or hyperplasic cases or due to the sequence of endometrial sampling: first the cytology and then the biopsy as hypothesized by the authors. A brief note on the time gap between endometrial cytology and biopsy is appreciated. We observed the possibility of bias of the investigators who were keen to highlight the efficacy of endometrial cytology in comparison to biopsy.This exercise adds some valuable information to the excising body of knowledge on managing asymptomatic postmenopausal women with liquid-based endometrial cytology. Low cost, good tolerability, and the fact that it can be carried out as an outpatient procedure (3) makes it an excellent option for women with other comorbid factors. It opens the door for future trends and advances in this method such as immunohistochemical staining rather than routine Papanicolaou stain of the cytology obtained. Gynecologists should be made aware of the advantages of liquid-based endometrial cytology in assessing the endometrium.

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Hysteroscopically Targeted Biopsies Compared with Blind Samplings in Endometrial Assessment of Menopausal Women Taking Tamoxifen for Breast Cancer

Cited by 16 publications

References 22 publications

Hysteroscopy as a standard procedure for assessing endometrial lesions among postmenopausal women

Hysteroscopy as a standard procedure for assessing endometrial lesions among postmenopausal women

Surveillance for Endometrial Cancer in Women on Tamoxifen: The Role of Liquid-Based Endometrial Cytology – Cytohistological Correlation in a Population of 168 Women

Liquid-based endometrial cytology: its possible value in postmenopausal asymptomatic women

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