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

Abstract

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.

Endometrial carcinoma in high‐risk populations: is it time to consider a screening policy?

“…37 Many studies have evaluated the surveillance of women undergoing long-term tamoxifen treatment, but the best method remains to be determined. 38 Buccoliero et al, 33 in a series of 33 patients receiving tamoxifen, observed a 100% correlation between the endometrial LBC and biopsy results.…”

“…The overall sensitivity and specificity of cytology were 95% and 66% when EC and atypical cytology specimens were considered to be positive. Overall, cumulative data in the literature on nearly 4000 patients revealed a sensitivity ranging from 78% to 100% and specificity from 95% to 100%, with a PPV of 78–100% and NPV of 96–100% …”

“…Interestingly, endometrial LBC revealed a low rate of inadequate specimens in the general population (2.2–4%) and selected groups. In particular, the rate of inadequate specimens was markedly lower with LBC than with endometrial biopsy in postmenopausal women (5% versus 69%) and tamoxifen users (14% versus 78%) …”

“…Overall, cumulative data in the literature on nearly 4000 patients revealed a sensitivity ranging from 78% to 100% and specificity from 95% to 100%, with a PPV of 78-100% and NPV of 96-100%. [24][25][26][27][28][29][30][31][32][33][34][35][36] In some studies, endometrial LBC revealed a very high diagnostic accuracy in the early detection of EC, even in troublesome subgroups of women, such as tamoxifen users, postmenopausal women or patients with low-risk endometrial polyps. Tamoxifen has represented the standard adjuvant therapy in the management of women with endocrine-responsive breast cancer, but its oestrogenic activity can promote endometrial pathologies such as polyps, hyperplasias and cancers.…”

“…In particular, the rate of inadequate specimens was markedly lower with LBC than with endometrial biopsy in postmenopausal women (5% versus 69%) 30 and tamoxifen users (14% versus 78%). 33…”