Ultrasonographic evaluation of the endometrium and correlation with endometrial sampling in postmenopausal patients treated with tamoxifen

Abstract

Seventy-two asymptomatic, postmenopausal women treated with tamoxifen for breast cancer were studied prospectively with vaginal ultrasonography, followed by endometrial sampling. Seventy-one patients demonstrated an endometrial echo of more than 5 mm, and one displayed an endometrial echo of less than 5 mm. No patient with an endometrial echo of less than 5 mm displayed any endometrial pathology. Different endometrial pathologic conditions were found when the endometrial echo was over 5 mm. When classifying those patients whose ultrasonic endometrial widths were wider than 5 mm, on the basis of different endometrial histologic findings, no obvious correlation was found between the various pathologic endometrial findings and endometrial thickness. Thus, a "thicker" endometrial sonographic image did not necessarily correlate with pathologic endometrial findings. When ultrasonic endometrial thickness of 5 mm was considered the upper limit of normal, the sensitivity of ultrasonography in correlating to positive histologic findings was 91% and the specificity was 96%. These findings suggest that there is good correlation between endometrial width measured by ultrasonographic assessment and histologic findings.

Prospective study on gynaecological effects of two antioestrogens tamoxifen and toremifene in postmenopausal women

“…However, what is noteworthy in our data is that endometrial thickening in antioestrogen users is not a sign of endometrial proliferation but in effect, a thick endometrium can be atrophic. This has been detected also in some previous studies (Cohen et al, 1993;Touraine et al, 1995;Ismail, 1996). Thus, endometrial thickening is probably a result of the enlargement of subendometrial glands (Goldstein, 1994;Neven, 1995;McGonigle et al, 1998) and is no indication for endometrial biopsy.…”

Tamoxifen and Endometrial Cancer

“…Lahti et al [9] reported that if a cutoff of >5 mm was used to define an abnormal endometrial echo, 22 (51.2%) patients had no abnormal endometrial pathology. Similar findings were reported by Cohen et al [25] who prospectively performed endometrial biopsies following vaginal sonography in 72 tamoxifen-treated breast cancer patients. Among the patients with an endometrial stripe greater than 5 mm, approximately 70% had no identifiable endometrial tissue and only one patient was found to have endometrial cancer.…”

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

“…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] . Analogously, in our series, the biopsy provided insufficient tissue in 78% of the women.…”