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Objetivos: avaliar sensibilidade, especificidade, valor preditivo positivo e negativo e razão de probabilidade da ultra-sonografia transvaginal e da histeroscopia quando comparadas com o exame histopatológico do endométrio em mulheres com câncer de mama tratadas com tamoxifeno. Método: estudo transversal, com trinta mulheres, em que se avaliou a ecogenicidade do eco endometrial e a sua espessura por meio de ultra-sonografia transvaginal. Realizou-se histeroscopia que foi descrita como normal (endométrio normal ou atrófico) ou anormal (espessamento, pólipo, mioma, sinéquia). Mediante biópsia endometrial foi obtido material para exame histopatológico e os resultados foram considerados normais (endométrio de maturação irregular e/ou atrofia) ou anormais (pólipos, hiperplasia simples ou complexa, miomas ou carcinoma endometrial). Resultados: a prevalência geral de alterações endometriais foi de 36,6%. Os achados mais freqüentes foram a atrofia cística (46,6%) e os pólipos (26,6%). Por meio de curva ROC determinou-se que o melhor ponto de corte da medida da espessura do endométrio foi 8 mm. Esta medida apresentou sensibilidade de 72,7%, especificidade de 78,9%, valor preditivo positivo de 66,6%, valor preditivo negativo de 83,3% e razão de probabilidade de 3,4. A histeroscopia apresentou sensibilidade de 90,9%, especificidade de 68,4%, valor preditivo positivo de 62,5%, valor preditivo negativo de 92,8% e razão de probabilidade de 2.8. Conclusão: os achados mais freqüentes foram a atrofia cística e os pólipos. A ultra-sonografia transvaginal apresentou maior taxa de falso-positivo (42,1%), utilizando ponto de corte da espessura do endométrio de 5 mm, porém melhorou-se a acurácia quando se utilizou a medida de 8 mm obtido pela confecção de curva ROC. Purpose: to analyze sensitivity, specificity, positive and negative predictive values and the likelihood ratio of transvaginal ultrasound and hysteroscopy when compared with the histopathologic examination of the endometrium in women with breast cancer who have been treated with tamoxifen. Methods: transversal study with 30 women in whom transvaginal ultrasound evaluated the echogenic pattern of endometrial echo and its thickness. Hyteroscopy was performed and described as normal (normal or atrophic endometrium) or abnormal (thickening, polyps, leiomyoma, synechia). Material for histopathology was obtained from endometrial biopsy and the findings were considered normal (irregular endometrial maturation and/or atrophy) or abnormal (polyps, simple or complex hyperplasia, leiomyoma or endometrial carcinoma). Results: the general diagnosis of endometrial modifications was present in 36.6% of patients. The most frequent results were cystic atrophy (46.6%) and endometrial polyps (26.6%). Through the ROC curve the best cutoff of 8 mm of endometrial thickness measure was determined. This measure showed sensitivity of 72.7%, specificity of 72.9%, positive predictive value of 66.6%, negative predictive value of 83.3% and likelihood ratio of 3.4. Hysteroscopy showed sensitivity of 90.9%, specificity of 68.4%, positive predictive value of 62.5%, negative prediction value of 92.8% and likelihood ratio of 2.8. Conclusions: the most frequent endometrial modifications were cystic atrophy followed by polyps. Transvaginal ultrasound showed a higher rate of false-positive (42.1%), when the cutoff for the thickness of the endometrium was 5 mm; however acuracy improved when the measure of 8 mm was used. The cutoff of 8 mm was determined through the ROC curve

Alterações Endometriais em Pacientes com Câncer de Mama Tratadas com Tamoxifeno