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WS05‐05A role of ultrasound in follow‐up of tamoxifen patients
Author(s) -
Predanic M
Publication year - 2000
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1046/j.1469-0705.2000.00009-1-34.x
Subject(s) - medicine , endometrial polyp , tamoxifen , endometrial hyperplasia , carcinoma , endometrial biopsy , endometrial cancer , endometrium , gynecology , breast cancer , biopsy , atypical hyperplasia , cancer , oncology , hysteroscopy
Recently suggested role of tamoxifen as a preventive agent in women at high risk of breast cancer has a potential to increase significantly the number of women treated with tamoxifen agent. By the fact that tamoxifen is beneficial in taming the breast cancer, but detrimental to the uterus by increasing the risk of endometrial carcinoma, hyperplasia, and development of endometrial polyps, surveillance of endometrial changes in patients on tamoxifen is needed. However, no cost‐effective method has been found for screening for the rare occurrence of endometrial carcinoma. Therefore, the ACOG does not recommend routine endometrial screening of tamoxifen‐treated breast cancer patients. Regardless of aforementioned recommendation, ultrasound (US) is very helpful as a first line for diagnosis of endometrial pathology in symptomatic or asymptomatic patients with previous endometrial pathology. Endometrial thickness < 5 mm is reassuring, > 5–8 mm calls for further investigation such as sonohysterography to rule out polyps. If it fails to demonstrate polyps, but cystic structures still present and letter on endometrial biopsy (or D & C) shows atrophic changes of the endometrium or material is insufficient for analysis, likely diagnosis is Cystic Endometrial Atrophy. Additionally, Color Doppler flow measurement helps in differentiation between atrophic cystic endometria and polyps, hyperplasia or even cancer in terms that atrophic endometrial are mainly avascular, whereas endometrial polyps and carcinomas are richly vascularized within the endometrium as well as in surrounding myometrial tissue. How and how often endometrial surveillance should be done? 1. Recommend us or endometrial biopsy evaluation prior to tamoxifen treatment; 2. Follow up with endometrial biopsy/D & C if symptomatic; or 3. If asymptomatic but patient at high risk (history of previous endometrial disorders, obesity, long duration of tamoxifen treatment), recommend us 6 months. US findings 1. If endometrial thickness > 5–8 mm, exclude endometrial polyps by sonohysterography; and add color doppler to evaluate vascularity pattern; 2. If no polyps with thick endometrium on sonohysterography and avascular pattern present, perform blind or hysteroscopic guided endometrial biopsy; 3. If findings are atrophic endometrium or insufficient material for diagnosis, assume atrophic (± cystic) endometrial changes and continue annual/semiannual endometrial evaluation (± US); 4. If (+) simple hyperplasia, consider progestin and/or D & C treatment; 5. Consider hysterectomy as final option if endometrial pathology persists.