A randomized trial on the use of ultrasonography or office hysteroscopy for endometrial assessment in postmenopausal patients with breast cancer who were treated with tamoxifen

• Published in: American journal of obstetrics and gynecology 1998-07, Vol.179 (1), p.62-70
• Main Authors: Timmerman, Dirk, Deprest, Jan, Bourne, Tom, Van den Berghe, Ivo, Collins, William P., Vergote, Ignace
• Format: Article
• Language: English
• Subjects: Aged; Antineoplastic Agents, Hormonal - therapeutic use; Biological and medical sciences; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - drug therapy; Breast Neoplasms - pathology; Cross-Over Studies; Drug toxicity and drugs side effects treatment; endometrium; Evaluation Studies as Topic; Female; Humans; hysteroscopy; Hysteroscopy - methods; Mass Screening - methods; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Physicians' Offices; polyps; Postmenopause; Sensitivity and Specificity; Statistics as Topic; tamoxifen; Tamoxifen - therapeutic use; Toxicity: urogenital system; Ultrasonography
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/S0002-9378(98)70294-7

OBJECTIVE: Our purpose was to compare the screening effectiveness and acceptability of transvaginal ultrasonography (with sonohysterography if endometrial thickness was >4 mm) with office hysteroscopy. STUDY DESIGN: This randomized crossover study comprised 53 consecutive asymptomatic (without vaginal bleeding) postmenopausal patients with breast cancer who had taken tamoxifen (20 or 40 mg/day) for at least 6 months. RESULTS: Two patients had endometrial cancer (1 primary, 1 breast secondary), both detected only by transvaginal ultrasonography. Twenty-six patients had at least 1 polyp (total 47, all benign). The women who had polyps were not significantly different in their age, body mass, months of tamoxifen intake, or the cumulative dose. The sensitivity and specificity of transvaginal ultrasonography were 85% and 100%, respectively. The corresponding values for office hysteroscopy were 77% and 92%. It was significant that more patients preferred transvaginal ultrasonography to hysteroscopy ( P < .001). CONCLUSION: Transvaginal ultrasonography (plus sonohysterography) may be more effective and acceptable than office hysteroscopy for detecting endometrial abnormalities in women taking tamoxifen. (Am J Obstet Gynecol 1998;179:62-70.)