Assessment of the endometrium in postmenopausal breast cancer patients on tamoxifen: an ultrasound, hystroscopic, histopathlogical and flow cytometric study

الملخص EN

Objectives : breast cancer patients receiving tamoxifen have an increased risk of developing premalignant and malignant endometrial lesions; hence, screening techniques are advocated. Methods: We performed a prospective study on 100 postmenopausal breast cancer patients (PMBCP), 80 tamoxifen users and 20 controls, to elucidate the endure-trial changes associated with tamoxifen use and to evaluate the sensitivity of transvaginal ultrasonography (TVU) and hysteroscopy as screening tools in this group of patients.

The duration of tamoxifen exposure ranged from 5-72 months (mean = 30 m). Results : Endometrial thickness ranged from 1-26 mm (mean = 6.4 mm) with a significant difference between tamoxifen users and nonusers (13.5 & 4.2 mm respectively, p < 0.001).

Also, there was a significant correlation between endometrial thickness and the duration of tamox-ifen exposure (p = 0.006).

Hysteroscopy and endometrial biopsy were performed in 96 patients, 20 of them revealed serious endometrial changes, of whom 18 were confirmed by histology.

The remaining 76 had benign features.

There was a significant difference between tamoxifen treated and non-treated patients regarding the frequency of pathologic abnormalities.

The concordance between TVU and hysteroscopy was 73.3 %, TVU and histopathology was 70.6 % and between hysteroscopy and histopathology was 93.8 %. Conclusion : there is an increased incidence of en-dome trial premalignant and malignant conditions in tamox-ifen treated PMBCP.

However, TVU alone is not sufficient for screening such patients due to the high false positive rates.

Therefore, patients with ³ 5 mm thickness should perform hysteroscopy evaluation with endometrial biopsy at least whenever bleeding is reported.

Flow cytometer is useful in the follow-up of PMBCP using tamoxifen since aneuploidy peaks and / or a high S-phase fraction (SPF) were detected in cases of atypical hyperplasia and prolix ergative endometrium which precede the development of endometrial carcinoma.