Significance of endovaginal ultrasonography in assessing tamoxifen-associated changes of the endometrium. A prospective study

Abstract

Background. A prospective study was conducted investigating the value of endovaginal ultrasound in the assessment of tamoxifen-associated changes of the endometrium in patients with breast cancer. Methods. Seventy postmenopausal patients with breast cancer treated with anti-estrogens for at least 6 months were entered. Those with bleeding disorders and/or an endometrial thickness of ≥ 10 mm found on ultrasonography underwent hysteroscopy and dilatation and curettage (DandC) for further histological evaluation. In 22 patients, positive ultrasound findings could be compared with histopathology. Results. 82% of the 22 patients with positive sonographic findings had a glandular-cystic hyperplasia or a glandular-cystic polyp. No adenomatous hyperplasia or endometrial cancer was observed in our series. Conclusion. Vaginal ultrasound represents a useful diagnostic tool to detect tamoxifen-associated changes of the endometrium. A threshold of 10 mm endometrial thickness appears suitable to identify endometrial abnormalities while reducing the rate of false-positive findings to an acceptable level. However, the role of vaginal ultrasound in screening for endometrial cancer or premalignant lesions remains uncertain.