Endometrial surveillance in tamoxifen users: role, timing and accuracy of hysteroscopic investigation: observational longitudinal cohort study

Abstract

To determine the role, timing and indications for endometrial hysteroscopic investigation in relation to the clinical, ultrasound and histological features of the endometrium during tamoxifen (TAM) use. We performed an observational longitudinal cohort study (years 2007-2012) that investigated the endometria of 151 TAM users with hysteroscopy and histology. For all patients, gynaecological history, years of adjuvant treatment, ultrasound endometrial thickness measurement and indications for hysteroscopy were recorded. Hysteroscopic findings showed that 100% of patients referred for simple follow-up had no evidence of endometrial disease. We found a strong correlation between previous history of abnormal uterine bleeding (with or without endometrial thickening) and hysteroscopic suspicion of endometrial atypia that was confirmed by histology. Hysteroscopy had 83.3% sensitivity, 99% specificity, 83.3% positive predictive value (PPV) and 99% negative predictive value (NPV) in detecting endometrial atypia. No significant correlation was found between endometrial thickening to O5 mm without bleeding and histological atypia. Similarly, the duration of treatment was not related to endometrial thickening and histological atypia. Endometrial stromal hyperplasia was detected by histology in 70.5% of patients with endometrial thickness measurements ranging from 5 to 10 mm. In contrast, no atypia was detected when endometrial thickness was !5 mm. Ultrasound performed using a 5-mm cut-off threshold for endometrial thickness resulted in 100% sensitivity, 15% specificity, 4% PPV and 100% NPV in detecting endometrial atypia, while a 10-mm cut-off threshold resulted in 84% sensitivity, 69% specificity, 10% PPV and 99% NPV. Low-risk TAM users do not require different endometrial surveillance than the general population. Hysteroscopy could play a fundamental role in determining the endometrial status of patients before the initiation of TAM treatment and in assessing the endometrial status of patients when bleeding occurs.

Assessment of tumor size as a useful marker for the surgical staging of endometrial cancer

“…The preoperative assessment of tumor size using imaging techniques such as hysteroscopy (33), ultrasonography or magnetic resonance, should be included in the diagnosis of patients with suspected endometrial cancer in order to guide the surgeon to determine the most appropriate surgical strategy for each patient.…”

Coexistence of adenomyosis and endometrioid endometrial cancer: Role in surgical guidance and prognosis estimation

“…For all patients, demographic data were documented, including age, body mass index (BMI), history of comorbid conditions (hypertension and/or diabetes) and previous use of tamoxifen (19,20). All eligible patients were adequately informed at the time of admission regarding the possible use of their data for further analysis and publication in accordance with the Italian Privacy Law (675/96).…”

Quality of Life in Patients Affected by Endometrial Cancer: Comparison Among Laparotomy, Laparoscopy and Vaginal Approach

“…The median length of post-operative hospitalization was 3 days (2-5) in Group-0, 6 days (3-10) in Group-1 and 4 days (3)(4)(5)(6)(7)(8) in Group-2. The length of hospitalization for the three groups was significantly different between Group-0 vs Group-1 (p<0.001), between Group-0 vs Group-2 (p=0.006) and between Group-2 vs Group-1 (p<0.001).…”

“…The greatest incidence of EC is found in postmenopausal women [1], despite in some cases it occurred also in pre-menopausal ones with known risk factors such as obesity, diabetes, hypertension and previous Tamoxifen use [2][3][4].…”