Hysteroscopic Dynamic Assessment of the Endometrium in Patients Treated with Long-Term Tamoxifen

Pérez-Medina, Tirso; Salazar, Francisco; Sanfrutos, Luis; Ríos, Mar; Jimenez, J Ramos; Troyano, J. M.; Cayuela, E.; Iglesias, E.

doi:10.1016/j.jmig.2010.12.014

Cited by 18 publications

(7 citation statements)

References 12 publications

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“…Poor understanding of the severity of these potential side effects of TAM treatment could be responsible for the use of invasive and costly diagnostic procedures (e.g. endometrial biopsy) that often give negative results, particularly in the absence of reports of abnormal uterine bleeding (AUB; Pérez-Medina et al 2011).…”

Section: Introductionmentioning

confidence: 99%

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

Saccardi¹,

Gizzo²,

Patrelli³

et al. 2013

Endocrine-Related Cancer

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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.

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Section: Introductionmentioning

confidence: 99%

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

Saccardi¹,

Gizzo²,

Patrelli³

et al. 2013

Endocrine-Related Cancer

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“…A few studies have examined hysteroscopic findings in patients exposed to TAM. In one such study, hysteroscopic endometrial patterns were classified into five patterns that changed in order: atrophic, cystic, hypervascularized, endometrial polyp, and suspected malignancy 14 . Another study showed that 51% of patients with TAM therapy had endometrial abnormalities in hysteroscopy, with a significantly higher incidence of normal/atrophic endometrium and TAM‐induced cystically thickened endometrium 15, 16 …”

Section: Discussionmentioning

confidence: 99%

Atypical vessels in hysteroscopy: Usefulness in prediction of malignant diseases in patients treated with tamoxifen

Oka

Sakai

Yamagami

et al. 2021

J of Obstet and Gynaecol

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Aim Tamoxifen (TAM) is widely used in adjuvant endocrine therapy for invasive breast cancer as a selective estrogen modulator, but this treatment has a risk of developing endometrial malignancy. However, hysteroscopic findings during or after TAM treatment are unclear. The aim of this study is to examine the association between hysteroscopic patterns and malignant histological findings during or after treatment with TAM. Methods The subjects were patients who received TAM after surgery for breast cancer and underwent hysteroscopy at our institution from January 2016 to December 2019. Clinicopathological factors and hysteroscopic findings were collected from medical records and investigated retrospectively. Histologically, atypical endometrial hyperplasia, endometrial cancer, and carcinosarcoma were classified as malignant diseases. Results A total of 26 patients were eligible for the study. Hysteroscopic findings included an irregular surface of the endometrium (n = 3, 11.5%), atypical vessels (n = 10, 38.5%), papillary structure (n = 3, 11.5%), and polypoid structure (n = 18, 69.2%). Histological examination revealed malignancy in six patients (23.0%). The percentage of atypical vessels in patients with malignancies was significantly higher than that in patients with a normal endometrium or benign lesion (100% vs. 20%, p = 0.0009). The sensitivity and specificity of atypical vessels in hysteroscopy for diagnosis of malignant diseases were 100% and 80%, respectively. Conclusions Hysteroscopic findings of atypical vessels may be useful for prediction of malignant diseases in patients treated with TAM.

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“…Atrophic, hypervascularized, cystic, polypoidal and cerebriform projections with irregular growths. [ 14 ] In the case of polyp in tamoxifen users, it is mandatory to remove the entire polyp as they have higher rate of malignant transformation than the non-tamoxifen patients Figure 11a and b .…”

Section: P Osttamoxifen [F Igure 10 a And B ]mentioning

confidence: 99%

Understanding the Endometrium at Menopause

Telang

Tanvir²

2021

Journal of Mid-Life Health

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The risk of premalignant and malignant endometrial pathologies increases in the postmenopausal period. Dilatation and curettage fail to diagnose one in ten endometrial pathologies. Hysteroscopy is the gold standard to evaluate the endometrial cavity. Hysteroscopy can identify malignant or benign pathology with approximately 20% false-positive results. Hysteroscopy combined with biopsy increases the accuracy of diagnosis up to 100%. This pictorial review takes you through the hysteroscopic view of normal-looking postmenopausal atrophic uterus, cystic atrophy, benign endometrial pathologies, endometrial hyperplasia, endometrial cancer, tamoxifen-induced endometrial hyperplasia and histiocytic endometritis. The purpose of this pictorial review is to guide the operator in systematic evaluation of the endometrial cavity with special attention to the thickness of the endometrium, vascular architecture, location of the lesion and surface aberrations, which adds value to the diagnosis and management of endometrial pathologies.

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Hysteroscopic Dynamic Assessment of the Endometrium in Patients Treated with Long-Term Tamoxifen

Cited by 18 publications

References 12 publications

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

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

Atypical vessels in hysteroscopy: Usefulness in prediction of malignant diseases in patients treated with tamoxifen

Understanding the Endometrium at Menopause

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