Tamoxifen and Endometrial Pathologies: A Prospective Study

Seoud, Muhieddine; Shamseddine, Ali; Khalil, Ali; Salem, Ziad; Saghir, M. Ziad; Bikhazi, K.; Bitar, Nizar; Azar, Ghassan; Kaspar, Hanna G.

doi:10.1006/gyno.1999.5519

Cited by 56 publications

(23 citation statements)

References 19 publications

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“…According to ACOG suggestions, AUB is the clinical sign most commonly linked to endometrial disease that requires investigation to exclude the possible onset of endometrial atypia (Love et al 1999, Seoud et al 1999. In fact, our data showed that the 83.3% of histological endometrial atypia was preceded by AUB.…”

Section: Discussionmentioning

confidence: 51%

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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: Discussionmentioning

confidence: 51%

“…In a study of 80 TAM-treated patients, Seoud et al (1999) showed that all patients who developed abnormalities had AUB but found no correlation between endometrial thickness and endometrial pathology. In this study, the only patient who developed endometrial cancer had endometrial thickness of 3 mm.…”

Section: Discussionmentioning

confidence: 97%

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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“…Seoud et al concluded that the value of routine screening for endometrial pathology in patients on tamoxifen is controversial. They found that all patients who developed an abnormal endometrium had abnormal vaginal bleeding [7]. Bernstein et al in a case control study concluded that endometrial cancer associated with tamoxifen use and the risk increased with the duration of tamoxifen use [8].…”

Section: Tamoxifen Therapy For Breast Cancer and Endometrial Pathologymentioning

confidence: 99%

Tamoxifen Therapy for Breast Cancer and Endometrial Pathology

Kochar

Arora

Chattopadhyay³

2005

Medical Journal Armed Forces India

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Background: Tamoxifen, used as adjuvant therapy for carcinoma breast in postmenopausal women to prevent relapse has estrogenic effect on the endometrium. Methods: 104 patients on tamoxifen for more than six months were subjected to a clinical examination and transvaginal sonography. Patients with endometrial thickness > 8 mm were further evaluated by hysteroscopy and endometrial biopsy. Results: 35(34%) patients were symptomatic. The average endometrial thickness was 11.2 mm which correlated with duration of tamoxifen use. 27(48%) patients had abnormal hysteroscopic findings. 35 (63%) of endometrial biopsies revealed abnormal endometrium. One case of endometrial carcinoma was diagnosed. The results were statistically analysed. There is a significant association between symptomatic status and endometrial thickness and duration of tamoxifen use. Conclusion: All patients on long term tamoxifen should be annually screened for endometrial pathology. MJAFI 2005; 61 : 313-315

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“…A well-known problem of performing TVUS in tamoxifen-treated women is a high incidence of apparent endometrial thickening and an associated increase in invasive procedures, most of which are not indicated. [28][29][30] Measurement of endometrial thickness by TVUS in tamoxifen-treated women therefore appears not to be a reliable screening tool. In the LIBERATE study, TVUS was performed in tamoxifen-treated women at screening only in order to exclude endometrial polyps.…”

Section: Discussionmentioning

confidence: 99%

Safety of tibolone in the treatment of vasomotor symptoms in breast cancer patients—Design and baseline data ‘LIBERATE’ trial

et al. 2007

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Many patients with a history of breast cancer (BC) will suffer from vasomotor symptoms, which can be induced or exacerbated by treatment with tamoxifen or aromatase inhibitors. The LIBERATE trial was designed as a randomized, double-blind, multicenter trial to demonstrate that tibolone 2.5mg/day (Livial ® ) is non-inferior to placebo regarding BC recurrence in women with vasomotor symptoms surgically treated for primary BC within the last 5 years. Secondary objectives are effects on vasomotor symptoms as well as overall survival, bone mineral density and health-related quality of life.Mean age at randomization was 52.6 years, and the mean time since surgery was 2.1 years. The mean daily number of hot flushes and sweating episodes was 7.3 and 6.1, respectively. For the primary tumor, Stage IIA or higher was reported for > 70% of the patients. In subjects whose receptor status was known, 78.2% of the tumors were estrogen receptors positive. At randomization, tamoxifen was given to 66.2% of all patients and aromatase inhibitors to 7%. Chemotherapy was reported by 5% at randomization.The adjuvant tamoxifen use in LIBERATE allows a comparison with the Stockholm trial (showing no risk of BC recurrence associated with hormone therapy), which was stopped prematurely subsequent to HABITS. The LIBERATE trial is the largest, ongoing, well-controlled study for treatment of vasomotor symptoms in BC patients.

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Tamoxifen and Endometrial Pathologies: A Prospective Study

Cited by 56 publications

References 19 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

Tamoxifen Therapy for Breast Cancer and Endometrial Pathology

Safety of tibolone in the treatment of vasomotor symptoms in breast cancer patients—Design and baseline data ‘LIBERATE’ trial

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