VALUE OF SONOHYSTEROGRAPHY IN ASYMPTOMATIC POSTMENOPAUSAL TAMOXIFEN-TREATED PATIENTS

A prospective study was performed to assess the efficacy of sonohyster ography (SHG) in identifying endometrial pathologies among asymptomati c, postmenopausal breast cancer patients treated with tamoxifen. In th is study the uterine cavity of 68 such patients with endometrial thick ness of greater than or equal to 8 mm was prospectively evaluated by S HG. Forty-six (67.6%) patients in whom SHG did not identify any findin gs in the uterine cavity (negative group) were followed by diagnostic hysteroscopy. Another 22 (32.4%) who were identified by SHG to have ab normal endometrial findings, such as an echogenic or polypoid mass (po sitive group), were followed by operative hysteroscopy and by postoper ative SHG. In the positive group the basal transvaginal sonogram revea led an endometrial echogenic mass In only 10 (45.5%). In the remaining 12 (54.5%) patients, the transvaginal sonogram identified only thick endometrium. In these latter 12 patients, histological assessment conf irmed endometrial polyps in 8 (66.7%) and fibroid in 1 (8.3%). Four (1 8.2%) patients in the positive group had no histological endometrial p athology. Two (50%) of them had a uterine septum as diagnosed during h ysteroscopy, in one (25%) operative hysteroscopy failed to resect the endometrial polyp, and in another (25%) there was a false-positive SHG diagnosis. Overall, SHG accurately diagnosed endometrial and/or other Intrauterine pathology in 95.5% of these patients. In the 46 patients with ''negative'' basal SHG features, diagnostic hysteroscopy confirm ed this diagnosis. Thus, there was no SHG false-negative diagnosis. Co mparing the results of the basal SHG with those of operative hysterosc opy and/or the histopathological findings in the positive group, the s ensitivity of SHG was 1.0, the specificity 0.0, positive predictive va lue 95.5%, and negative predictive value 0.0. It is suggested that SHG is a useful diagnostic tool for the assessment of specific endometria l pathologies in asymptomatic postmenopausal breast cancer patients tr eated with tamoxifen who were diagnosed by transvaginal sonography to have thick endometrium. (C) 1997 Academic Press.