SONOGRAPHIC EVALUATION OF THE UTERUS IN POSTMENOPAUSAL WOMEN RECEIVING TAMOXIFEN - CHARACTERIZATION OF MID-UTERINE ABNORMALITIES

Background: Tamoxifen is known to exert agonist estrogenic effects on the uterus. Its use in postmenopausal women has also been associated w ith various endometrial and uterine abnormalities that can be detected by endovaginal sonography. Objective: To study postmenopausal patient s receiving tamoxifen who were referred for evaluation following the d etection of abnormal uterine findings by endovaginal sonography. Metho ds: Fifty-two women treated with tamoxifen for breast cancer who were found to have an abnormal uterine sonogram constituted the study popul ation. Uterine sonograms were reviewed and clinical and sonographic da ta were correlated with the results of the histologic examinations. Re sults: Forty-five women demonstrated a thickened mid-uterine structure . Of these, in thirty-nine patients (87%) either no tissue or scant fr agments of normal endometrium were obtained on curettage, and six wome n (13%) had endometrial hyperplasia. Seven women had fluid loculation lined by thin endometrium. Their subsequent histologic examination was normal. The sonograms of the women who demonstrated an appearance of a thickened endometrium but no neoplasia, characteristically demonstra ted hyperechogenic cystic area with no midline echo. Conclusions: Amon g 52 postmenopausal patients receiving tamoxifen presented with an abn ormal uterine sonogram, 39 (75%) women were found to have a thick mid- uterine structure resembling a thickened endometrium without histologi c evidence of neoplasia. This phenomenon can be characterized by typic al sonographic features, and may be differentiated from other uterine abnormalities.