ENDOMETRIAL THICKNESS IN TAMOXIFEN-TREATED PATIENTS - CORRELATION WITH CLINICAL AND PATHOLOGICAL FINDINGS

OBJECTIVE. This study was performed to evaluate sonographic measuremen ts of endometrial thickness in postmenopausal breast cancer patients b eing treated with tamoxifen and to correlate endometrial thickness wit h pathology, symptoms, and duration of tamoxifen treatment. MATERIALS AND METHODS, Pelvic sonograms and medical records of 91 postmenopausal breast cancer patients being treated with tamoxifen were retrospectiv ely reviewed. Histologic results were available in 46 patients (51%). Endometrial thickness was measured in anteroposterior dimension and wa s considered normal when less than 8 mm. Endometrial thickness was the n correlated with histopathologic findings, symptoms, and duration of tamoxifen treatment. RESULTS. Forty-seven examinations (52%) showed en dometrial thickness of less than 8 mm and 44 examinations (48%) showed endometrial thickness of 8 mm or more. Endometrial biopsy was perform ed in 10 women (21%) in whom the endometrial thickness Was less than 8 mm, revealing seven normal endometria, one endometrial polyp, and two insufficient samples. Endometrial biopsy was performed in 36 women (8 2%) in whom endometrial thickness was 8 mm or more, revealing three ca ses with more than one diagnosis. In this group, diagnoses included 14 normal endometria, 12 endometrial polyps, four endocervical polyps, t hree hyperplasias, two endometrial cancers, one papillary syncytial me taplasia, one cystic change, one inflammatory debris, and one insuffic ient sample. Postmenopausal bleeding prompted 20 studies, 12 of which revealed endometrial thickness of 8 mm or more. We found no difference in endometrial thickness of patients who had bleeding versus those wh o had no bleeding. Endometrial thickness increased with the duration o f tamoxifen treatment. Seventy-three women being treated with tamoxife n for less than 5 years had a median endometrial thickness of 5 mm, an d 44% of biopsies yielded abnormal results. Eighteen women receiving t amoxifen 5 years or longer had a median endometrial thickness of 14 mm , and 58% of endometrial biopsies in this group were abnormal. The two endometrial cancers occurred in women who were treated with tamoxifen for 6 years. Correlation between duration of tamoxifen use and endome trial thickness was significant (p <.026). CONCLUSION. The majority of women being treated with tamoxifen were asymptomatic, but 48% of sono grams revealed an endometrial thickness of 8 mm or more. Endometrial p olyps, the most common abnormality, were diagnosed in 33% of biopsies performed for endometrial thickness of 8 mm or more. Endometrial thick ness showed no correlation with symptoms, but we found a statistically significant correlation between increased endometrial thickness and d uration of tamoxifen treatment that was longer than 5 years.