THE USE OF TRANSVAGINAL ULTRASOUND AND SALINE INFUSION SONOHYSTEROGRAPHY FOR THE EVALUATION OF ASYMPTOMATIC POSTMENOPAUSAL BREAST-CANCER PATIENTS ON TAMOXIFEN

Tamoxifen has been shown to decrease the recurrence rate of breast can cer. Evidence that tamoxifen use may be associated with an increased r isk of endometrial cancer has caused investigators to recommend routin e invasive sampling. We have assessed a minimally invasive alternative for endometrial surveillance of tamoxifen-treated patients utilizing transvaginal ultrasound and saline infusion sonohysterography. Asympto matic women (n = 44) with breast cancer on postoperative tamoxifen tre atment were referred to our gynecological ultrasound unit. Initially, the endometrial echo was measured with unenhanced transvaginal ultraso und. If a distinct echo measured less than or equal to 5 mm, no furthe r procedure was performed. For thickened or inadequately visualized ec hoes, sonohysterography was performed. If a thin echo was noted on son ohysterography, no further procedure was performed. If focal changes w ere detected, hysteroscopy/dilatation and curettage (D&C) was performe d. For generalized symmetrically thickened echoes, a blind biopsy was done. If sonohysterography was unsuccessful, hysteroscopy/D&C was perf ormed. Eleven (25%) patients had thin unenhanced echoes of less than o r equal to 5 mm. Twenty-five (57%) patients had thickened endometrial echoes. Three (7%) had naturally occurring endometrial fluid outlining a polyp. An endometrial echo could not be visualized in five (11%) pa tients. Sonohysterography was successfully performed in 21 out of 30 ( 70%) patients with either thickened or non-visualized unenhanced echoe s. Of these, two patients had thin endometria with coexisting myomas; seven had thin endometria with typical tamoxifen-induced subendometria l changes; and seven had focal polypoid thickening confirmed by hyster oscopy/D&C. Histology revealed carcinoma associated with two, prolifer ation in one and four polyps. Five patients had thickened unenhanced e choes with symmetrically thickened single-layer measurements on sonohy sterography. Histology, revealed that three were proliferative, one wa s inactive and one was hyperplastic, In the nine patients with unsucce ssful sonohysterography, hysteroscopy/D&C revealed inactive endometria in six, and three polyps. Our paradigm of evaluating the endometrial response to tamoxifen is concluded to overcome the shortcomings of eit her unenhanced transvaginal ultrasound or blind biopsy alone while it kept the number of invasive sampling procedures to 55% (24 out of 44).