TAMOXIFEN AND THE UTERUS - POTENTIAL UTERINE RISKS OF ANTIESTROGENS -THE APPROACH OF THE EUROPEAN-INSTITUTE-OF-ONCOLOGY

Tamoxifen has been widely used as adjunctive therapy for women with br east cancer because it acts as an excellent anti-oestrogen for breast tissue. However, tamoxifen has been found to be associated with variou s endometrial pathologies, such as endometrial hyperplasia, endometria l polyps and endometrial carcinoma [De Muylder and colleagues. Int J G ynecol Pathol 1991, 36, 127-129]. Transvaginal ultrasonography has bee n found to be an accurate diagnostic method in assessing endometrial t hickness in correlation with various physiological and pathological en dometrial conditions. Consistently, an endometrial thickness less than 4-5 mm has been associated with inactive endometrium on biopsy [Granb erg S and colleagues. Am J Obstet Gynecol 1991, 164, 47-52]. However, transvaginal ultrasonography has limited use in the diagnosis of speci fic abnormalities because of many false positive monographic findings in patients receiving tamoxifen. Some patients taking tamoxifen show h eterogeneous centrally located uterine changes when initially viewed w ith vaginal probe ultrasound. When such patients are viewed with a tec hnique of fluid enhancement (sonohysterography), some changes thought to be in the endometrium were actually in the proximal myometrium, pro bably due to reactivation of adenomyosal foci in the form of microcyst s [Goldstein SR. Am J Obstet Gynecol 1994, 170, 447-451]. The aim of t his study is to assess the clinical value of sonohysterography in iden tifying endometrial diseases among asymptomatic, postmenopausal breast cancer patients treated with tamoxifen 20 mg/day, and to compare its accuracy with that of transvaginal ultrasonography, hysteroscopy and e ndometrial sampling. (C) 1998 Elsevier Science Ltd. All rights reserve d.