Endometrial abnormalities in breast cancer patients with tamoxifen therapy

Objective Evaluation of the effect of tamoxifen therapy on endometrium in p atients who have previously undergone surgery for breast cancer. Design An analysis of hysteroscopic findings and their correlation with tho se from previous vaginal ultrasonography and subsequent endometrial samplin g. Setting The hysteroscopy unit of a university clinic. Subjects 64 patients referred from the breast clinic, who had previously un dergone surgery for breast cancer and who were receiving adjuvant tamoxifen therapy, with either suspicious findings on routine vaginal ultrasonograph y or abnormal uterine bleeding. Of the patients, 22 were premenopausal (gro up A) and 42 postmenopausal (group B). Each group was divided in two subgro ups, comprising either symptomatic patients (groups A1 and B1) or asymptoma tic patients (groups A2 and B2). Intervention Diagnostic hysteroscopy. Results All six patients of group A1 were found to have hyperplastic endome trium on hysteroscopy. Subsequent biopsy after dilation and curettage (D&C) revealed simple endometrial hyperplasia in all samples, plus endometrial p olyps in two cases. Despite suspicious appearances on vaginal ultrasonograp hy, all 16 asymptomatic premenopausal patients (group A2) were found on hys teroscopy to have normal endometrium. Among the 29 patients with postmenopa usal uterine bleeding (group B1) 22 showed hyperplastic endometrial finding s on hysteroscopy. The histopathological results from the subsequent D&C, c onfirmed the hysteroscopic findings, showing various degrees of endometrial hyperplasia and three adenocarcinomas (4.7% of the total number of patient s or 10.3% of those with postmenopausal bleeding). Normal or atrophic endom etrium was observed in nine of the 13 patients in group B2; there was one p olyp, and three cases of hyperplastic endometrium, which were found to be s imple hyperplasia on pathological investigation. Conclusions Monitoring of the uterine cavity in patients receiving tamoxife n therapy is mandatory, especially where there is postmenopausal bleeding. Hysteroscopy findings display a considerably higher degree of correlation w ith endometrial pathology results, than do vaginal ultrasonography findings .