Limited value of sonohysterography for endometrial screening in asymptomatic, postmenopausal patients treated with tamoxifen

Objectives. Sonohysterography (SHG) has been proposed as a useful tool for the surveillance of the endometrium in patients receiving tamoxifen. This s tudy aimed to assess the value of SHG in asymptomatic patients who would ha ve been biopsy candidates because of abnormal transvaginal ultrasound (TVUS ) results. Methods. The study population included postmenopausal breast cancer patient s receiving adjuvant tamoxifen who had asymptomatic abnormalities at TVUS ( endometrial thickness greater than or equal to 8 mm or endometrial echo not adequately visualized). SHG was performed with an Aloka SSD 680 system usi ng a 5-MHz vaginal probe, with sterile saline solution as contrast medium. Results. Forty-one patients entered the study. A regular endometrial echo w as identified by SHG in 9 patients (21.9%). Histology was obtained in the r emaining 32 patients with positive (n = 27, 65.8%) or unsuccessful (n = 5, 12.2%) SHG. Benign polyps (n = 15, 36.6%) and endometrial atrophy (n = 14, 34.1%) were the most common findings; 3 patients (7.3%) had simple hyperpla sia. Conclusions. Breast cancer patients with asymptomatic, tamoxifen-associated TVUS abnormalities have little additional benefit from SHG. More than 2/3 remain candidates for biopsy, which usually yields benign or insignificant findings, (C) 2000 Academic Press.