Saline Infusion Sonography and Office Hysteroscopy to Assess Endometrial Morbidity Associated with Tamoxifen Intake

• Published in: Gynecologic oncology Vol. 86; no. 3; pp. 323 - 329
• Main Authors: Garuti, Giancarlo, Cellani, Fulvia, Grossi, Francesco, Colonnelli, Monica, Centinaio, Giovanna, Luerti, Massimo
• Format: Journal Article
• Language: English
• Published: San Diego, CA Elsevier Inc 01-09-2002; Elsevier
• Subjects: Antineoplastic Agents, Hormonal - adverse effects; Biological and medical sciences; breast cancer; Breast Neoplasms - drug therapy; endometrial cancer; Endometrium - diagnostic imaging; Endometrium - drug effects; Endometrium - pathology; Estrogen Receptor Modulators - adverse effects; Feasibility Studies; Female; Female genital diseases; Gynecology. Andrology. Obstetrics; Humans; hysteroscopy; Hysteroscopy - methods; Medical sciences; Middle Aged; saline infusion sonography; sonohysterography; tamoxifen; Tamoxifen - administration & dosage; Tamoxifen - therapeutic use; transvaginal ultrasonography; Tumors; Ultrasonography; hysteroscopy; sonohysterography; endometrial cancer; breast cancer; saline infusion sonography; transvaginal ultrasonography; tamoxifen; Antineoplastic agent; Performance evaluation; Hysteroscopy; Acceptance; Antiestrogen; Antihormone; Uterine diseases; Postmenopause; Female; Mammary gland; Non steroid compound; Endometrium; Hysterography; Public health; Sonography; Human; Malignant tumor; Medical screening; Pelvic pain; Tamoxifene; Female genital diseases; Mammary gland diseases; Treatment; Health economy; Cost analysis; Comparative study
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1006/gyno.2002.6783

Objective.The objective of this study was to compare office feasibility, patient acceptance, and diagnostic accuracy of hysteroscopy (HYS) and saline infusion sonography (SIS) in breast cancer patients taking tamoxifen.
Methods. Sixty-six asymptomatic postmenopausal women on tamoxifen for breast cancer underwent SIS, followed by outpatient HYS with endometrial biopsy. In all women an endometrial stripe over 4 mm was previously measured by transvaginal ultrasonography (TU). Histologic reports were matched with sonographic and hysteroscopic findings. After SIS and HYS, patients were asked to rate pelvic pain experienced during the two procedures on a 10 cm Visual Analog Scale (VAS).
Results. SIS and HYS were not accomplished in 26 (39.3%) and 4 (6.0%) patients, respectively, due to cervical stenosis or patient intolerance. No adverse event was recorded after 40 SIS and 62 hysteroscopic procedures. Pathologic assessment reported 15 polyps (22.7%), 7 hyperplasias (10.5%), and 2 submucous myomas (3.0%). Sensitivity, specificity, and negative and positive predictive values of SIS in distinguishing between normal and abnormal endometrium were 85.7, 83.3, 93.7, and 66.0%, respectively, whereas HYS provided corresponding values of 100, 94.1, 97.8, and 100%, respectively. No significant difference was found between SIS and HYS in the subjective perception of pelvic pain (VAS scores 3.02 ± 2.8 and 3.82 ± 2.7, respectively).
Conclusions. Office hysteroscopy is a safe and conclusive diagnostic tool for endometrial investigation in menopausal women on tamoxifen. It exposes the patients to the same pelvic discomfort as SIS, but has a better feasibility rate and diagnostic accuracy.