TAMOXIFEN AND ENDOMETRIAL PATHOLOGY:ULTRASONOGRAPHIC, HYSTEROSCOPIC AND HISTHOLOGICALFINDINGS

The surveillance of women undergoing long-term tamoxifen treatment is
still a controversial problem.
The aim of the present study was to evaluate the endometrial abnormalities by ultrasonography, hysteroscopy and biopsy in postmenopausal patients treated with tamoxifen as adiuvant therapy for breast cancer.
74 patients (41 with abnormal uterine bleeding and 33 asymptomatic) underwent vaginal ultrasonography, hysteroscopy and endometrial biopsy.
At ultrasonography endometrial thickness was<5mm in 17 patients, >5mm in 38; polips were suspected in 12 patients; in 3 cases endometrial carcinoma was suspected. At hysteroscopy polips were present in 41 patients and in 23 of them cystic atrophy was associated; vascular congestion was also present in 20 cases; neoplastic lesion was suspected in 5 cases.
Histological findings were represented by: scanty or insufficient material for diagnosis in 15 cases; proliferative endometrium in 4 cases; endometrial polyps in 21 women; hyperplasia in 3 and dysplasia in 2 cases; neoplasia in 7 patients ( 4 endometrial adenocarcinomas, 2 carcinomas of the cervix, 1 endometrial adenosarcoma ).
These results show an association between tamoxifen therapy in breast cancer patients and neoplasic uterine pathology. No correlation has been documented between length of treatment and grade of endometrial lesion. Ultrasonography alone is usefull in asymptomatic patiens because selects patients with increased endometrial thickness which should undergo hysteroscopy. Hysteroscopy is more accurate in detecting polips, hyperplastic and neoplastic changes.