Comparative Study on Hysteroscopic and Histologic Examinations of the Endometrium in Postmenopausal Women Taking Tamoxifen
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Objectives: To evaluate the histologic effects of tamoxifen on the endometrium using hysteroscopy in postmenopausal women with breast cancer.Methods: The study included 46 postmenopausal patients who were referred from another clinic due to thickening or bleeding of the endometrium after taking tamoxifen for breast cancer. All patients underwent transvaginal sonography (TVS) and hysteroscopic endometrial biopsy with a 5-mm, continuous-flow, operating hysteroscope.Results: The incidence of malignancy was high (20%) in cases of abnormal uterine bleeding (AUB) after taking tamoxifen. However, in the non-AUB group with thick endometrium after taking tamoxifen, the incidence of adenocarcinoma was 3.2%.Conclusions: Our findings confirm the estrogen-like effect of tamoxifen on the endometrium. Endometrial evaluation with TVS suggests further diagnostic procedures; moreover, histologic examination is necessary under hysteroscopy, especially in cases of endometrial bleeding after taking tamoxifen.
Abstract
Objectives: To evaluate the histologic effects of tamoxifen on the endometrium using hysteroscopy in postmenopausal women with breast cancer.Methods: The study included 46 postmenopausal patients who were referred from another clinic due to thickening or bleeding of the endometrium after taking tamoxifen for breast cancer. All patients underwent transvaginal sonography (TVS) and hysteroscopic endometrial biopsy with a 5-mm, continuous-flow, operating hysteroscope.Results: The incidence of malignancy was high (20%) in cases of abnormal uterine bleeding (AUB) after taking tamoxifen. However, in the non-AUB group with thick endometrium after taking tamoxifen, the incidence of adenocarcinoma was 3.2%.Conclusions: Our findings confirm the estrogen-like effect of tamoxifen on the endometrium. Endometrial evaluation with TVS suggests further diagnostic procedures; moreover, histologic examination is necessary under hysteroscopy, especially in cases of endometrial bleeding after taking tamoxifen.
참고문헌 (22)
- Suh-Burgmann EJ, "Surveillance for endometrial cancer in women receiving tamoxifen", Ann Intern Med, 131, pp.127~135 (1999)
- Markovitch O, "Long-term follow-up of postmenopausal breast cancer patients following discontinuation of tamoxifen therapy", Maturitas, 59, pp.387~393 (2008)
- Cohen I, "Risk factors of endometrial polyps resected from postmenopausal patients with breast carcinoma treated with tamoxifen", Cancer, 92, pp.1151~1155 (2001)
- Cohen I, "Significance of secondary ultrasonographic endometrial thickening in postmenopausal tamoxifen-treated women", Cancer, 94, pp.3101~3106 (2002)
- Hwang KR, "The endometrial ultrasonographic changes in postmenopausal breast cancer patients taking aromatase inhibitors after stopping of tamoxifen treatment", J Korean Soc Menopause, 14, pp.130~138 (2008)
- Achiron R, "Tamoxifen and the uterus: an old drug tested by new modalities", Ultrasound Obstet Gynecol, 7, pp.374~378 (1996)
- 신철화, "폐경 후 자궁 출혈에 대한 자궁경의 효과", Obstetrics & Gynecology Science, 50(9) (2007), 대한산부인과학회
- Ceci O, "Hysteroscopic evaluation of the endometrium in postmenopausal women taking tamoxifen", J Am Assoc Gynecol Laparosc, 7, pp.185~189 (2000)
- Early Breast Cancer Trialists' Collaborative Group (EBCTCG), "Aromatase inhibitors versus tamoxifen in early breast cancer: patient-level meta-analysis of the randomised trials", Lancet, 386, pp.1341~1352 (2015)
- Ozsener S, "Endometrial pathology of 104 postmenopausal breast cancer patients treated with tamoxifen", Eur J Gynaecol Oncol, 19, pp.580~583 (1998)
- Hann LE, "Endometrial thickness in tamoxifen-treated patients: correlation with clinical and pathologic findings", AJR Am J Roentgenol, 168, pp.657~661 (1997)
- Cohen I, "Endometrial pathology in postmenopausal tamoxifen treatment: comparison between gynaecologically symptomatic and asymptomatic breast cancer patients", J Clin Pathol, 52, pp.278~282 (1999)
- Seoud M, "Tamoxifen and endometrial pathologies: a prospective study", Gynecol Oncol, 75, pp.15~19 (1999)
- Lee DO, "Comparison of histologic results from hysteroscopic biopsy and blinded biopsy by currettage in women with tamoxifen therapy after breast cancer", J Korean Soc Menopause, 14, pp.246~250 (2008)
- Cheng WF, "Comparison of endometrial changes among symptomatic tamoxifentreated and nontreated premenopausal and postmenopausal breast cancer patients", Gynecol Oncol, 66, pp.233~237 (1997)
- Kedar RP, "Effects of tamoxifen on uterus and ovaries of postmenopausal women in a randomised breast cancer prevention trial", Lancet, 343, pp.1318~1321 (1994)
- Dijkhuizen FP, "Transvaginal ultrasonography and endometrial changes in postmenopausal breast cancer patients receiving tamoxifen", Maturitas, 25, pp.45~50 (1996)
- Neven P, "Should tamoxifen users be screened for endometrial lesions?", Lancet, 351, pp.155~157 (1998)
- Timmerman D, "A randomized trial on the use of ultrasonography or office hysteroscopy for endometrial assessment in postmenopausal patients with breast cancer who were treated with tamoxifen", Am J Obstet Gynecol, 179, pp.62~70 (1998)
- Ramondetta LM, "Endometrial cancer in polyps associated with tamoxifen use", Am J Obstet Gynecol, 180, pp.340~341 (1999)
- American College of Obstetricians, "ACOG committee opinion No. 440: The role of transvaginal ultrasonography in the evaluation of postmenopausal bleeding", Obstet Gynecol, 114, pp.409~411 (2009)
- Committee on Practice Bulletins-Gynecology, "Practice bulletin no. 128: diagnosis of abnormal uterine bleeding in reproductive-aged women", Obstet Gynecol, 120, pp.197~206 (2012)