Assessment of Endometrial Hyperplasias in 69 Tamoxifen-Treated Asymptomatic Postmenopausal Women

Objective: To analyze the relationship between transvaginal ultrasonography (TU), hysteroscopy and endometrial histology in asymptomatic postmenopausal women with breast cancer using tamoxifen, in terms of hyperplasias. Design: Prospective study Setting: University clinic Patients: 69 postmenopausal aymptomatic breast cancer women on tamoxifen Interventions: TU and hysteroscopy plus endometrial biopsy Main Outcome Measures: Sensitivity specifity, positive and negative predictive values of diagnostic procedures were calculated. The relationship between duration of tamoxifen use and development of hyperplasias are calculated by using simple logistic regression. Results: Most common abnormality encountered was polyps (60.9%). A case of endometrioid adenocarcinoma on a polyp and 6 cases of hyperplasia (one atypical hyperplasia) along with the polyps were categorized into "polyps only" by hysteroscopy. Hence all would have been missed if biopsies if biopies were not taken. Positive predictive value (PPV) of TU was calculated to be 69.6%. Sensitivity and PPV of hysteroscopy is low for hyperplasia (33.3% and 50% respectively). A positive correlation was noted (p = 0.002) between duration of tamoxifen use and development of hyperplasia related changes. Conclusions: Long term use of tamoxifen in postmenopausal asymptomatic breast cancer patients is associated with higher incidence of hyperplasia related changes. Hyperplasia might coexist with or on a polyp, therefore hysteroscopy might miss these pathologies if ample amount of biopsies are not taken.