Sonohysterography for evaluation of endometrial abnormalities in breast cancer patients under tamoxifen therapy

Rahbar, Nahid; Torshizi, Zahra; Ghorbani, Raheb

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Koomesh

Journal of Semnan University of Medical Sciences

e-ISSN 2345-3699

p-ISSN 1608-7046

Cover image of the article: Sonohysterography for evaluation of endometrial abnormalities in breast cancer patients under tamoxifen therapy

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Outline

Abstract
References
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Sonohysterography for evaluation of endometrial abnormalities in breast cancer patients under tamoxifen therapy

Authors

Nahid Rahbar, Zahra Torshizi, Raheb Ghorbani

^,*

*Corresponding Author: Email: ghorbani.raheb93@gmail.com

Koomesh:Vol. 22, issue 3; 428-436

Published online:Sep 05, 2020

Article type:Research Article

Received:Sep 01, 2019

Accepted:Jan 05, 2020

How to Cite:Rahbar N, Torshizi Z, Ghorbani R. Sonohysterography for evaluation of endometrial abnormalities in breast cancer patients under tamoxifen therapy. koomesh. 2020;22(3):e153198. doi:

Abstract

Introduction: Tamoxifen may have secondary adverse effects on the endometrium. The aim of this study was to investigate the endometrial evaluation in women with breast cancer under tamoxifen therapy with Saline infusion Sonohysterography (SIS). Materials and Methods: This cross-sectional study was performed on 40 breast cancer patients under adjutant tamoxifen (20 mg/day for at least 6 months) therapy referred to Amir-al-Momenin hospital in Semnan, Iran, gynecological clinic, by oncologist during 2018 to 2019. Requested data including individual characteristics and results of vaginal sonography, Sonohysterography, Pathology and hysteroscopy were recorded in checklist. Results: The mean±SD age of patients was 46.0 ± 6.4 years. 39 patients (97.5%) had amenorrhea. The mean±SD duration of breast cancer was 3.1±1.3 years and the duration of tamoxifen use was 26.3 ± 13.7 months. Sonohysterography was performed without any complication in all patients. The most important findings in the Sonohysterography were endometrial thickness ≥ 5 mm in 6(15%), echogenic lesion in uterine cavity in 4(10%) and subendometrial cysts in 13 (32.5%) patients. Notably, vaginal sonography found endometrial thickness ≥5 in 16 cases, while Sonohysterography had abnormal findings just in 8 (50%) patients. Overall agreement of Sonohysterography with pathology, hysteroscopy and vaginal sonography was 80%, 80% and 75% respectively. Conclusion: The findings showed that patients under adjutant tamoxifen therapy are at risk for endometrial pathologies such as polyps and hyperplasia. Sonohysterography is well tolerated and has a good overall agreement with pathologic findings and in comparison with vaginal sonography reduces unnecessary invasive interventions.

Highlights

KeywordsSaline Infusion Sonohysterography Hysteroscopy Vaginal Sonography Tamoxifen Breast Cancer Endometrial Abnormality سونوهیستروگرافی سونوگرافی واژینال هیستروسکوپی تاموکسیفن سرطان پستان اختلال اندومتر

References

1.
Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015; 136: E359-386.
2.
Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomized trials. Lancet 2005; 365: 1687-1717.
3.
Davies C, Pan H, Godwin J, Gray R, Arriagada R, Raina V, et al. Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial. Lancet 2013; 381: 805-816.
4.
Taylor H, Pal L, Seli E. Speroff's clinical gynecologic endocrinology and infertility. 9th ed. Philadelphia: Wolters Kluwer 2020; 561.
5.
Puljiz M, Danoli D, Alvir I, Mami I. Effects of tamoxifen on the female genital tract. Libri Oncol 2014; 42: 61-64.
6.
Akhavan S. The effect of tamoxifen therapy on the endometrium and Ovary in patients with breast cancer. Obstet Gynecol Sci 2018; 61: 615-620.
7.
Rahmani M, Farmanbordar L, Omranipour R, Malek M, Zand S. Evaluation of saline sonohysterography findings in patients with breast cancer receiving tamoxifen adjuvant therapy. Arch Breast Cancer 2016; 3: 118-125.
8.
El Sheikh H, Atwa Kh, Sammour MA. Sonohysterography for evaluation of endometrial abnormalities associated with tamoxifen therapy for breast cancer. Egy J Radiol Nucl Med 2013; 44: 953-958.
9.
Inal M, Yildirim Y, Incebiyik A, Sanci M, Ispahi C. Diagnostic accuracy of sonohysterography in the evaluationof uterine cavities in tamoxifen administered asymptomatic postmenopausal breast cancer patients with endometrialthickness 5mm. Gynecol Surg 2006; 3 : 271-274.
10.
Fritz M, Speroff L. Clinical gynecologic endocrinology and infertility. 8thed. Philadelphia: Lippincott Williams & Wilkins 2011; 659.
11.
American College of Obstetricians and Gynecologists Committee on Gynecologic Practice. ACOG committee opinion. 2014, No. 601: Tamoxifen and uterine cancer. Available from: URL:https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/ Committee-on-Gynecologic-Practice/Tamoxifen-and-Uterine-Cancer? IsMobileSet=false.
12.
Moradan S, Darzi SN, Ghorbani R. Diagnostic value of saline infusion sonohysterography for detecting endometrial focal lesion. Pan Afr Med J 2019; 33: 211.
13.
Mohammad Jafary R, Barati M, Najafian M, Saadati N, Shojaie K. Comparison of sensitivity & specificity of transvaginal sonography, saline infusion sonohysterography and hysteroscopy in evaluation of women with abnormal uterine bleeding. JSSU 2009; 17: 249-254. (Persian).
14.
Vroom AJ, Timmermans A, Bongers MY, van den Heuvel ER, Geomini PMAJ, van Hanegem N. Diagnostic accuracy of saline contrast sonohysterography in detecting endometrial polyps in women with postmenopausal bleeding: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2019; 54: 28-34.
15.
Gultekin IB, Imamoglu GI, Gultekin S, Yilmaz EA, Yilmaz Z, Alkan A, Kucukozkan T. Elastosonographic evaluation of endometrium in women using tamoxifen for breast cancer. Niger J Clin Pract 2019; 22: 92-100.
16.
van Leeuwen FE, Benraadt J, Coebergh JW, Kiemeney LA, Gimbrre CH, Otter R, et al. Risk of endometrial cancer after tamoxifen treatment of breast cancer. Lancet 1994; 343: 448-452.
17.
Develiolu OH, Omak M, Bilgin T, Esmer A, Tfeki M. The endometrium in asymptomatic breast cancer patients on tamoxifen: value of transvaginal ultrasonography with saline infusion and Doppler flow. Gynecol Oncol 2004; 93: 328-335.
18.
Ito T, Katagiri C, Murata Y, Hamazoe R, Morita K. Indication for histological examination of endometrium in breast carcinoma patients receiving tamoxifen therapy. J Obstet Gynaecol Res 2001; 27: 141-145.
19.
Franchi M, Ghezzi F, Donadello N, Zanaboni F, Beretta P, Bolis P. Endometrial thickness in tamoxifen-treated patients: an independent predictor of endometrial disease. Obstet Gynecol 1999; 93: 1004-1008.
20.
Gelmon K. One step forward or one step back with tamoxifen? Lancet 2000; 356: 868-869.
21.
Gerber B, Krause A, Reimer T, Mylonas I, Makovitzky J, Kundt G, et al. Anastrozole versus tamoxifen treatment in postmenopausal women with endocrine-responsive breast cancer and tamoxifen-induced endometrial pathology. Clin Cancer Res 2006; 12: 1245-1250.
22.
Piazze J, Cerekja A, Buccheri M, Martiello S, La Torre R. Transvaginal ultrasound, hysterosonography and hysteroscopy in the monitoring of tamoxifen treated breast cancer patients: which is better? In: Pereira E and Soria J, Editors. Handbook of prenatal diagnosis. 1nd ed. New York: Nova Science Publishers; 2010; p. 309-312.
23.
Pokharel HP, Bhatla N, Kriplani A, Mukhopadhyay A, Srivastava A, Ralhan R. Evaluation of endometrial changes and p53 expression in tamoxifen treated women: comparison of various methods. Kathmandu Univ Med J (KUMJ) 2006; 4: 145-151.
24.
Hann LE, Kim CM, Gonen M, Barakat R, Choi PH, Bach AM.Sonohysterography compared with endometrial biopsy for evaluation of the endometrium in tamoxifen-treated women. J Ultrasound Med 2003; 22: 1173-1179.
25.
Hann LE, Gretz EM, Bach AM, Francis SM. Sonohysterography for evaluation of the endometrium in women treated with tamoxifen. AJR Am J Roentgenol 2001; 177: 337-342.
26.
Polin SA, Ascher SM. The effect of tamoxifen on the genital tract. Cancer Imaging 2008; 8: 135-145.
27.
Barbati A, Mariani L, Porpora MG, Anceschi M, Collini P, Lauro V,et al. Serum evaluation of P53 protein in patients with gynaecological cancer. Anticancer Res 2000; 20: 1033-1035.
28.
Love CD, Muir BB, Scrimgeour JB, Leonard RC, Dillon P, Dixon JM. Investigation of endometrial abnormalities in asymptomatic women treated with tamoxifen and an evaluation of the role of endometrial screening. J Clin Oncol 1999; 17: 2050-2054.
29.
Yousefi Z, Homayie F, Rafei S. The evaluation of the endometrial thickness of amenorrhea breast cancer patients treated with tamoxifen. Arak Med Univ J (AMUJ) 2011; 14: 101-107. (Persian).

Copyright

© 2020, Author(s). This open-access article is available under the Creative Commons Attribution 4.0 (CC BY 4.0) International License (https://creativecommons.org/licenses/by/4.0/), which allows for unrestricted use, distribution, and reproduction in any medium, provided that the original work is properly cited.

Outline

Sonohysterography for evaluation of endometrial abnormalities in breast cancer patients under tamoxifen therapy

Abstract

Highlights

References

Copyright

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