Abstract
ABSTRACT Background: Multiple endometrial lesions have been reported in tamoxifen -treated breast cancer patients. As a consequence, a thorough uterine cavity examination is often necssary. Objective: To compare the efficacy of transvaginal ultrasound versus hysteroscopy in detecting the endometrial changes in tamoxifen-treated breast cancer patients, and to correlate the findings of both methods with histopathological examination of endometrial biopsies. Patients and methods: Twenty seven patients who had mastactomies for breast cancer and receiving tamoxifen (TAM) were enrolled in this prospective study. They subjected to transvaginal ultrasonography (TVUS) and hysteroscopy for endometrial assessment. Endometrial biopsy was taken from all participants for hitstopathological examination. The ultrasongraphic and hysteroscopic findings were compared and correlated with the histopathological results. Results: The diagnostic accuracy of TVUS versus hysteroscopy in detecting endometrial changes in breast cancer TAM treated women was as follows;TVUS had a sensitivity (82.4%), specificity (30.0%), PPV (66.7%), NPV (50.0%) and accuracy (63%) ;while, the hysteroscope had sensitivity (94.1%), specificity (60.0%), PPV (80.0%), NPV (85.7%) and accuracy (81.5%). Conclusion: Because of certain discrepancies between TVUS and histopathological results in TAM treated women, TVUS is not the best tool for evaluating the endometrium in those patients. The utility of the hysteroscopic image processing helps in the triage of women who require endometrial surveillance, so it will reduce the pathologist's workload and the patient's apprehension while waiting for histopathology result. Nevertheless hysteroscope cannot establish a conclusive diagnosis of premalignant or malignant lesions, but it provides a direct view for targeted biopsies to create a definitive diagnosis.
Highlights
Breast cancer accounts for around a quarter of all cancers diagnosed in women worldwide
Despite the fact of TAM has an antiestrogen in the breast tissue but it has estrogenic effect on endometrium and myometrium.TAM treatment for a long time has been linked to an increase in risk of endometrial polyps, leiomyomas, endometrial hyperplasia, adenomyosis and even endometrial cancer[1]
The diagnostic performance of ultrasonography and hysteroscopy in detection of endometrial changes regarding the histopathological reference, we found that hysteroscopy was more sensitive than ultrasound in the diagnosis of endometrial lesions, table 4, and this was consistent with the result of Le Donne et al.[17] who showed a significant association between hysteroscopy and histological findings regarding the diagnosis of endometrial atrophy, polyps, hyperplasia and cancer (P
Summary
Breast cancer accounts for around a quarter of all cancers diagnosed in women worldwide. Aim of the study: To compare the efficacy of transvaginal ultrasound versus hysteroscopy in detecting the endometrial changes in tamoxifentreated breast cancer patients, and to correlate the findings of both methods with histopathological examination of endometrial biopsies. Patients and Methods: Twenty seven patients who had mastactomies for breast cancer and receiving tamoxifen (TAM) were enrolled in this prospective study. They subjected to transvaginal ultrasonography (TVUS) and hysteroscopy for endometrial assessment. Results: The diagnostic accuracy of TVUS versus hysteroscopy in detecting endometrial changes in breast cancer TAM treated women was as follows;TVUS had a sensitivity (82.4%), specificity (30.0%), PPV (66.7%), NPV (50.0%) and accuracy (63%) ;while, the hysteroscope had sensitivity (94.1%), specificity (60.0%), PPV (80.0%), NPV (85.7%) and accuracy (81.5%). Hysteroscope cannot establish a conclusive diagnosis of premalignant or malignant lesions, but it provides a direct view for targeted biopsies to create a definitive diagnosis
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