Hysteroscopic endometrial evaluation in postmenopausal women taking tamoxifen for breast cancer

Abstract

27. Hysteroscopic Endometrial Evaluation in Postmenopausal Women Taking Tamoxifen for Breast Cancer O Ceci, S Bettocchi, F Marello, RD Venere, AR Pellegrino, A Masciandaro, R Zaccaro. II Institute of Obstetrics and Gynecology, University of Bari, Bari, Italy. Objective. To evaluate endometrial modifications in postmenopausal women with breast cancer taking tamoxifen. Measurements and Main Results. Eighty-eight postmenopausal women (age 37-81 yrs) underwent TVUS and office hysteroscopy with eye-directed biopsies using a 5-ram continuous-flow operative office hysteroscope. Eighteen patients had received tarnoxifen for less than 12 months (range 4-11 too, group 1) and 70 for at least 12 months (range 12-72 mo, group 2). Transvaginal ultrasound revealed endometrial thickness greater than 5 mm in 62 women in group 1 and 7 in group 2. In group 1, hysteroscopy revealed 2 endometrial polyps, and in group 2 it found 26 endometrial polyps, 9 cases of endometrial hyperplasia, and 4 areas of focal adenocarcinoma. Twelve women in group 2 complained of abnormal uterine bleeding, whereas all patients in group 1 were asymptomatic. Conclusion. These data confirm the estrogenic effect of tamoxifen on endometrium. Endometrial evaluation by TVUS can suggest further diagnostic procedures (i.e., sonohysterography) but only hysteroscopy allows visualization of lesions and eye-directed biopsies. 28. Office Treatment of Large Endometrial Polyps Using the VersaPoint Bipolar Device O Ceci, F Marello, RD Venere, AR Pellegrino, L Laricchia, S Bettocchi. II Institute of Obstetrics and Gynecology, University of Bari, Bari, Italy. Objective. To demonstrate the possibility to treat fibrotic polyps larger than 1.5 cm in an office setting using a normal 5 mm operative hysteroscope without anesthesia instead of the resectoscope. Measurements and Main Results. Thirty-five women (age 21-63 yrs) with a history of AUB or sterility underwent resection of polyps with a 5-mm operative hysteroscope and 5F bipolar probe (VersaPoint) without anesthesia or analgesia. Only two postmenopausal women were asymptomatic, and polyps were occasionally discovered during evaluation for HRT. Polyps were sliced into pieces large enough to be extracted through the internal cervical ostium with the help of a 5F grasping forceps. Particular attention was paid to vaporization of a polyp's base to avoid regrowth. In all patients polyps were larger than 1.5 cm. Patient discomfort was minimal: 29 women had none, 4 had mild discomfort comparable with menstrual pain, and the remaining 2 had light pain. Average operating time was 19 minutes. Follow-up at 3 months showed a normal uterine cavity in all patients, with no reappearance of pathology. Conclusion. Endometrial fibrotic polyps larger than 1.5 cm can be treated in an outpatient or office setting without significant discomfort and with minimal operating time. Resectoscopy should be considered only for specific, selected cases. 29. Is ThermaChoice an Office Procedure? 1j Chaddha, 2R McCorvey, 2B Love. 1Atlanta West Women's Center, Douglasville, Georgia; 2Women's Wellness Center, Montgomery, Alabama. Objective. To discuss whether ThermaChoice could become an office procedure. Measurements and Main Results. In most studies 30% to 90% of cases were done with local anesthesia and intravenous sedation. In fact, in one study 90% of patients had local anesthesia in the office setting. With general anesthesia, ThermaChoice procedures can be performed in less than 30 minutes, and with local anesthesia they can be done in less than 20 minutes. If these cases could be shifted to the office, 80% of the cost of the ThermaChoice procedure could be eliminated. Conclusion. If the cost associated with ThermaChoice could be reduced, it could easily become an office