Sonohysterography Compared With Endometrial Biopsy for Evaluation of the Endometrium in Tamoxifen-Treated Women

Abstract

Tamoxifen is widely used today as an adjuvant to treating breast cancer and as a preventive measure, but it has been associated with endometrial abnormalities. Both endometrial biopsy and sonohysterography have been used to evaluate the endometrium. This trial compared these 2 procedures in 51 consecutive tamoxifen-treated women with postmenopausal bleeding or an endometrial thickness exceeding 8 mm. Surgical pathologic findings were available for 27 women who had hysteroscopy with dilation and curettage. Sonohysterography disclosed endometrial polyps in 32 women, but only 2 of them had polyps demonstrated by endometrial biopsy. Biopsy findings were normal in 4 women with more than 5 mm of endometrial thickening. All but 2 of 26 polyps evident on sonohysterography were confirmed by histopathologic assessment. One polyp exhibited complex endometrial hyperplasia but not malignancy. Endometrial biopsy detected only 1 of 24 polyps confirmed by surgical pathologic analysis of hysteroscopy specimens. Polyps were found on dilation and curettage in 21 of 23 women having benign endometrium on biopsy. Endometrial biopsy was only 4% sensitive in detecting polyps (95% confidence interval [CI], 0-21%), compared with 100% for sonohysterography (95% CI, 86-100%). Sonohysterography is substantially more sensitive than endometrial biopsy in detecting endometrial polyps. Polyps are frequent in tamoxifen-treated women, suggesting that sonohysterography be considered if there is abnormal uterine bleeding or endometrial thickening, even if endometrial biopsy is negative.