他莫昔芬对乳腺癌患者子宫内膜影响的前瞻性临床病理研究

目的:前瞻性研究他莫昔芬对乳腺癌患者子宫内膜的影响。方法:对2005年1月~2008年10月于温州医学院附属第二医院乳腺外科手术的155例乳腺癌患者进行随访,以阴道B超、宫腔镜及子宫内膜活检评价服用他莫昔芬前后子宫内膜情况。结果:可评价患者共135例,其中绝经前46例,绝经后89例。服用他莫昔芬后,未绝经组36例(78.26%)出现异常阴道流血,9例(19.56%)出现子宫内膜病变,绝经组22例(24.72%)发生异常阴道流血,出现子宫内膜病变29例(32.60%),其中术前绝经组18例(18/59,30.51%),化疗后绝经组11例(11/30,36.67%)。阴道B超对绝经后子宫内膜病变诊断的灵敏度为52.3%,特异度为90.2%,宫腔镜诊断相应的灵敏度为81.8%,特异度为100%。结论:他莫昔芬导致绝经后妇女子宫内膜病变发生增加,对绝经前妇女的影响还不确定。阴道B超可作为初步检测手段,宫腔镜检查可提高诊断的准确率。

Prospective assessment of endometrium in women taking tamoxifen for breast cancer

Objective：Prospectively assess the effect of tamoxifen on endometrium for breast cancer women.Methods：A prospective study was performed on 155 breast cancer patients who had undergone operation in the 2nd affiliated hospital of Wenzhou Medical College from January 2005 to October 2008.All the patients＇ endometriums were evaluated by transvaginal ultrasound（TVS）,hysteroscopy and biopsy before and after tamoxifen therapy.Result：135 tamoxifen-treated patients were evaluated.In premenopausal group,36（36/46,78.26%） patients suffered from abnormal uterine bleeding.9（9/46,19.56%）patients had pathologic changes include endometrial ployp,hyperplasia.In menopausal group,22（22/89,24.72%） patients suffered from abnormal uterine bleeding.29（29/89,32.60%）patients had pathologic changes include endometrial ployp,endometrial hyperplasia and atypical hyperplasia.Among them,18 patients underwent menopause before operation,while 11 patients underwent menopause after chemotherapy.The calculated performance indicators（sensitivity,specificity） for TVS and hysteroscopy to detect the endometrial disease were（52.3%,90.2%）,（81.8%,100%）.Conclusion：Tamoxifen can cause endometrial disease in menopausal women.More attention should be paid to the menopausal women treated by tamoxifen.It may not be a good choice for the TAM users to be detected only by transvaginal ultrasound.The hysteroscopy is a valuable method for getting correct pathologic results.