Saline sonohysterography for monitoring asymptomatic postmenopausal breast cancer patients taking tamoxifen.

OBJECTIVES: To evaluate the effectiveness of sonohysterography for monitoring asymptomatic postmenopausal breast cancer patients on long-term tamoxifen therapy. METHODS: Thirty-eight asymptomatic postmenopausal patients receiving tamoxifen for breast cancer were enrolled into the study. The endometrium of study subjects was measured by transvaginal ultrasound. If a distinct echo measured < or = 5 mm, no further procedure was performed. For thickened or inadequately visualized endometrium by transvaginal ultrasound (TVS), sonohysterography was performed. Endometrial biopsies were performed for patients with generalized symmetrical changes on sonohysterography. In cases with focal changes, or inadequate SHG, hysteroscopy/dilatation and curettage (D&C) were performed. RESULTS: Transvaginal ultrasound examination showed 12 (31.6%) patients with thin endometrium < or = 5 mm, 18 (47.4%) cases with thickened endometrium while eight (21%) cases were not adequately visualized by TVS. Sonohysterography was satisfactorily performed in 22 of 26 (84.6%) cases. Of these, three cases showed thin endometrium, 10 patients had endometrial polyps (45.5%) and nine patients showed abnormal endometrial-myometrial junction. Histology revealed hyperplasia in three cases and well differentiated adenocarcinoma associated with one polyp. Endometrial curettage for cases with abnormal endometrial-myometrial junction showed endometrial hyperplasia in two cases. Hysteroscopy and D&C were performed for four (15.4%) patients where SHG was unsuccessful, histopathology revealed inactive endometrium in three cases and one was hyperplastic. CONCLUSIONS: Sonohysterography is superior to unenhanced transvaginal sonography in specifying the abnormal ultrasonographic appearance induced by prolonged tamoxifen therapy, it is easily performed, cost-effective and very well tolerated by the patients with no complications. Sonohysterography is recommended as a minimally invasive diagnostic tool for the assessment of endometrial changes in asymptomatic postmenopausal breast cancer patients on long-term tamoxifen therapy with thickened endometrium or inadequately visualized endometrial echo on transvaginal sonography.