乳腺癌术后三苯氧胺治疗对子宫内膜病变的影响及其诊疗进展

 三苯氧胺（tamoxifen，TAM）是一种选择性雌激素受体调节剂，广泛用于乳腺癌术后的内分泌治疗。TAM在乳腺癌组织中表现为雌激素受体拮抗作用，抑制癌细胞生长。在子宫内膜，TAM产生弱雌激素样效应，长期使用可引起子宫内膜息肉、子宫内膜增生、子宫内膜浸润性癌及子宫肉瘤等。乳腺癌术后TAM治疗的患者发生子宫内膜病变的高危因素有遗传因素、绝经后、肥胖、糖尿病、高血压、无孕激素拮抗的雌激素使用史等。因此，乳腺癌术后进行TAM治疗的患者需密切随访内膜情况。超声检查方便、无创，对内膜的监测意义重大，但假阳性率较高。诊断性刮宫和宫腔镜检查获取子宫内膜病理是诊断子宫内膜病变的金标准。目前，TAM治疗相关子宫内膜病变的超声下内膜厚度界值尚不明确，对于接受诊断性刮宫或宫腔镜检查的适应证也尚无定论。本文综述了乳腺癌术后TAM治疗对子宫内膜的影响，并总结TAM治疗相关子宫内膜病变的诊疗进展。

Effects of tamoxifen on the endometrium and progress in its diagnosis and treatment of postoperative breast cancer

Tamoxifen (TAM) is a selective estrogen receptor modulator, which is widely used in endocrine therapy of postoperative breast cancer.TAM inhibits the growth of breast cancer by competitive antagonism at the estrogen receptor level.TAM has partial agonist on the uterus, which promote benign and malignant uterine pathology, such as endometrial hyperplasia, endometrial polyps, endometrial invasive cancer, and uterine sarcomas.High-risk factors for endometrial disease in patients treated with TAM include genetic factors, postmenopausal, obesity, diabetes, hypertension, and receiving unopposed estrogen.Hence, routine endometrial surveillance is important for these patients.Ultrasonography is significant for endometrial thickness monitoring despite its high false positive rate.Endometrial biopsy is the golden standard for diagnosis.However, the current endometrial thickness threshold for the TAM-related endometrial lesions is not clear, and there is no unified opinion on the indications for hysteroscopy or diagnostic curettage.Therefore, we reviewed the effects of TAM on the endometrium and summarized its progress in diagnosis and treatment of postoperative breast cancer.