Hysteroscopic dynamic assessment of the endometrium in patients treated with long-term tamoxifen

Abstract

Study objective: To describe the evolutive endometrial hysteroscopic patterns in patients undergoing long-term tamoxifen treatment.

Design: Prospective analysis. Analysis of variance test with post hoc Bonferroni test and homogeneity test of percentages were used for hypothesis contrast between the groups.

Design classification: Canadian task force II-2.

Setting: Four Spanish tertiary care hospitals.

Patients: A total of 278 patients with breast cancer diagnosed between 2002 and 2004, which completed 5-years adjuvant therapy with tamoxifen.

Interventions: Ultrasonography and hysteroscopic explorations were performed before starting the treatment and then at yearly intervals during the 5 years of adjuvant treatment.

Measurements and main results: Hysteroscopic endometrial changes were significant throughout the years of treatment. Tamoxifen-exposed endometria present five different patterns: atrophic, cystic, hypervascularized, endometrial polyp, and suspicious of malignancy. Endometrial carcinoma appeared in four patients (1.5%) that bled during the follow-up.

Conclusion: Tamoxifen produces five different endometrial patterns that evolve dynamically throughout the 5 years of treatment.