Mourits M J, Van der Zee A G, Willemse P H, Ten Hoor K A, Hollema H, De Vries E G
Department of Gynecology, University Hospital Groningen, Groningen, 9713 GZ, The Netherlands.
Gynecol Oncol. 1999 Apr;73(1):21-6. doi: 10.1006/gyno.1998.5316.
The increased risk of endometrial carcinoma following the use of tamoxifen has stimulated studies on endometrial diagnostic screening methods. In tamoxifen users the endometrial thickening observed with transvaginal ultrasonography (TVU) frequently cannot be confirmed by hysteroscopy or histology.
The aim was to investigate the relationship between TVU and hysteroscopic and histologic endometrial findings in postmenopausal patients using tamoxifen.
Fifty-three asymptomatic postmenopausal tamoxifen-using breast cancer patients underwent a gynecological examination combined with TVU. Patients with an endometrial thickness of >5 mm were offered hysteroscopy and endometrial biopsy.
Thirty-one patients (58%) had an endometrial thickness of >5 mm with enhanced, inhomogeneous echogenicity. Hysteroscopy was performed in 22 patients and 3 underwent hysterectomy. Seven of 22 patients had endometrial polyps, histologically characterized by cystically dilated glands lined with atrophic epithelium and periglandular stromal condensation. Histology of the three hysterectomy specimens showed a similar picture of atrophic luminal epithelium, covering dilated glands lined with atrophic epithelium and surrounded by dense stroma, which resembled the histology of the endometrial polyps. In all three specimens the histologically measured endometrial thickness corresponded with that on TVU.
Tamoxifen can induce specific endometrial changes consisting of cystically dilated glands with periglandular stromal condensation while the overlying epithelium remains atrophic. The changes occur either in the endometrium itself or as a protrusion of the endometrium, i.e., as endometrial polyps. These findings explain the discrepancy between ultrasound, hysteroscopy, and histology. Due to the high number of false-positive findings, TVU is not an effective screening instrument in these patients.
使用他莫昔芬后子宫内膜癌风险增加，这促使人们对子宫内膜诊断性筛查方法展开研究。在使用他莫昔芬的患者中，经阴道超声检查（TVU）发现的子宫内膜增厚情况，往往无法通过宫腔镜检查或组织学检查得到证实。
旨在研究使用他莫昔芬的绝经后患者中，TVU与宫腔镜及组织学子宫内膜检查结果之间的关系。
53例无症状的绝经后乳腺癌患者在使用他莫昔芬期间接受了妇科检查及TVU检查。子宫内膜厚度>5mm的患者接受了宫腔镜检查及子宫内膜活检。
31例患者（58%）的子宫内膜厚度>5mm，回声增强且不均匀。22例患者接受了宫腔镜检查，3例接受了子宫切除术。22例接受宫腔镜检查的患者中有7例患有子宫内膜息肉，组织学特征为内衬萎缩上皮的囊性扩张腺体及腺周间质浓缩。3例子宫切除标本的组织学表现显示，管腔上皮萎缩，覆盖着内衬萎缩上皮的扩张腺体，周围为致密间质，与子宫内膜息肉的组织学表现相似。在所有3个标本中，组织学测量的子宫内膜厚度与TVU测量结果相符。
他莫昔芬可诱导特定的子宫内膜变化，包括内衬萎缩上皮的囊性扩张腺体及腺周间质浓缩，而其上覆上皮仍保持萎缩状态。这些变化可发生于子宫内膜本身，也可表现为子宫内膜的突出，即子宫内膜息肉。这些发现解释了超声、宫腔镜检查及组织学检查结果之间的差异。由于假阳性结果数量较多，TVU并非这些患者有效的筛查工具。
