Liedman R, Lindahl B, Andolf E, Willen R, Ingvar C, Ranstam J
Department of Obstetrics and Gynecology, Lund University Hospital, 221 85 Lund, Sweden.
Anticancer Res. 2000 Nov-Dec;20(6C):4889-91.
To estimate endometrial thickness by transvaginal ultrasound technique (TVU) in patients treated with tamoxifen; and to compare the results with hysteroscopy and directed biopsy, and to relate the findings to curettage material.
Fifty-four women, over 50 years of age at the time of their primary breast cancer operation and scheduled for adjuvant treatment of tamoxifen, were investigated. If the endometrium measured 8 mm or more (35 patients) hysteroscopy and directed biopsy was performed.
In the 35 patients, hysteroscopy and curretage revealed polyps in 18 cases (51.4%), proliferation in 1 case (2.9%) and atrophy in 16 cases (45.7%). In 54.3% (19 cases) of the patients the histopathological finding was a polyp or benign proliferation of the endometrium in agreement with the thickened endometrium seen with TVU. In the remaining 45.7% (16 cases) of the patients a thickened endometrium by transvaginal ultrasound was false positive as the hysteroscopic and subsequent histopathological diagnosis only showed atrofia of the uterine endometrium.
In almost half of the patients the TVU gave a misleading picture concerning the condition of the endometrium. Changes in the myometrium and related connective tissue could be misinterpreted by the ultrasound technique as changes in the endometrium. These results may confirm the theory that stimulation and changes by antiestrogenic treatment of the uterine tissue is not only restricted to the endometrium. In patients with thickened endometrium measured by TVU, a dilatation and curettage is not sufficient, as TVU has not the ability to differentiate between endometrial polyps and myometrial changes. A hysteroscopy and directed biopsy could therefore be performed.
采用经阴道超声技术（TVU）评估接受他莫昔芬治疗患者的子宫内膜厚度；将结果与宫腔镜检查及直视下活检结果进行比较，并将这些发现与刮宫材料相关联。
对54名年龄超过50岁、因原发性乳腺癌接受手术且计划接受他莫昔芬辅助治疗的女性进行了研究。如果子宫内膜厚度测量值达到或超过8mm（35例患者），则进行宫腔镜检查及直视下活检。
在这35例患者中，宫腔镜检查及刮宫显示18例（51.4%）有息肉，1例（2.9%）有增生，16例（45.7%）有萎缩。54.3%（19例）患者的组织病理学检查结果为子宫内膜息肉或良性增生，与经阴道超声所见的增厚子宫内膜相符。在其余45.7%（16例）患者中，经阴道超声显示的增厚子宫内膜为假阳性，因为宫腔镜检查及后续组织病理学诊断仅显示子宫内膜萎缩。
几乎一半的患者中，经阴道超声对子宫内膜状况给出了误导性图像。超声技术可能会将子宫肌层及相关结缔组织的变化误判为子宫内膜的变化。这些结果可能证实了这样一种理论，即抗雌激素治疗对子宫组织的刺激和变化不仅局限于子宫内膜。对于经阴道超声测量显示子宫内膜增厚的患者，刮宫并不足够，因为经阴道超声无法区分子宫内膜息肉和子宫肌层变化。因此，可以进行宫腔镜检查及直视下活检。
