Paschopoulos M, Kontostolis E, Lolis E D, Koliopoulos G, Alamanos Y, Paraskevaidis E
Department of Obstetrics & Gynecology, Ioannina University Hospital, Greece.
JSLS. 2001 Jul-Sep;5(3):211-4.
Long-term administration of tamoxifen causes endometrial changes. The aim of this study was to evaluate the role of transvaginal sonography and vaginoscopic hysteroscopy in the screening of patients on tamoxifen.
Seventy patients with breast cancer treated with tamoxifen 20 mg daily underwent transvaginal sonography and vaginoscopic hysteroscopy, a modified relatively painless approach, at the beginning of the treatment and at a follow-up visit approximately 9 months after its initiation.
At the follow-up visit, the mean uterine dimensions and mean endometrial thickness as measured by ultrasound were significantly larger, and pulsatility and resistance indices of the uterine arteries as measured by Doppler were significantly lower. Sonography revealed abnormal endometrial thickness in 73% (51 of 70) of the patients, and 83% (58 of 70) had hysteroscopical changes. Sonography missed 1 case of endometrial adenocarcinoma.
Vaginoscopic hysteroscopy, an approach that causes reduced pain, can add significantly to the sensitivity of transvaginal sonography for the detection of endometrial changes in patients with breast cancer receiving tamoxifen. It is recommended for every patient prior to the initiation of treatment and at the follow-up visits.
长期服用他莫昔芬会引起子宫内膜变化。本研究的目的是评估经阴道超声检查和阴道镜宫腔镜检查在他莫昔芬治疗患者筛查中的作用。
70例每天服用20mg他莫昔芬治疗的乳腺癌患者在治疗开始时以及开始治疗后约9个月的随访时接受了经阴道超声检查和阴道镜宫腔镜检查（一种改良的相对无痛的方法）。
在随访时，超声测量的平均子宫大小和平均子宫内膜厚度显著增大，多普勒测量的子宫动脉搏动指数和阻力指数显著降低。超声检查发现73%（70例中的51例）患者子宫内膜厚度异常，83%（70例中的58例）有宫腔镜检查改变。超声检查漏诊1例子宫内膜腺癌。
阴道镜宫腔镜检查这种引起疼痛减轻的方法，可显著提高经阴道超声检查对接受他莫昔芬治疗的乳腺癌患者子宫内膜变化的检测敏感性。建议在治疗开始前和随访时对每位患者进行此项检查。
