Department of Woman and Child Health, U.O.C. di Ginecologia e Ostetricia, University of Padua, Via Giustiniani 3, Padua, Italy.
Endocr Relat Cancer. 2013 Jun 24;20(4):455-62. doi: 10.1530/ERC-13-0020. Print 2013 Aug.
To determine the role, timing and indications for endometrial hysteroscopic investigation in relation to the clinical, ultrasound and histological features of the endometrium during tamoxifen (TAM) use. We performed an observational longitudinal cohort study (years 2007-2012) that investigated the endometria of 151 TAM users with hysteroscopy and histology. For all patients, gynaecological history, years of adjuvant treatment, ultrasound endometrial thickness measurement and indications for hysteroscopy were recorded. Hysteroscopic findings showed that 100% of patients referred for simple follow-up had no evidence of endometrial disease. We found a strong correlation between previous history of abnormal uterine bleeding (with or without endometrial thickening) and hysteroscopic suspicion of endometrial atypia that was confirmed by histology. Hysteroscopy had 83.3% sensitivity, 99% specificity, 83.3% positive predictive value (PPV) and 99% negative predictive value (NPV) in detecting endometrial atypia. No significant correlation was found between endometrial thickening to >5 mm without bleeding and histological atypia. Similarly, the duration of treatment was not related to endometrial thickening and histological atypia. Endometrial stromal hyperplasia was detected by histology in 70.5% of patients with endometrial thickness measurements ranging from 5 to 10 mm. In contrast, no atypia was detected when endometrial thickness was <5 mm. Ultrasound performed using a 5-mm cut-off threshold for endometrial thickness resulted in 100% sensitivity, 15% specificity, 4% PPV and 100% NPV in detecting endometrial atypia, while a 10-mm cut-off threshold resulted in 84% sensitivity, 69% specificity, 10% PPV and 99% NPV. Low-risk TAM users do not require different endometrial surveillance than the general population. Hysteroscopy could play a fundamental role in determining the endometrial status of patients before the initiation of TAM treatment and in assessing the endometrial status of patients when bleeding occurs.
为了确定子宫内膜宫腔镜检查在与他莫昔芬（TAM）使用相关的子宫内膜临床、超声和组织学特征方面的作用、时间和适应症。我们进行了一项观察性纵向队列研究（2007-2012 年），对 151 例接受 TAM 治疗的患者进行了宫腔镜和组织学检查。所有患者均记录了妇科病史、辅助治疗年限、超声子宫内膜厚度测量和宫腔镜检查指征。宫腔镜检查结果显示，100%因单纯随访而就诊的患者均无子宫内膜疾病证据。我们发现，既往异常子宫出血史（伴或不伴子宫内膜增厚）与宫腔镜怀疑子宫内膜非典型性之间存在很强的相关性，而组织学证实了这一点。宫腔镜检查对子宫内膜非典型性的敏感性为 83.3%，特异性为 99%，阳性预测值（PPV）为 83.3%，阴性预测值（NPV）为 99%。子宫内膜厚度>5mm 但不出血与组织学非典型性之间无显著相关性。同样，治疗时间与子宫内膜增厚和组织学非典型性无关。组织学检查发现，70.5%的子宫内膜厚度测量值为 5-10mm 的患者存在子宫内膜间质增生。相比之下，子宫内膜厚度<5mm 时未检测到非典型性。使用 5mm 作为子宫内膜厚度的截断阈值进行超声检查，对子宫内膜非典型性的敏感性为 100%，特异性为 15%，PPV 为 4%，NPV 为 100%；而使用 10mm 作为截断阈值时，敏感性为 84%，特异性为 69%，PPV 为 10%，NPV 为 99%。低风险 TAM 使用者与一般人群相比，不需要不同的子宫内膜监测。宫腔镜检查可以在开始 TAM 治疗前确定患者的子宫内膜状况，并在出血时评估患者的子宫内膜状况。
