Schwartz L B, Snyder J, Horan C, Porges R F, Nachtigall L E, Goldstein S R
Clinical Obstetrics and Gynecology, New York University Medical Center, USA.
Ultrasound Obstet Gynecol. 1998 Jan;11(1):48-53. doi: 10.1046/j.1469-0705.1998.11010048.x.
Tamoxifen has been shown to decrease the recurrence rate of breast cancer. Evidence that tamoxifen use may be associated with an increased risk of endometrial cancer has caused investigators to recommend routine invasive sampling. We have assessed a minimally invasive alternative for endometrial surveillance of tamoxifen-treated patients utilizing transvaginal ultrasound and saline infusion sonohysterography. Asymptomatic women (n = 44) with breast cancer on postoperative tamoxifen treatment were referred to our gynecological ultrasound unit. Initially, the endometrial echo was measured with unenhanced transvaginal ultrasound. If a distinct echo measured < or = 5 mm, no further procedure was performed. For thickened or inadequately visualized echoes, sonohysterography was performed. If a thin echo was noted on sonohysterography, no further procedure was performed. If focal changes were detected, hysteroscopy/dilatation and curettage (D&C) was performed. For generalized symmetrically thickened echoes, a blind biopsy was done. If sonohysterography was unsuccessful, hysteroscopy/D&C was performed. Eleven (25%) patients had thin unenhanced echoes of < or = 5 mm. Twenty-five (57%) patients had thickened endometrial echoes. Three (7%) had naturally occurring endometrial fluid outlining a polyp. An endometrial echo could not be visualized in five (11%) patients. Sonohysterography was successfully performed in 21 out of 30 (70%) patients with either thickened or non-visualized unenhanced echoes. Of these, two patients had thin endometria with coexisting myomas; seven had thin endometria with typical tamoxifen-induced subendometrial changes: and seven had focal polypoid thickening confirmed by hysteroscopy/D&C. Histology revealed carcinoma associated with two, proliferation in one and four polyps. Five patients had thickened unenhanced echoes with symmetrically thickened single-layer measurements on sonohysterography. Histology revealed that three were proliferative, one was inactive and one was hyperplastic. In the nine patients with unsuccessful sonohysterography, hysteroscopy/D&C revealed inactive endometria in six, and three polyps. Our paradigm of evaluating the endometrial response to tamoxifen is concluded to overcome the shortcomings of either unenhanced transvaginal ultrasound or blind biopsy alone while it kept the number of invasive sampling procedures to 55% (24 out of 44).
他莫昔芬已被证明可降低乳腺癌的复发率。有证据表明使用他莫昔芬可能会增加子宫内膜癌的风险，这使得研究人员建议进行常规侵入性取样。我们评估了一种利用经阴道超声和生理盐水灌注超声子宫造影对接受他莫昔芬治疗的患者进行子宫内膜监测的微创替代方法。44名接受他莫昔芬术后治疗的无症状乳腺癌女性被转诊至我们的妇科超声科。最初，用未增强的经阴道超声测量子宫内膜回声。如果测得的明显回声≤5mm，则不再进行进一步检查。对于增厚或显示不清的回声，进行超声子宫造影。如果在超声子宫造影中发现薄回声，则不再进行进一步检查。如果检测到局灶性改变，则进行宫腔镜检查/扩张刮宫术（D&C）。对于普遍对称性增厚的回声，进行盲目活检。如果超声子宫造影不成功，则进行宫腔镜检查/D&C。11名（25%）患者有≤5mm的薄未增强回声。25名（57%）患者子宫内膜回声增厚。3名（7%）患者有自然存在的子宫内膜液勾勒出一个息肉。5名（11%）患者无法显示子宫内膜回声。在30名（70%）回声增厚或未增强显示不清的患者中，21名成功进行了超声子宫造影。其中，2名患者子宫内膜薄且伴有肌瘤；7名患者子宫内膜薄且有典型的他莫昔芬诱导的子宫内膜下改变；7名患者经宫腔镜检查/D&C证实有局灶性息肉样增厚。组织学检查显示2例伴有癌，1例增生，4例为息肉。5名患者未增强回声增厚，超声子宫造影显示单层测量对称性增厚。组织学检查显示3例为增生性，1例为无活性，1例为增生性。在9名超声子宫造影不成功的患者中，宫腔镜检查/D&C显示6例子宫内膜无活性，3例为息肉。我们评估子宫内膜对他莫昔芬反应的模式被认为克服了单独使用未增强经阴道超声或盲目活检的缺点，同时将侵入性取样程序的数量保持在55%（44例中的24例）。
