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 Ultrasound A Poor Tool For Detecting Endometrial Cancer in Women on Tamoxifen WESTPORT, Jul 26 (Reuters Health) - Transvaginal ultrasound has a high false-positive scan rate for endometrial thickening and is thus a poor screening tool for detecting endometrial cancer in women taking tamoxifen, according to a report published in the July issue of the Journal of Clinical Oncology. Dr. C. D. B. Love and colleagues, from Western General Hospital in Edinburgh, UK, used transvaginal ultrasound to study endometrial characteristics in 357 women treated with tamoxifen for a mean period of 66 months and in 130 control patients. They report that tamoxifen-treated patients had a mean endometrial thickness of 7.3 mm, significantly greater than the mean thickness in the control group, 2.5 mm. The authors also observed "...a statistically significant...positive correlation between length of time on tamoxifen and endometrial thickness." According to the paper, 145 women in the tamoxifen group (41%), but none of the controls, had an endometrial thickness greater than 5 mm, which was defined as abnormal. All of the women with abnormal endometrial thickness were referred for outpatient hysteroscopy. Of the 134 women in whom hysteroscopy could be performed, endometrial atrophy was detected in 61, reflecting "...a false-positive rate of 46% of [transvaginal ultrasound]," which Dr. Love's team calls "...unacceptable for a screening technique." Edema and other benign changes accounted for the endometrial thickening in the remaining 73 women. "The apparent endometrial thickness on [transvaginal ultrasound] seems directly related to duration of tamoxifen treatment and does not necessarily indicate serious endometrial pathology," the investigators conclude. "Caution is therefore required when interpreting [transvaginal ultrasound] scans in women treated with tamoxifen," they continue, "...and in women with apparent endometrial thickening, it would seem appropriate to proceed to outpatient hysteroscopy as the second-line investigation rather than inpatient general anesthetic procedures (D&C)." In an accompanying editorial, Dr. Richard R. Barakat, from Memorial Sloan-Kettering Cancer Center in New York, estimates that "...annual screening could potentially decrease mortality in only...0.03%...of all tamoxifen-treated patients." In view of the number of women treated with tamoxifen, he suggests that the cost of screening "...may be prohibitively high." Dr. Barakat recommends that "[a]ll women with breast cancer, whether or not they are receiving tamoxifen, should undergo an annual gynecologic evaluation, " but adds that "[e]ndometrial sampling with or without a transvaginal sonogram should be reserved for patients with any sign of abnormal vaginal bleeding." J Clin Oncol 1999;17:1967-1968,2050-2054. |
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