Klinische Relevanz sonomorphologischer Veränderungen des Endometriums unter Tamoxifentherapie

Ziel dieser prospektiven Diagnosestudie war es, die Effektivitat des Vaginalultraschalls in der Nachsorge von Brustkrebs-Patientinnen unter Tamoxifentherapie zu uberprufen. Zusatzlich sollten spezifische sonomorphologische Veranderungen des Endometriums unter Tamoxifentherapie aufgezeigt werden. 82 symptomlose, postmenopausale Patientinnen, welche zwischen 20 und 40 mg Tamoxifen durchschnittlich 25 ± 16 Monate genommen hatten, nahmen an einer vaginosonographischen Untersuchung teil. Beurteilt wurde das gesamte innere Genitale mit besonderer Berucksichtigung der Cavumbreite, Homogenitat und Abgrenzbarkeit des Endometriums. In 49 Fallen wurde ein homogenes, gut abgrenzbares Cavumecho 10 mm, or endometrium > 5 showing bizarre struetures not clearly separated from the myometrium was an indication for performing curettage. In 49 patients, ultrasound yielded a normal result. Twelve patients showed homogeneous, well-definable endometrial thickness between 6 and 10 mm. In 21 cases, the endometrium was thickened to more than 10 mm, losing homogeneity and sonographie separability from the underlying tissue. Thus, in 21 of the 82 patients, curettage had to be performed. In 8 cases only, an atrophic endometrium could be found. In a control after curettage, the sonographie appearance of endometrial hyperplasia was unchanged in these 8 patients. In the other 13 patients that showed an enlarged, atypical endometrium, we found 10 cases with endometrial polyps and 3 cases with hyperplasia, one of them atypical. We think that transvaginal ultrasound is a good means to detect and evaluate endometrial alterations induced by tamoxifen treatment of postmenopausal breast cancer patients. With tamoxifen we suggest the cut-off level for enlarged endometrium to be definitely higher than starting at 6 mm. Nevertheless, loss of homogeneity and loss of endometrial separability should immediately lead to further diagnostic procedures. Because of the tamoxifen-specific phenomenon of „pseudoendometrial hyperplasia“, it is very important not to overinterpret ultrasonographic findings in the further follow-up of tamoxifen-treated patients who have already undergone curettage.