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Efficacy of sonohysterography and hysteroscopy for evaluation of endometrial lesions in tamoxifen treated patients: a systematic review

  • Federica Di Guardo1,*,
  • Giosuè Giordano Incognito1
  • Chiara Lello2
  • Gisella D’Urso1
  • Fortunato Genovese1
  • Marco Palumbo1

1Department of General Surgery and Medical Surgical Specialties, University of Catania, 95125 Catania, Italy

2Department of Drug and Health Sciences, University of Catania, 95125 Catania, Italy

DOI: 10.31083/j.ejgo4301003 Vol.43,Issue 1,February 2022 pp.78-86

Submitted: 20 October 2021 Accepted: 05 January 2022

Published: 15 February 2022

*Corresponding Author(s): Federica Di Guardo E-mail: fediguardo@gmail.com

Abstract

Objective: This review aims to evaluate the incidence of endometrial lesions in tamoxifen-treated breast cancer patients identified by hysteroscopy (HS) and sonohysterography (SIS) and the diagnostic accuracy of the two methods to detect them. Methods: A systematic review of the literature concerning the role of HS and SIS for evaluation of the endometrium in tamoxifen-treated breast cancer patients was performed. We searched MEDLINE (PubMed), EMBASE, Cochrane Central Register of Controlled Trials, IBECS, BIOSIS, Web of Science, SCOPUS, congress abstracts, and Grey literature (Google Scholar; British Library). The search terms used were “hysteroscopy”, “hysterosonography”, “sonohysterography” combined with “tamoxifen”; 89 citations were identified and selected in the initial screening. Results: 28 studies were included in the systematic review. There were 61 citations excluded because they were review articles (n = 9) or case report (n = 5) and non-English articles (n = 8), and had too little information in the full text (n = 39). Similar accuracy between SIS and HS in detection of endometrial tamoxifen-related lesions was found. Conclusions: SIS may represent a minimally invasive, simple, safe, well-tolerated and cost-effective alternative to HS, associated with few contraindications and no potential complications.


Keywords

Hysteroscopy; Hysterosonography; Sonohysterography; Tamoxifen; Breast cancer

Cite and Share

Federica Di Guardo,Giosuè Giordano Incognito,Chiara Lello,Gisella D’Urso,Fortunato Genovese,Marco Palumbo. Efficacy of sonohysterography and hysteroscopy for evaluation of endometrial lesions in tamoxifen treated patients: a systematic review. European Journal of Gynaecological Oncology. 2022. 43(1);78-86.

References

[1] Jordan VC. Long-term adjuvant tamoxifen therapy for breast cancer. Breast Cancer Research and Treatment. 1990; 15: 125–136.

[2] Fentiman IS. The endocrine prevention of breast cancer. British Journal of Cancer. 1989; 60: 12–14.

[3] Ferguson SE, Olshen AB, Viale A, Awtrey CS, Barakat RR, Boyd J. Gene expression profiling of tamoxifen-associated uterine cancers: evidence for two molecular classes of endometrial carcinoma. Gynecologic Oncology. 2004; 92: 719–725.

[4] Dallenbach-Hellweg G, Hahn U. Mucinous and clear cell adeno-carcinomas of the endometrium in patients receiving antiestrogens (tamoxifen) and gestagens. International Journal of Gynecological Pathology. 1995; 14: 7–15.

[5] Fisher B, Costantino JP, Wickerham DL, Redmond CK, Kavanah M, Cronin WM, et al. Tamoxifen for Prevention of Breast Cancer: Report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. JNCI: Journal of the National Cancer Institute. 1998; 90: 1371–1388.

[6] Fisher B, Costantino JP, Redmond CK, Fisher ER, Wickerham DL, Cronin WM. Endometrial Cancer in Tamoxifen-Treated Breast Cancer Patients: Findings from the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-14 *. JNCI: Journal of the National Cancer Institute. 1994; 86: 527–537.

[7] Berlière M. Uterine Side Effects of Tamoxifen: a need for Systematic Pretreatment Screening. Obstetrics & Gynecology. 1998; 91: 40–44.

[8] Cohen I, Beyth Y, Tepper R, Figer A, Shapira J, Cordoba M, et al. Adenomyosis in postmenopausal breast cancer patients treated with tamoxifen: a new entity? Gynecologic Oncology. 1995; 58: 86–91.

[9] Barakat RR. Tamoxifen and endometrial neoplasia. Clinical Obstetrics and Gynecology. 1996; 39: 629–640.

[10] Hulka CA, Hall DA. Endometrial abnormalities associated with tamoxifen therapy for breast cancer: sonographic and pathologic correlation. AJR. American Journal of Roentgenology. 1993; 160: 809–812.

[11] Love CD, Muir BB, Scrimgeour JB, Leonard RC, Dillon P, Dixon JM. Investigation of endometrial abnormalities in asymp-tomatic women treated with tamoxifen and an evaluation of the role of endometrial screening. Journal of Clinical Oncology. 1999; 17: 2050–2054.

[12] Ascher SM, Imaoka I, Lage JM. Tamoxifen-induced uterine abnormalities: the role of imaging. Radiology. 2000; 214: 29–38.

[13] Karlsson B, Granberg S, Wikland M, Ylöstalo P, Torvid K, Marsal K, et al. Transvaginal ultrasonography of the endometrium in women with postmenopausal bleeding–a Nordic multicenter study. American Journal of Obstetrics and Gynecology. 1995; 172: 1488–1494.

[14] Goldstein SR, Nachtigall M, Snyder JR, Nachtigall L. Endometrial assessment by vaginal ultrasonography before endometrial sampling in patients with postmenopausal bleeding. American Journal of Obstetrics and Gynecology. 1990; 163: 119–123.

[15] Yildizhan B, Yildizhan R, Ozkesici B, Suer N. Transvaginal ultrasonography and saline infusion sonohysterography for the detection of intrauterine lesions in preand post-menopausal women with abnormal uterine bleeding. The Journal of International Medical Research. 2008; 36: 1205–1213.

[16] Achiron R, Grisaru D, Golan-Porat N, Lipitz S. Tamoxifen and the uterus: an old drug tested by new modalities. Ultrasound in Obstetrics and Gynecology. 1996; 7: 374–378.

[17] Dijkhuizen FPHLJ, Brölmann HAM, Oddens BJJ, Roumen RMH, Coebergh JWW, Heintz APM. Transvaginal ultrasonography and endometrial changes in postmenopausal breast cancer patients receiving tamoxifen. Maturitas. 1996; 25: 45–50.

[18] Jurutka PW, Bartik L, Whitfield GK, Mathern DR, Barthel TK, Gurevich M, et al. Vitamin D receptor: key roles in bone mineral pathophysiology, molecular mechanism of action, and novel nutritional ligands. Journal of Bone and Mineral Research. 2007; 22: V2–10.

[19] Di Guardo F, Della Corte L, Vilos GA, Carugno J, Török P, Giampaolino P, et al. Evaluation and treatment of infertile women with Asherman syndrome: an updated review focusing on the role of hysteroscopy. Reproductive BioMedicine Online. 2020; 41: 55–61.

[20] Chiofalo B, Palmara V, Vilos GA, Pacheco LA, Lasmar RB, Shawki O, et al. Reproductive outcomes of infertile women undergoing “see and treat” office hysteroscopy: a retrospective observational study. Minimally Invasive Therapy & Allied Technologies. 2021; 30: 147–153.

[21] Di Guardo F, Palumbo M. Asherman syndrome and insufficient endometrial thickness: a hypothesis of integrated approach to restore the endometrium. Medical Hypotheses. 2020; 134: 109521.

[22] Genovese F, D’Urso G, Di Guardo F, Insalaco G, Tuscano A, Ciotta L, et al. Failed diagnostic hysteroscopy: Analysis of 62 cases. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2020; 245: 193–197.

[23] Leone FPG, Carsana L, Lanzani C, Vago G, Ferrazzi E. Sonohysterographic endometrial sampling and hysteroscopic endometrial biopsy: a comparative study. Ultrasound in Obstetrics & Gynecology. 2007; 29: 443–448.

[24] La Sala GB, Blasi I, Gallinelli A, Debbi C, Lopopolo G, Vinci V, et al. Diagnostic accuracy of sonohysterography and transvaginal sonography as compared with hysteroscopy and endometrial biopsy: a prospective study. Minerva Ginecologica. 2011; 63: 421–427.

[25] Bartkowiak R, Kaminski P, Wielgos M, Bobrowska K. The evaluation of uterine cavity with saline infusion sonohysterography and hysteroscopy in infertile patients. Neuro Endocrinology Letters. 2006; 27: 523–528.

[26] Parsons AK, Lense JJ. Sonohysterography for endometrial abnormalities: preliminary results. Journal of Clinical Ultrasound. 1993; 21: 87–95.

[27] Brown SE, Coddington CC, Schnorr J, Toner JP, Gibbons W, Oehninger S. Evaluation of outpatient hysteroscopy, saline infusion hysterosonography, and hysterosalpingography in infertile women: a prospective, randomized study. Fertility and Sterility. 2000; 74: 1029–1034.

[28] Soares SR, Barbosa dos Reis MM, Camargos AF. Diagnostic accuracy of sonohysterography, transvaginal sonography, and hysterosalpingography in patients with uterine cavity diseases. Fertility and Sterility. 2000; 73: 406–411.

[29] Gaucherand P, Piacenza JM, Salle B, Rudigoz RC. Sonohys-terography of the uterine cavity: preliminary investigations. Journal of Clinical Ultrasound. 1995; 23: 339–348.

[30] Jorizzo JR, Riccio GJ, Chen MYM, Carr JJ. Sonohysterography: the next Step in the Evaluation of the Abnormal Endometrium. RadioGraphics. 1999; 19: S117–S130.

[31] Leone FPG, Lanzani C, Ferrazzi E. Use of strict sonohystero-graphic methods for preoperative assessment of submucous myomas. Fertility and Sterility. 2003; 79: 998–1002.

[32] Ferrazzi E, Leone FPG. Investigating abnormal bleeding on HRT or tamoxifen: the role of ultrasonography. Best Practice & Research. Clinical Obstetrics & Gynaecology. 2004; 18: 145–156.

[33] van Dongen H, de Kroon CD, Jacobi CE, Trimbos JB, Jansen FW. Diagnostic hysteroscopy in abnormal uterine bleeding: a systematic review and meta-analysis. BJOG: an International Journal of Obstetrics and Gynaecology. 2007; 114: 664–675.

[34] Ahmadi F, Rashidy Z, Haghighi H, Akhoond M, Niknejadi M, Hemat M, et al. Uterine cavity assessment in infertile women: Sensitivity and specificity of three-dimensional Hysterosonography versus Hysteroscopy. Iranian Journal of Reproductive Medicine. 2013; 11: 977–982.

[35] Ayida G, Chamberlain P, Barlow D, Kennedy S. Uterine cavity assessment prior to in vitro fertilization: comparison of transvaginal scanning, saline contrast hysterosonography and hysteroscopy. Ultrasound in Obstetrics & Gynecology. 1997; 10: 59–62.

[36] Bingol B, Gunenc MZ, Gedikbasi A, Guner H, Tasdemir S, Tiras B. Comparison of diagnostic accuracy of saline infusion sonohysterography, transvaginal sonography and hysteroscopy in postmenopausal bleeding. Archives of Gynecology and Ob-stetrics. 2011; 284: 111–117.

[37] Bonilla-Musoles F, Raga F, Osborne NG, Blanes J, Coelho F. Three-dimensional hysterosonography for the study of endometrial tumors: comparison with conventional transvaginal sonography, hysterosalpingography, and hysteroscopy. Gynecologic Oncology. 1997; 65: 245–252.

[38] Gumus II, Keskin EA, Kiliç E, Aker A, Kafali H, Turhan NO. Diagnostic value of hysteroscopy and hysterosonography in endometrial abnormalities in asymptomatic postmenopausal women. Archives of Gynecology and Obstetrics. 2008; 278: 241–244.

[39] Tehranian A, Bayani L, Heidary S, Rastad H, Rahimi A, Hosseini L. Diagnostic accuracy of sonohysterography compared to endometrial biopsy in premenopausal women with abnormal uterine bleeding. Medical Journal of the Islamic Republic of Iran. 2015; 29: 201.

[40] Ceci O, Bettocchi S, Marello F, Di Venere R, Pellegrino AR, Laricchia L, et al. Hysteroscopic evaluation of the endometrium in postmenopausal women taking tamoxifen. The Journal of the American Association of Gynecologic Laparoscopists. 2000; 7: 185–189.

[41] Ceci O, Bettocchi S, Nappi L, Di Venere R, Pansini MV, Di Fazio F. Comparison of hysteroscopic and hysterectomy findings to assess the diagnostic accuracy of office hysteroscopy in tamoxifen-treated patients with breast cancer. The Journal of the American Association of Gynecologic Laparoscopists. 2003; 10: 392–395.

[42] De Muylder X, Neven P, De Somer M, Van Belle Y, Vanderick G, De Muylder E. Endometrial lesions in patients undergoing tamoxifen therapy. International Journal of Gynaecology and Obstetrics. 1991; 36: 127–130.

[43] Dibi RP, Zettler CG, Pessini SA, Ayub AV, de Almeida SB, da Silveira GPG. Tamoxifen use and endometrial lesions. Menopause. 2009; 16: 293–300.

[44] Exacoustos C, Zupi E, Cangi B, Chiaretti M, Arduini D, Romanini C. Endometrial evaluation in postmenopausal breast cancer patients receiving tamoxifen: an ultrasound, color flow Doppler, hysteroscopic and histological study. Ultrasound in Obstetrics & Gynecology. 1995; 6: 435–442.

[45] Fong K, Kung R, Lytwyn A, Trudeau M, Chapman W, Nugent P, et al. Endometrial evaluation with transvaginal us and hysterosonography in asymptomatic postmenopausal women with breast cancer receiving tamoxifen. Radiology. 2001; 220: 765–773.

[46] Garuti G, Grossi F, Cellani F, Centinaio G, Colonnelli M, Luerti M. Hysteroscopic assessment of menopausal breast-cancer patients taking tamoxifen; there is a bias from the mode of endometrial sampling in estimating endometrial morbidity? Breast Cancer Research and Treatment. 2002; 72: 245–253.

[47] Giorda G, Crivellari D, Veronesi A, Perin T, Campagnutta E, Carbone A, et al. Comparison of ultrasonography, hysteroscopy, and biopsy in the diagnosis of endometrial lesions in post-menopausal tamoxifen-treated patients. Acta Obstetricia Et Gynecologica Scandinavica. 2002; 81: 975–980.

[48] Lahti E, Blanco G, Kauppila A, Apaja-Sarkkinen M, Taski-nen PJ, Laatikainen T. Endometrial changes in postmenopausal breast cancer patients receiving tamoxifen. Obstetrics and Gynecology. 1993; 81: 660–664.

[49] LE Donne M, Alibrandi A, Ciancimino L, Azzerboni A, Chiofalo B, Triolo O. Endometrial pathology in breast cancer patients: Effect of different treatments on ultrasonographic, hysteroscopic and histological findings. Oncology Letters. 2013; 5: 1305–1310.

[50] Marchesoni D, Driul L, Fabiani G, Di Loreto C, Cataldi P, Mozzanega B. Endometrial histologic changes in post-menopausal breast cancer patients using tamoxifen. International Journal of Gynaecology and Obstetrics. 2001; 75: 257–262.

[51] Mourits MJ, Van der Zee AG, Willemse PH, Ten Hoor KA, Hollema H, De Vries EG. Discrepancy between ultrasonography and hysteroscopy and histology of endometrium in post-menopausal breast cancer patients using tamoxifen. Gynecologic Oncology. 1999; 73: 21–26.

[52] Neis KJ, Brandner P, Schlenker M. Tamoxifen-induced hyperplasia of the endometrium. Contributions to Gynecology and Obstetrics. 2000; 20: 60–68.

[53] Neven P, De Muylder X, Van Belle Y, Van-Hooff I, Vanderick

G. Longitudinal hysteroscopic follow-up during tamoxifen treatment. The Lancet. 1998; 351: 36.

[54] Neven P, De Muylder X, Van Belle Y, Vanderick G, De Muylder

E. Hysteroscopic follow-up during Tamoxifen treatment. European Journal of Obstetrics & Gynecology and Reproductive Biology. 1990; 35: 235–238.

[55] Pérez-Medina T, Salazar FJ, San-Frutos L, Ríos M, Jiménez JS, Troyano J, et al. Hysteroscopic dynamic assessment of the endometrium in patients treated with long-term tamoxifen. Journal of Minimally Invasive Gynecology. 2011; 18: 349–354.

[56] Saccardi C, Gizzo S, Patrelli TS, Ancona E, Anis O, Di Gangi S, et al. Endometrial surveillance in tamoxifen users: role, timing and accuracy of hysteroscopic investigation: observational longitudinal cohort study. Endocrine-Related Cancer. 2013; 20: 455–462.

[57] Teixeira AC, Urban LABD, Schwarz RS, Pereira C, Millani TCC, Passos AP. Value of sonographic endometrial findings in patients under tamoxifen therapy. Radiologia Brasileira. 2007; 40.

[58] Bertelli G, Valenzano M, Costantini S, Rissone R, Angiolini C, Signorini A, et al. Limited Value of Sonohysterography for Endometrial Screening in Asymptomatic, Postmenopausal Patients Treated with Tamoxifen. Gynecologic Oncology. 2000; 78: 275–277.

[59] El Sheikh H, Atwa K, Sammour MA. Sonohysterography for evaluation of endometrial abnormalities associated with tamoxifen therapy for breast cancer. The Egyptian Journal of Radiology and Nuclear Medicine. 2013; 44: 953–958.

[60] Elhelw B, Ghorab MN, Farrag SH. Saline sonohysterography for monitoring asymptomatic postmenopausal breast cancer patients taking tamoxifen. International Journal of Gynaecology and Obstetrics. 1999; 67: 81–86.

[61] Hann LE, Kim CM, Gonen M, Barakat R, Choi PH, Bach AM. Sonohysterography compared with endometrial biopsy for evaluation of the endometrium in tamoxifen-treated women. Journal of Ultrasound in Medicine. 2003; 22: 1173–1179.

[62] Hann LE, Gretz EM, Bach AM, Francis SM. Sonohysterography for Evaluation of the Endometrium in Women Treated with Tamoxifen. American Journal of Roentgenology. 2001; 177: 337–342.

[63] McElrath T, Anderson P, Fields A, Somma L, Gross S, Runow-icz CD. Saline infusion sonography: a diagnostic and therapeutic intervention for patients on tamoxifen. Obstetrics and Gynecology. 2000; 95.è

[64] Garuti G, Cellani F, Colonnelli M, Garzia D, Gonfiantini C, Luerti M. Hysteroscopically targeted biopsies compared with blind samplings in endometrial assessment of menopausal women taking tamoxifen for breast cancer. The Journal of the American Association of Gynecologic Laparoscopists. 2004; 11: 62–67.

[65] Jung H, Jung JK, Kim SB, Cho EA, Um MJ. Comparative Study on Hysteroscopic and Histologic Examinations of the Endometrium in Postmenopausal Women Taking Tamoxifen. Journal of Menopausal Medicine. 2018; 24: 81.

[66] Timmerman D, Deprest J, Bourne T, Van den Berghe I, Collins WP, Vergote I. A randomized trial on the use of ultrasonography or office hysteroscopy for endometrial assessment in post-menopausal patients with breast cancer who were treated with tamoxifen. American Journal of Obstetrics and Gynecology. 1998; 179: 62–70.

[67] Fong K, Causer P, Atri M, Lytwyn A, Kung R. Transvaginal us and Hysterosonography in Postmenopausal Women with Breast Cancer Receiving Tamoxifen: Correlation with Hysteroscopy and Pathologic Study. RadioGraphics. 2003; 23: 137–150.

[68] Amor F, Vaccaro H, Alcázar JL, León M, Craig JM, Martinez

J. Gynecologic Imaging Reporting and Data System. Journal of Ultrasound in Medicine. 2009; 28: 285–291.

[69] Tandon V, Kapoor B, Gupta A, Gupta G, Khajuria V, Gupta

S. Effects of tamoxifen therapy on the endometrium in post-menopausal patients of breast cancer. Indian Journal of Pharmacology. 2006; 38: 289.

[70] Schwärzler P, Concin H, Bösch H, Berlinger A, Wohlgenannt K, Collins WP, et al. An evaluation of sonohysterography and diagnostic hysteroscopy for the assessment of intrauterine pathology. Ultrasound in Obstetrics & Gynecology. 1998; 11: 337–342.

[71] Tepper R, Beyth Y, Altaras MM, Zalel Y, Shapira J, Cordoba M, et al. Value of Sonohysterography in Asymptomatic Post-menopausal Tamoxifen-Treated Patients. Gynecologic Oncology. 1997; 64: 386–391.

[72] Achiron R, Lipitz S, Sivan E, Goldenberg M, Mashiach S. Sono-hysterography for ultrasonographic evaluation of tamoxifen-associated cystic thickened endometrium. Journal of Ultrasound in Medicine. 1995; 14: 685–688.

[73] Bourne TH, Lawton F, Leather A, Granberg S, Campbell S, Collins WP. Use of intracavity saline instillation and transvaginal ultrasonography to detect tamoxifen-associated endometrial polyps. Ultrasound in Obstetrics and Gynecology. 1994; 4: 73–75.

[74] Tamanaha S, Aldrighi JM, Santos RED, Prado RAA. Sensitivity and specificity of hysterosonography in endometrial abnormalities in asymptomatic postmenopausal women. Revista Da Associacao Medica Brasileira (1992). 2004; 50: 427–432. (In Portuguese)

[75] Markovitch O, Tepper R, Aviram R, Fishman A, Shapira J, Cohen I. The value of sonohysterography in the prediction of endometrial pathologies in asymptomatic postmenopausal breast cancer tamoxifen-treated patients. Gynecologic Oncology. 2004; 94: 754–759.

[76] Ascher SM, Johnson JC, Barnes WA, Bae CJ, Patt RH, Ze-man RK. MR imaging appearance of the uterus in postmenopausal women receiving tamoxifen therapy for breast cancer: histopathologic correlation. Radiology. 1996; 200: 105–110.

[77] Cohen I, Bernheim J, Azaria R, Tepper R, Sharony R, Beyth Y. Malignant Endometrial Polyps in Postmenopausal Breast Cancer Tamoxifen-Treated Patients. Gynecologic Oncology. 1999; 75: 136–141.

[78] Gerber B, Krause A, Müller H, Reimer T, Külz T, Makovitzky J, et al. Effects of adjuvant tamoxifen on the endometrium in post-menopausal women with breast cancer: a prospective long-term study using transvaginal ultrasound. Journal of Clinical Oncology. 2000; 18: 3464–3470.

[79] Cook LS, Weiss NS, Schwartz SM, White E, McKnight B, Moore DE, et al. Population-based study of tamoxifen therapy and subsequent ovarian, endometrial, and breast cancers. Journal of the National Cancer Institute. 1995; 87: 1359–1364.

[80] Neven P, Shepherd JH, Lowe DG. Tamoxifen and the gynaecologist. British Journal of Obstetrics and Gynaecology. 1993; 100: 893–897.

[81] Cohen I, Rosen DJ, Shapira J, Cordoba M, Gilboa S, Altaras MM, et al. Endometrial changes with tamoxifen: comparison between tamoxifen-treated and nontreated asymptomatic, postmenopausal breast cancer patients. Gynecologic Oncology. 1994; 52: 185–190.

[82] Goldstein RB. Saline Infusion Sonohysterography. Ultrasound Clinics. 2006; 1: 385–414.

[83] Jansen FW, Vredevoogd CB, van Ulzen K, Hermans J, Trim-bos JB, Trimbos-Kemper TC. Complications of hysteroscopy: a prospective, multicenter study. Obstetrics and Gynecology. 2000; 96: 266–270.

[84] Saidi MH, Sadler RK, Theis VD, Akright BD, Farhart SA, Villanueva GR. Comparison of sonography, sonohysterography, and hysteroscopy for evaluation of abnormal uterine bleeding. Journal of Ultrasound in Medicine. 1997; 16: 587–591.

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