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Endometrial Evaluation with Transvaginal US and Hysterosonography in Asymptomatic Postmenopausal Women with Breast Cancer Receiving Tamoxifen¹

¹ From the Departments of Medical Imaging (K.F., P.N., P.G., D.S.), Obstetrics and Gynecology (R.K.), Pathology (A.L.), and Medical Oncology (M.T.), Sunnybrook and Women’s College Health Sciences Centre, 76 Grenville St, Toronto, Ontario, Canada M5S 1B2; the Departments of Pathology (W.C.) and Radiation Oncology (L.M.), Princess Margaret Hospital-University Health Network, Toronto, Ontario, Canada; and the Centre for Research in Women’s Health, University of Toronto, Ontario, Canada (T.M.). From the 2000 RSNA scientific assembly. Received November 26, 2000; revision requested January 22, 2001; revision received March 9; accepted April 3. Supported by the Canadian Breast Cancer Foundation (Ontario Chapter) and the Helen and Paul Phelan Foundation. Address correspondence to K.F. (e-mail: katherine.fong@swchsc.on.ca).

PURPOSE: To determine performance characteristics of transvaginal ultrasonography (US) and hysterosonography for diagnosing endometrial abnormality in asymptomatic postmenopausal women with breast cancer receiving tamoxifen.

MATERIALS AND METHODS: The authors prospectively examined 138 women receiving tamoxifen by using transvaginal US, hysterosonography, and office hysteroscopy. The combined hysteroscopic-histopathologic diagnosis was the reference standard. Sensitivity, specificity, positive and negative predictive values, and likelihood ratios of transvaginal US and hysterosonography were calculated.

RESULTS: All 138 women underwent transvaginal US; 104, successful hysterosonography; and 117, successful hysteroscopy. Uterine abnormality was present in 47 (40.2%) of 117 women: 45 with polyps and two with submucosal fibroids. Receiver operating characteristic curve analysis revealed 6 mm to be the optimal endometrial thickness cutoff for diagnosing endometrial abnormalities. When a thickness greater than 6 mm or a focal endometrial finding was considered abnormal, transvaginal US had a sensitivity of 85.1% and a specificity of 55.7%. In 92 women who completed transvaginal US, hysterosonography, and hysteroscopy, hysterosonography was more specific (79.2%; P = .008) but not significantly more sensitive (89.7%; P = .508) than transvaginal US. When women with abnormal transvaginal US findings were further examined with hysterosonography, the sequential combination of transvaginal US and hysterosonography was more specific (77.1%) than transvaginal US alone (P < .001), without a significant decrease in sensitivity (78.7%; P = .25).

CONCLUSION: In asymptomatic postmenopausal women receiving tamoxifen, 6 mm is the optimal endometrial thickness cutoff for diagnosing endometrial abnormalities with transvaginal US. Further examination with hysterosonography can improve specificity by reducing the high false-positive rate of transvaginal US.

Index terms: Uterus, abnormalities, 854.315, 854.317, 854.318, 854.3192, 854.3199 • Uterus, endometrium • Uterus, US, 854.12985, 854.12989

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