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© 2003 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 22:1173-1179 • 0278-4297

Sonohysterography Compared With Endometrial Biopsy for Evaluation of the Endometrium in Tamoxifen-Treated Women

Lucy E. Hann, MD, Cathleen M. Kim, MD, Mithat Gonen, PhD, Richard Barakat, MD, Patricia H. Choi, MD and Ariadne M. Bach, MD

Departments of Radiology (L.E.H., C.M.K., P.H.C., A.M.B.), Epidemiology and Biostatistics (M.G.), and Surgery (R.B.), Memorial Sloan-Kettering Cancer Center, New York, New York USA.

Address correspondence and reprint requests to Lucy E. Hann, MD, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021 USA. E-mail: hannl{at}mskcc.org.

Objective. This study was performed to compare endometrial biopsy and sonohysterography for evaluation of the endometrium in tamoxifen-treated women. Methods. Medical records were retrospectively reviewed to identify 51 consecutive tamoxifen-treated women who had sonohysterography and correlative endometrial biopsy for evaluation of postmenopausal bleeding or thickened endometrium of greater than 8 mm. Endometrial biopsy and sonohysterographic results were compared in all women, and for 27 (53%) women who had hysteroscopy with dilation and curettage, endometrial biopsy and sonohysterographic findings also were compared with surgical pathologic findings. Results. Thirty-two (63%) of 51 sonohysterograms revealed endometrial polyps; 4 (8%) showed endometrium of greater than 5 mm; 14 (27%) showed endometrium of less than 5 mm; and 1 (2%) was inadequate. Endometrial biopsy findings were benign endometrium in 42 (82%), polyps in 4 (8%), and insufficient samples in 5 (10%). Among the adequate sonohysterograms, 64% (32 of 50) resulted in a diagnosis of polyps (95% confidence interval, 49%–77%) whereas the corresponding proportion for endometrial biopsy was 9% (4 of 46; 95% confidence interval, 2%–21%). For the group with hysteroscopy, 24 (92%) of 26 polyps were confirmed histopathologically; 1 polyp had complex hyperplasia. Polyps were present in 23 (89%) of 26 women with benign endometrium or insufficient samples by endometrial biopsy, and only 1 confirmed polyp was identified by endometrial biopsy. The sensitivity of sonohysterography for diagnosis of endometrial polyps (100%) was significantly higher than for endometrial biopsy (4%; P < .01). Conclusions. In tamoxifen-treated women, sonohysterography provides a significant improvement in sensitivity for diagnosis of endometrial polyps compared with endometrial biopsy.

Key Words: endometrial biopsy • endometrial polyp • sonohysterography • tamoxifen




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Copyright © 2003 by the American Institute of Ultrasound in Medicine.