Sonohysterography for evaluation of endometrial abnormalities in breast cancer patients under tamoxifen therapy

Introduction: Tamoxifen may have secondary adverse effects on the endometrium. The aim of this study was to investigate the endometrial evaluation in women with breast cancer under tamoxifen therapy with Saline infusion Sonohysterography (SIS). Materials and Methods: This cross-sectional study was performed on 40 breast cancer patients under adjutant tamoxifen (20 mg/day for at least 6 months) therapy referred to Amir-al-Momenin hospital in Semnan, Iran, gynecological clinic, by oncologist during 2018 to 2019. Requested data including individual characteristics and results of vaginal sonography, Sonohysterography, Pathology and   hysteroscopy were recorded in checklist. Results: The mean±SD age of patients was 46.0 ± 6.4 years.  39 patients (97.5%) had amenorrhea. The mean±SD duration of breast cancer was 3.1±1.3 years and the duration of tamoxifen use was 26.3 ± 13.7 months. Sonohysterography was performed without any complication in all patients.  The most important findings in the Sonohysterography were endometrial thickness ≥ 5 mm in 6(15%), echogenic lesion in uterine cavity in 4(10%) and subendometrial cysts in 13 (32.5%) patients. Notably, vaginal sonography found endometrial thickness ≥5 in 16 cases, while Sonohysterography had abnormal findings just in 8 (50%) patients. Overall agreement of Sonohysterography with pathology, hysteroscopy and vaginal sonography was 80%, 80% and 75% respectively. Conclusion: The findings showed that patients under adjutant tamoxifen therapy are at risk for endometrial pathologies such as polyps and hyperplasia. Sonohysterography is well tolerated and has a good overall agreement with pathologic findings and in comparison with vaginal sonography reduces unnecessary invasive interventions.