Ceyda AYDIN, Arzu Koç BEBEK, Elif Ganime AYDENİZ, NURİ PEKER, Sibel GÜLOVA

Tamoksifen Tedavisi Alan Opere Meme Kanserli Hastalarda Endometrial Patolojiler, Risk Faktörleri ve Tanıda Transvajinal Ultrasonografinin Rolü

GİRİŞ ve AMAÇ: Meme kanseri tedavisi için tamoksifen kullanan hastalarda tamoksifenin endometriyum üzerine yaptığı değişikliklerin histopatolojik ve ultrasonografik olarak değerlendirilmesi ile bu değişikliklerin hipertansiyon, obezite, diabetes mellitus ile ilişkisini araştırılması amaçlanmıştır. GEREÇ ve YÖNTEM: Eğitim ve Araştırma Hastanesi Kadın Doğum Kliniği'nde, Ocak 2007 - Ocak 2012 yılları arasında meme kanseri nedeni ile opere olan ve tamoksifen kullanan hastalar dahil edilmiştir. Tranvaginal ultrasonografi (TVUSG) ile endometriyal görüntülemesi yapılan 128 hastada endometrial örnekleme yapulmış ve histopatolojik sonuçlar değerlendirilmiştir. BULGULAR: Endometrium kanseri saptanan olgularda TMX kullanım süreleri ortalama 4,43 yıl, endometrium kalınlığı ortalama 17,83 mm, malignite saptanmayan olgularda ise tamoksifen kullanım süresi ortalama 2,72 yıl ve endometrium kalınlığı ortalama 9,3 mm idi Yapılan ROC eğrisi ile endometrial kalınlık cut-off değeri 8.5 mm ve üzeri olarak alındığında endometrial patolojileri (endometrium kanseri, endometrial hiperplazi, endometrial polip) TVUSG ile %88.3 sensitivite ve %76,5 spesifisite ile belirlenebileceği saptandı. Eğer cut-off değeri 9,5 mm ve üzeri olarak alınırsa sensitivite %83.3'e gerilerken spesifisite %82,4'ye çıkmaktaydı. Endomerium kanseri saptanan olguların %100'ü hipertansif ve diabetes mellitusu olan hastalardı. TARTIŞMA ve SONUÇ: TMX endometrium kanseri yönünden risk faktörü olarak bilinen hipertansiyon ve diabetes mellituslu hastalarda endometrium kanseri gelişimini belirgin olarak tetiklemektedir. Bu risk ilacın kullanım süresi arttıkça artmaktadır. Risk faktörü olan hastalarda takipte ultrasonografik olarak endometrium kalınlığının cutt off değerinin 8.5 mm olarak alınması tüm endometrial patolojileri belirlemede yüksek sensitivite ve spesifisiteye sahiptir.

Endometrial Pathology, Risk Factors and The Diagnostic Value of Transvaginal Ultrasonography in Breast Cancer Patients Treated with Tamoxifen

INTRODUCTION: The aim of the study was to demonstrate the histopathological and ultrasonographic changes of endometrial tissue due to the tamoxifen use and to evaluate the affect of hypertension, obesity and diabetes mellitus on endometrial alteration. METHODS: One hundred and twenty eight patients who were administered tamoxifen at Training and Research Hospital between 2007-2012 were included to the study. Patients were checked annually with transvaginal ultrasonography underwent endometrial sampling in case of endometrial thickness > 5 mm and/or uterine bleeding. RESULTS: The mean time of tamoxifen treatment and the mean endometrial thickness were 4,43 years and 17,83 mm respectively at patients with endometrial cancer. Whenever compared with those cases without malignancy, the mean time of tamoxifen treatment and the mean endometrial thickness is 2,72 years and 9,3 mm respectively. The specificity and the sensitivity of transvaginal ultrasonography at detecting endometrial pathologies are 76.5% and 88,3% respectively when cut-off value of endometrial thickness was accepted as 8,5 mm. When the cutoff value was accepted 9,5 mm, the sensitivity decreased to 83,3% and specificity increased to 82,4%. DISCUSSION and CONCLUSION: Tamoxifen precipitates the development of endometrium cancer markedly in the patients with hypertension and diabetes mellitus. The increased duration of tamoxifen use is directly proportional with increasing risk of endometrial cancer. In patients with these risk factors, the sonographic follow-up criteria of endometrial thickness cut-off value should be accepted as 8,5 mm to obtain better result with higher sensitivity and specificity.

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