Doğukan ANĞIN, Hüsnü GÖKASLAN, Ferhat EKİNC, Resul KARAKUŞ, Pınar ANĞIN

Meme Kanseri Nedeniyle Tamoksifen veya Arimidex Kullanan Postmenopozal Asemptomatik Hastaların Endometriyal Değişikliklerinin Karşılaştırılması

Amaç: Postmenopozal dönemde meme kanser/i olan ve jinekolojik açıdan asemptomatik olup tamoksijen veya aromataz inhibitörü kullanan hastalardaki endometriyal değişikliklerin değerlendirilmesidir. Materyal metod: Postmenopozal asemptomatik meme kanserli hastalar arasından en az altı aydır tamoksijen kullanan 22 hasta ve arimideks kullanan 40 hasta çalışmaya dahil edildi. Hastalara rutin jinekolojik muayene sonrası bilateral uterin arter doppler sonografisi, transvajinal ultrasonografi ve salin injüzyon sonagrafisi uygulandı. Bu görüntüleme yöntemi sonrasında da hastalara pipelle kanülü ile endometriyal örnekleme uygulandı. Bulgular: Gruplar arasında endometriyal değişiklikler ve ultrasonografik bulgular karşılaştırıldı. Tamoksijen kullanan hastaların 3'ünde (%13,5), arimideks kullanan hastaların 6'sında (%15) endometrial polip saptandı. Eşik değeri 8,5 mm alındığında transvajinal ultrasonografinin patoloji sapıama da duyarlı lığı %33, özgüllüğü %90; eşik değeri 7,7 mm alındığında salin infüzyon sonagrafisinin duyarlılığı %33, özgüllüğü %92 olarak bulundu. Sonuç: Bütün hasta grubumuzda tamoksifen kullanımı aromataz inhibitörüne kıyasla endometrial kalınlıkta daha fazla artışa yol aç mıştır. Dopplerin endometrial patoloji açısından prediktif değeri saptanmamıştır. Transvajinal ultrasonografi mutlaka uygulanmalı, invazif bir işlem seçilecekse öncesinde salin infüzyon sonagrafisi uygulanmalıdır.

Objective: To evaluate the endometrial changes between asymptomatic postmenopausal women with breası cancer using tamoxifen or aramatas e inhibitors. Design: Asymptomatic postmenopausal patients with breası cancer who were on tamoxifen or arimidex therapy for more than six months w ere enrolled for the study. Twenty two women had been on tamoxifen and jorty women had been on arimidex. Routine gynecologic exam was performed for all patients. Transvaginal ultrasonography, saline injusion sonography and bilateral uterine artery doppler sonography were performed for all patients. Later endometrial biopsy was applied to all patients with pipelle canula. Results: The percentage oj endometrial jormations, sonography findings were compared between the two groups. Endometrial polip was detected in 3 patients who were on tamoxifen (13,5%) and 6 patients who were on arimidex (15%). The sensitivity of transvaginal ultrasonography was jound to be 33% with a specificity of 90% when the cut-off level for endometrial thickness was set as 8,5 mm. When the cut-off level during saline injusion sonography was set as 7,7 mm the sensitivity was 33% and the specificity was 92%. Conclusion:For our group of patients endometrial thickening was found to be higher in tamoxifen group when compared with the aromatase inhibitors group. Doppler sonography showed no predictive value for any endometrial pathology. Ultrasonography should be performed for screening, saline infusion sonography should be applied for any detected sonographic pathology bejare invasive diagnostic tests.

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