Re: PMB & Tamoxifen
From: Charlie Chambers (cchamber@gorge.net)
Fri Jan 21 14:25:21 2005
I know that Steve Goldstein has used SIS and a cutoff of a 3mm
endometrium with uniformity as a positive prognostic sign. Evidence of
asymmetry or thickening, he uses to determine the necessity of a
biopsy.
On Jan 21, 2005, at 12:05 PM, Joanne Bulley, MD wrote:
> But ... on Tamoxifen with PMB - you first have to PROVE that there is
> no cancer there and a SIS would not do that. She had to have the
> tissue
> sampling - and no tissue was obtained with office biopsy, so the
> curettage was necessary.
>
> Could you say with a SIS that you were 100% certain that ther was no
> tamoxifen induced endometrial cancer? If not ... then why do it?
>
> In the study you quote "Because none of these patients were clinically
> bleeding" -- it suggests that fluid enhancement would be beneficial for
> the patient without bleeding ... if you were doing any evaluation at
> all.
>
> But this patient was bleeding ... enough to drop her Hct a bit from
> its
> usual spot. (she has Chron's and is always on the border of anemia)
>
> So ... this suggests that the myometrial sonolucencies create the
> false
> positive of the 13mm endometrial stripe? So what ARE those
> sonolucencies
> that are seen by US in the woman on Tamoxifen?
>
> At Thu, 20 Jan 2005, art fougner, md wrote:
>>
>> Joanne
>>
>> this goes back to my suggestion of SIS in the evaluation of abnormal
>> bleeding.
>>
>> Am J Obstet Gynecol. 1994 Feb;170(2):447-51. Related Articles, Links
>>
>> Comment in:
>>
>> * Am J Obstet Gynecol. 1995 Feb;172(2 Pt 1):717-8.
>> * Am J Obstet Gynecol. 1995 Mar;172(3):1067-8.
>>
>> Click here to read
>> Unusual ultrasonographic appearance of the uterus in patients
>> receiving
>> tamoxifen.
>>
>> Goldstein SR.
>>
>> New York University School of Medicine, Department of Obstetrics and
>> Gynecology, NY.
>>
>> Tamoxifen is widely used as adjunctive therapy for patients with
>> breast
>> cancer and has been suggested as protection against the development of
>> breast cancer in women at risk on the basis of heredity. It is a
>> nonsteroidal estrogen antagonist, but like all antagonists it has some
>> agonistic properties. Its administration should result in atrophic
>> changes in the endometrium, but paradoxically some reports have found
>> hyperplasia and even carcinomas developing prospectively in patients
>> on
>> tamoxifen therapy. Increasingly, endovaginal ultrasonography is being
>> used for endometrial assessment in a wide variety of patients. This
>> report is the first description of an unusual ultrasonographic finding
>> in the uteri of some patients receiving tamoxifen. Initially believed
>> to be endometrial in location, when viewed after fluid instillation
>> (sonohysterogram) the heterogenous bizarre ultrasonographic appearance
>> was actually found to represent small subendometrial sonolucencies in
>> the proximal myometrium. Because none of these patients were
>> clinically
>> bleeding and all had inactive endometria on biopsy, it seems prudent
>> not
>> to overinterpret ultrasonography findings in patients receiving
>> tamoxifen who have not had fluid-enhanced assessment.
>>
>> art
>
> --
> Joanne Bulley, MD
> Keene, NH, USA
>
> "They who would give up an essential liberty for temporary security,
> deserve neither liberty nor security." -- Benjamin Franklin
>
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Charlie Chambers
--
Hood River, OR USA
cchamber@alumni.rice.edu
"All good things...come by grace,
and grace comes by art,
and art does not come easy."
Norman Maclean
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