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Re: Tamoxifen and endometrial changesFrom: dahmd@gate.netWed Oct 2 22:19:12 1996
Garry Siegel, M.D. posted about a woman taking Tamoxifen with biopsy-proven adenomatous hyperplasia (without atypia) in 1994 who has since been amenorrheic on Tamoxifen/Megace. A recent biopsy showed polyps without hyperplasia and ultrasound showed an endometrial thickness of 17mm. Zach Newton, M.D. responded (some snipped):
>As the goal is to avoid her dying of endometrial carcinoma, annual TVUS Although I do not believe that there are any proven "protocols" for surveillance of patients taking Tamoxifen, I suspect that vaginal ultrasound may well become the screening method of choice in patients taking this drug. However, I would not have advised annual TVUS in this particular patient. Some (Goldstein particularly) have discussed that perhaps vaginal ultrasound would be a useful method of following these patients, particularly used in conjunction with sonohysterography. Unfortunately, since this patient has an endometrial thickness that is already 17mm, she would fall out of every TVUS protocal I have ever read about (most state that 5-6mm is the upper limit) and therefore would have to have a biopsy performed *anyway*. It seems that TVUS, with or without sonohysterography, would only increase the cost of screening this particular patient. The biopsy, not the ultrasound, is the gold standard. I would sure want to see an annual endometrial pipelle biopsy on this lady since she has an "interesting" endometrium. Thanks, Ashley Hill D. Ashley Hill, M.D. dahmd@gate.net Orlando, FL
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