Post-menopausal bleeding - Is transvaginal ultrasound a useful first-line investigation in tamoxifen users?
A AbdaalY MushtaqL KhasatiJoseph MoneimFarhaan A KhanH AhmedH BoltonPublished in: Post reproductive health (2018)
Objective To evaluate the role of transvaginal ultrasound triage in women with a history of tamoxifen treatment who present with post-menopausal bleeding. Study design A retrospective review was undertaken of patients who presented with symptoms of post-menopausal bleeding and underwent ultrasound triage. Endometrial thickness and ultrasonographic features were then correlated with hysteroscopic and histopathological outcome data. The findings and outcomes for women with a history of tamoxifen use (tamoxifen group) were compared to those who had not taken tamoxifen (non-tamoxifen group). Results A total of 614 women with post-menopausal bleeding underwent transvaginal ultrasound triage, of whom 53 had a history of current or previous tamoxifen treatment. An endometrial thickness of ≥5 mm or the presence of other abnormal features was used to triage women to further investigation by hysteroscopy and biopsy. Endometrial thickness was significantly greater in the tamoxifen group (11 mm vs. 6 mm). Nearly all of the tamoxifen group were triaged to further investigation (98.1%), compared with significantly fewer in the non-tamoxifen group (68.3%) Overall, the incidence of endometrial pathology was also significantly higher in tamoxifen patients (43.4% vs. 31.7%). Conclusion For women presenting with post-menopausal bleeding, the use of transvaginal ultrasound as a triage tool is rarely helpful in evaluating women who have a history as tamoxifen use, as most will require further investigation with hysteroscopy and biopsy. A post-menopausal bleeding protocol that omits transvaginal ultrasound for women with a history of tamoxifen use may be an appropriate and effective pathway for managing these patients.
Keyphrases
- breast cancer cells
- estrogen receptor
- positive breast cancer
- emergency department
- magnetic resonance imaging
- end stage renal disease
- atrial fibrillation
- ultrasound guided
- polycystic ovary syndrome
- chronic kidney disease
- ejection fraction
- newly diagnosed
- randomized controlled trial
- type diabetes
- optical coherence tomography
- prognostic factors
- peritoneal dialysis
- endometrial cancer
- machine learning
- pregnant women
- risk factors
- electronic health record
- depressive symptoms
- deep learning
- patient reported outcomes