Meme Kanseri Olan Hastalarda Yapılan Endometrial Örnekleme Sonrası Elde Edilen Histopatolojik Sonuçlar: 5 Yıllık Deneyim

  • Tünay Efetürk Çorum Hitit Unversity Training Hospital
  • Mehmet Fırat Mutlu
  • Haldun Güner Gazi University Hospital

Abstract

Amaç: Meme Kanseri tanısı konulmuş hastalarda çeşitli endikasyonlarla yapılan endometrial örneklemelerin histopatolojik sonuçlarının dağılımını değerlendirmek ve bu sonuçların ultrasonla ölçülen endometrial kalınlıkla korelasyonunu saptamak.Yöntemler: Gazi Üniversitesi Hastanesi Kadın Hastalıkları ve Doğum Kliniğine başvuran, meme kanseri tanısıyla takip edilen hastaların endometrial örnekleme sonuçları retrospektif olarak değerlendirilmiştir. Değerlendirmeye dahil edilen hastalar daha önce tamoksifen kullanan ve kullanmayan, semptomatik olan ve olmayan (anormal uterin kanaması olan), ayrıca menopozal olan ve olmayan olmak üzere sınıflandırılmıştır. Örnekleme öncesi ultrasonografi bulguları kaydedilmiştir. Bulgular: Meme kanserli 106 hastanın %71.7'si örnekleme sırasında tamoksifen kullanmaktaydı. Tamoksifen kullanan ve kullanmayan hastaların endometrial histopatolojik sonuçları ve endometrial kalınlık ölçüsü arasında anlamlı fark saptanmamıştır. Tamoksifen kullanıcılarında düşük sensitivite ve spesifiteye rağmen endometrial kalınlık eşik değeri 9,45mm olarak saptanmıştır. Premenopozal ve postmenopozal hastaların endometrial kalınlık ve histopatolojik sonuçları arasında anlamlı fark saptanmamıştır. Sonuç: Endometrium kanseri açısından ek bir risk faktörü bulunmadığı sürece, takipte meme kanseri olan veya tamoksifen kullanan hastaların yıllık rutin kontrollere dahil edilmesi ve semptomatik olmaları halinde endometrial örnekleme yapılması önerilmektedir. Endometrial kalınlık eşik değerinin duyarlılığının düşük olması nedeniyle, örnekleme endikasyonu salt ultrasonografi bulgularıyla konulmamalıdır. Meme kanseriyle eşlik eden endometrium kanseri açısından klinisyenin duyarlı olması ve tamoksifenin 5 yıldan fazla kullanılmaması önerilmelidir.

Author Biographies

Tünay Efetürk, Çorum Hitit Unversity Training Hospital
Obstetrics and Gynecology
Mehmet Fırat Mutlu
Obst&GYN
Haldun Güner, Gazi University Hospital
Obst&GYN, Prof. Dr.

References

American Cancer Society. www.cancer.org.

Saadat M, Truong PT, Kader HA, Speers CH, Berthelet E, McMurtrie E, et al. Outcomes in patients with primary breast cancer and a subsequent diagnosis ofendometrial cancer: comparison of cohorts treated with andwithout tamoxifen. Cancer 2007; 110: 31–7.

Mellemkjaer L, Friis S, Olsen JH, Scélo G, Hemminki K, Tracey E, et al. Risk of second cancer among women with breast cancer. Int J Cancer 2006; 118:2285–92.

Early Breast Cancer Trialists Collaborative Group (EBCTCG). Effects of chemotherapy and hormonal therapyfor early breast cancer on recurrence and 15-year survival:an overview of the randomised trials. Lancet 2005;365:1687–717.

Cohen I. Endometrial pathologies associated with postmenopausal tamoxifen treatment. Gynecologic Oncology 2004;94:256–66.

Kedar RP, Bourne TH, Powles TJ, Collins WP, Ashley SE, Cosgrove DO, et al.Effects of tamoxifen on uterus andovaries of postmenopausal women in a randomized breast cancer prevention trial. Lancet 1994;343:1318–21.

Van Leeuwen FE, Benraadt J, Coesbergh JW, Kiemeney LA, Gimbrere CH, Otter R. Risk of endometrial cancer after tamoxifen treatment of breast cancer. Lancet 1994;343:1318–21.

Slomovitz BM, Burke TW, Eifel P, Ramondetta LM, Silva EG, Jhingran A, et al. Uterine papillaryserous carcinoma (UPSC): a singleinstitution review of 129 cases . Gynecol Oncol 2003;91:463–9.

Chan JK, Manuel MR, Cheung MK, OsannK, Husain A, Teng NN, et al. Breast cancerfollowed by corpus cancer: is there ahigher risk for aggressive histologic subtypes? Gynecol Oncol 2006;102:508–12.

Liang SX, Pearl M, Liang S, Xiang L, Jia L, Yang B, et al. Personal history of breast cancer as a significant risk factor for endometrial serous carcinoma in women aged 55 years old or younger. Int J Cancer. 2011; 128:763-70.

Levine DA, Lin O, Barakat RR, Robson ME, McDermott D, Cohen L, et al. Risk of endometrial carcinoma associated with BRCA mutation. Gynecol Oncol 2001; 80:395-8.

Thompson D, Easton DF, Breast Cancer Linkage Consortium. Cancer Incidence in BRCA1 mutation carriers. J Natl Cancer Inst 2002; 94:1358-65.

Garuti G, Cellani F, Centinaio G, Sita G, Nalli G, Luerti M. Baseline endometrial assessment before tamoxifen for breast cancer in asymptomatic menopausal women. Gynecologic Oncology 2005; 98: 63-7.

Riggs BL, Hartmann LC. Selective estrogen-receptor modulators -- mechanisms of action and application to clinical practice. N Engl J Med 2003; 348:618-29.

Varras M, Polyzos D, Akrivis C. Effects of tamoxifen on the human female genital tract: review of the literature. Eur JGynaecol Oncol 2003; 24: 258-68.

Neven P, Vergote I. Should tamoxifen users be screened for endometrial lesions? Lancet 1998; 351: 155-7.

Cohen I, Altaras MM, Shapira J, Tepper R, Beyth Y. Postmenopausal tamoxifen treatment and endometrial pathology. Obstet Gynecol Surv 1994; 49: 823-9.

Cohen I, Beyth Y, Tepper R, Figer A, Shapira J, Cordoba M, et al. Adenomyosis in postmenopausalbreast cancer patients treated with tamoxifen: a new entity? Gynecol Oncol 1995; 58: 86-91.

Ugwumadu AH, Bower D, Ho PK. Tamoxifen induced adenomyosisand adenomyomatous endometrial polyp. Br J Obstet Gynaecol 1993; 100: 386-8.

Lahti E, Blanco G, Kauppila A, Apaja-Sarkkinen M, Taskinen PJ, Laatikainen T. Endometrial changes in postmenopausal breascancer patients receiving tamoxifen. Obstet Gynecol 1993; 81:660-4.

Cheng WF, Lin HH, Torng PL, Huang SC. Comparison ofendometrial changes among symptomatic tamoxifen-treated andnontreated premenopausal and postmenopausal breast cancerpatients. Gynecol Oncol 1997; 66: 233-7.

Barakat RR. Tamoxifen and endometrial neoplasia. Clin Obstet Gynecol 1996; 39: 629-40.

Schlesinger C, Kamoi S, Ascher SM, Kendell M, Lage JM, Silverberg SG. Endometrial polyps: a comparison study of patients receiving tamoxifen with two control groups. Int JGynecol Pathol 1998; 17: 302-11

Cohen I, Bernheim J, Azaria R, Tepper R, Sharony R, Beyth Y. Malignant endometrial polyps in postmenopausal breast cancertamoxifen-treated patients. Gynecol Oncol 1999; 75: 136-41.

McGonigle KF, Shaw SL, Vasilev SA, Odom-Maryon T, Roy S, Simpson JF. Abnormalities detected on transvaginal ultrasonographyin tamoxifen-treated postmenopausal breast cancer patientsmay represent endometrial cystic atrophy. Am J Obstet Gynecol 1998; 178: 1145-50.

Goldstein SR. Unusual ultrasonographic appearance of the uterus in patients receiving tamoxifen. Am J Obstet Gynecol 1994; 170:447-51

Ismail SM. Pathology of endometrium treated with tamoxifen.J Clin Pathol 1994; 47: 827-33.

Osborne CK. Tamoxifen in the treatment of breast cancer. N Engl J Med 1998; 339: 1609-18.

Fisher B, Costantino JP, Redmond CK, Fisher ER, Wickerham DL, Cronin WM. Endometrial cancer in tamoxifentreated breast cancer patients: findings from the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-14. J Natl Cancer Inst 1994; 86: 527-37.

Fisher B, Costantino JP, Wickerham DL, Redmond CK, Kavanah M, Cronin WM, et al. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst 1998; 90: 1371-88.

Uziely B, Lewin A, Brufman G, Dorembus D, Mor-Yosef S. The effect of tamoxifen on the endometrium. Breast Cancer Res Treat 1993; 26: 101-5.

Andersson M, Storm HH, Mouridsen HT. Incidence of new primary cancers after adjuvant tamoxifen therapy and radiotherapy for early breast cancer. J Natl Cancer Inst 1991;83: 1013-7.

Braithwaite RS, Chlebowski RT, Lau J, George S, Hess R, Col NF. Meta-analysis of vascular and neoplastic events associated with tamoxifen. J Gen Intern Med 2003; 18:93-7

Swerdlow AJ, Jones ME. British Tamoxifen Second Cancer Study Group. Tamoxifen treatment for breast cancer and risk of endometrial cancer: a case-control study. J Natl Cancer Inst 2005; 97:375-84.

Mignotte H, Lasset C, Bonadona V, Lesur A, Luporsi E, Rodier JF, et al. Iatrogenic risks of endometrial carcinoma after treatment for breast cancer in a large French casecontrol study. Federation Nationale desCentres de Lutte Contre le Cancer (FNCLCC). Int J Cancer 1998; 76: 325-30.

Peters-Engl C, Frank W, Danmayr E, Friedl HP, Leodolter S, Medl M. Association between endometrial cancer and tamoxifen treatment of breast cancer. Breast Cancer Res Treat 1999; 54: 255-60.

Barakat RR, Gilewski TA, Almadrones L, Saigo PE, Venkatraman E, Hudis C, et al. Effect of adjuvant tamoxifen on the endometrium in women with breast cancer: a prospective study using office endometrial biopsy. J Clin Oncol 2000; 18: 3459-63.

Magriples U, Naftolin F, Schwartz PE, Carcangiu ML. High-grade endometrial carcinoma in tamoxifen-treated breast cancer patients. J Clin Oncol 1993; 11: 485-90.

Wilder JL, Shajahan S, Khattar NH, Wilder DM, Yin J, Rushing RS, et al. Tamoxifen-associated malignant endometrial tumors: pathologic features and expression of hormone receptors estrogen-alpha, estrogen-beta and progesterone; a case controlled study. Gynecol Oncol 2004; 92:553-8.

Narod SA, Pal T, Graham T, Mitchell M, Fyles A. Tamoxifen and risk of endometrial cancer. Lancet 2001; 357: 65-6; author reply 67.

Lasset C, Bonadona V, Mignotte H, Bremond A. Tamoxifen and risk of endometrial cancer. Lancet 2001; 357: 66-7.

Bergman L, Beelen ML, Gallee MP, Hollema H, Benraadt J, van Leeuwen FE. Risk and prognosis of endometrial cancer after tamoxifen for breast cancer. Comprehensive Cancer Centres ALERT Group. Assessment of liver and endometrial cancer risk following tamoxifen. Lancet 2000; 356: 881-7.

Curtis RE, Freedman DM, Sherman ME, Fraumeni JF Jr. Risk of malignant mixed mullerian tumors after tamoxifen therapy for breast cancer. J Natl Cancer Inst 2004; 96:70-4.

Cohen I, Rosen DJ, Shapira J, Cordoba M, Gilboa S, Altaras MM, et al. Endometrial changes with tamoxifen: comparison between tamoxifen-treated and nontreated asymptomatic, postmenopausal breast cancer patients. GynecolOncol 1994; 52: 185-90.

Fong K, Causer P, Atri M, Lytwyn A, Kung R. Transvaginal US and hysterosonography in postmenopausal women with breast cancer receiving tamoxifen: correlation with hysteroscopy and pathologic study. Radiographics 2003; 23: 137-50; discussion 151-5.

Levine D, Gosink BB, Johnson LA. Change in endometrial thickness in postmenopausal women undergoing hormone replacement therapy. Radiology 1995; 197: 603-8.

Gerber B, Krause A, Müller H, Reimer T, Külz T, Makovitzky J, et al. Effects of adjuvant tamoxifen on the endometrium in postmenopausal women with breast cancer: a prospective long-term study using transvaginalultrasound. J Clin Oncol 2000; 18: 3464-70.

Franchi M, Ghezzi F, Donadello N, Zanaboni F, Beretta P, Bolis P. Endometrial thickness in tamoxifen-treated patients: an independent predictor of endometrial disease. Obstet Gynecol1999; 93: 1004-8.

Cohen I, Rosen DJ, Tepper R, Cordoba M, Shapira Y, Altaras MM, et al. Ultrasonographic evaluation of the endometrium and correlation with endometrial sampling in postmenopausal patients treated with tamoxifen. J Ultrasound Med 1993; 12: 275-80.

Hulka CA, Hall DA. Endometrial abnormalities associated with tamoxifen therapy for breast cancer: sonographic and pathologic correlation. AJR Am J Roentgenol 1993; 160: 809-12.

Dijkhuizen FP, Brölmann HA, Oddens BJ, Roumen RM, Coebergh JW, Heintz AP. Transvaginal ultrasonography and endometrial changes in postmenopausal breast cancer patients receiving tamoxifen. Maturitas 1996; 25:45-50.

Bertelli G, Venturini M, Del Mastro L, Garrone O, Cosso M, Gustavino C, et al. Tamoxifen and the endometrium: findings of pelvic ultrasound examination and endometrial biopsy in asymptomatic breast cancer patients. Breast Cancer Res Treat 1998; 47:41-6.

Cecchini S, Ciatto S, Bonardi R, Mazzotta A, Grazzini G, Pacini P, et al. Screening by ultrasonography for endometrial carcinoma in postmenopausal breast cancer patients under adjuvant tamoxifen. Gynecol Oncol 1996; 60:409-11.

Fung MF, Reid A, Faught W, Le T, Chenier C, Verma S, et al. Prospective longitudinal study of ultrasound screening for endometrial abnormalities in women with breast cancer receiving tamoxifen. Gynecol Oncol 2003; 91:154-9.

Chin J, Konje JC, Hickey M Levonorgestrel intrauterine system for endometrial protection in women with breast cancer on adjuvant tamoxifen Cochrane Database Syst Rev. 2009; 7: CD007245

Bezircioglu I, Baloglu A, Tarhan MO, Oziz E, Yigit S. Evaluation of endometrium by transvaginal ultrasonography and Doppler in tamoxifen-treated women with breast cancer. Eur J Gynaecol Oncol. 2012;33:295-9.

Kahraman K, Pabuccu E, Taskin S, Sukur YE, Ozmen B, Ortac F. The role of ultrasound and symptom-based triage for detection of pathological endometrial changes in patients undergoing tamoxifen therapy for breast cancer. Eur J Gynaecol Oncol. 2011; 32:667-71.

Published
2013-04-28
Section
Original Research