To examine the clinical usefulness or predictive value of measuring endometrial thickness using ultrasonography in patients receiving tamoxifen as adjuvant therapy for breast carcinoma.
A retrospective chart review was conducted at Lehigh Valley Hospital from 1994 to 1997 on patients who 1) received tamoxifen therapy for at least 12 months, and 2) received a screening transvaginal ultrasonogram and subsequent endometrial sampling for histologic evaluation. Critical study variables included patient age, duration of tamoxifen therapy, endometrial thickness, descriptive ultrasonographic findings, and the final histologic diagnoses.
Fifty-four patients were identified by the inclusion criteria. The study population had similar pathological diagnoses when compared with previous studies. The sensitivity and specificity for pathologically significant diagnoses found on screening ultrasonography alone when using an endometrial thickness of 9 mm were 77% and 59% respectively, with a positive predictive value of 37% and a negative predictive value of 89%. Fifteen patients with endometrial thickness between 6 mm and 9 mm received biopsies at an approximate total cost of $7875.
Ultrasonographic evaluation of endometrial thickness as a screening examination for clinically significant endometrial pathology has an acceptable predictive value at a threshold of 9 mm. This finding suggests an opportunity for an improved cost-effective protocol in the treatment of these patients. Additional prospective studies are needed to evaluate the appropriate cost-effective use of screening ultrasonography.
Received for publication October 12, 1998; accepted June 21, 1999.
Reprint requests: Vincent R. Lucente, MD, Chief of Gynecology, Lehigh Valley Hospital Department of Obstetrics and Gynecology, 17th and Chew Streets, P.O. Box 7017, Allentown, PA 18105.
© 2000 Lippincott Williams & Wilkins, Inc.