Endometrial Pathology in Tamoxifen-treated Breast Cancer Patients: Correlation of Endometrial Thickness on Ultrasound, Preoperative Sampling, and Final Pathology Tamoksifen Tedavisi Alan Meme Kanseri Hastalarında Endometrial Patoloji: Ultrasonografide Endometrial Kalınlık, Preoperatif Örnekleme ve Nihai Patoloji Arasındaki İlişki

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Kantarcı S., Karabulut A., Kilis S., Dağlı U., Uçar İ., İNAN A. H.

Anatolian Journal of General Medical Research, cilt.35, sa.2, ss.178-184, 2025 (Scopus, TRDizin)

Özet

Objective: This study aims to evaluate the relationship between endometrial thickness measured via transvaginal ultrasonography (TVUSG), preoperative endometrial biopsy findings, and final histopathology results, in breast cancer patients receiving tamoxifen therapy who underwent hysterectomy for benign indications. Methods: A retrospective observational study was conducted on 77 tamoxifen-treated breast cancer patients who underwent hysterectomy between January 1, 2020; and January 1, 2025. Data included patient demographics, tamoxifen usage, TVUSG measurements of endometrial thickness, preoperative biopsy outcomes, and final hysterectomy pathology findings were collected. Statistical analyses included t-tests, Mann-Whitney U, chi-square, receiver operating characteristic (ROC) curve, and Cohen’s Kappa tests. Results: Postoperative endometrial pathology was detected in 36.4% of patients. Those with pathological findings had significantly greater endometrial thickness (11.74±6.20 mm vs. 7.93±4.27 mm; p=0.01) and longer tamoxifen use duration (4.52±2.97 vs. 2.83±2.07 years; p=0.01). ROC curve analysis revealed moderate diagnostic performance of endometrial thickness (area under the curve =0.686; 95% confidence interval: 0.565-0.807; p=0.007), with an optimal cut-off of 7.5 mm, yielding 75.0% sensitivity and 63.3% specificity. A lower threshold of 4.5 mm provided higher sensitivity (96.4%) but poor specificity (24.5%). Preoperative biopsy demonstrated limited diagnostic utility, with 35.7% sensitivity, 73.5% specificity, and a low agreement with final pathology (Cohen’s Kappa =0.095; p=0.397). Conclusion: The diagnostic accuracy of preoperative endometrial biopsy and endometrial thickness measurement was found to be limited in tamoxifen-treated patients. Individualized follow-up strategies are needed, particularly for symptomatic patients with prolonged tamoxifen use or increased endometrial thickness. Larger-scale studies are required to guide clinical management.