Skip to main content

Advertisement

SpringerLink
Log in

The relationship of endometrial pathologies with endometrial thickness and inflammatory markers in breast cancers using tamoxifen

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

Some proliferative and neoplastic changes can be seen in the endometrium of breast cancers using tamoxifen adjuvant therapy (TMX-BC). Identifying risk groups is crucial, but methods and frequency of endometrial follow-up are still controversial. This study aimed to investigate the clinical, ultrasonographic, and inflammatory factors to differentiate pathological endometrium in TMX-BC.

Methods

This study retrospectively analyzed endometrial biopsy results of TMX-BC (n 361). Normal endometrium (Group I, n 237) and pathological endometrium (Group II, n 124) were compared for clinical, ultrasonographic, and inflammatory features. Neutrophil and platelet to lymphocyte ratio (NLR; PLR), mean platelet volume (MPV), platelet distribution width (PDW), red blood cell distribution width (RDW), and lymphocyte–monocyte ratio (LMR) were the inflammatory markers.

Results

The majority of TMX-BC with endometrial biopsy were asymptomatic (72.6%) and had normal endometrium (65.7%). Pathologic endometrium included endometrial polyp (31.9%), endometrial hyperplasia (1.7%), and endometrial cancer (0.8%). The duration of tamoxifen, cancer stage, vaginal bleeding, and menopause was similar in Group I and Group II (p > 0.05). Group II had increased endometrial thickness (11.22 ± 5.44 mm) compared to Group I (8.51 ± 3.43 mm). Group II had higher RDW and PDW than Group I (p < 0.05). Endometrial thickness ≥ 10 mm had significant diagnostic potential in postmenopausal women (AUC 0.676, p 0.000, CI 0.5–0.7), but not in premenopause.

Conclusion

PDW and RDW may be promising markers for pathological endometrium differentiation, but these preliminary findings should be validated by clinical studies. Measurement of endometrial thickness in asymptomatic patients may predict high-risk women with pathological endometrium in postmenopausal women. Further studies are needed in premenopausal women and those using tamoxifen for more than 5 years.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Desantis C, Siegel R, Bandi P, Jemal A (2011) Breast cancer statistics. CA Cancer J Clin 61(6):408–418. https://doi.org/10.3322/caac.20134

    Article  Google Scholar 

  2. Park WC, Jordan VC (2002) Selective estrogen receptor modulators (SERMS) and their roles in breast cancer prevention. Trends Mol Med 8(2):82–88. https://doi.org/10.1016/s1471-4914(02)02282-7

    Article  CAS  PubMed  Google Scholar 

  3. Davies C, Pan H, Godwin J et al (2013) Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial. Lancet 381(9869):805–816. https://doi.org/10.1016/S0140-6736(12)61963-1

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Fisher B, Costantino JP, Redmond CK, Fisher ER, Wickerham DL, Cronin WM (1994) Endometrial cancer in tamoxifen-treated breast cancer patients: findings from the national surgical adjuvant breast and bowel project (NSABP)B-14. J Natl Cancer Inst 86(7):527–537. https://doi.org/10.1093/jnci/86.7.527

    Article  CAS  PubMed  Google Scholar 

  5. Wickerham DL, Fisher B, Wolmark N, Bryant J, Costantino J, Bernstein L, Runowicz CD (2002) Association of tamoxifen and uterine sarcoma. J Clin Oncol 20(11):2758–2760. https://doi.org/10.1200/JCO.2002.20.11.2758

    Article  PubMed  Google Scholar 

  6. Achiron R, Lipitz S, Sivan E, Goldenberg M, Horovitz A, Frenkel Y, Mashiach S (1995) Changes mimicking endometrial neoplasia in postmenopausal, tamoxifen-treated women with breast cancer: a transvaginal Doppler study. Ultrasound Obstet Gynecol 6(2):116–120. https://doi.org/10.1046/j.1469-0705.1995.06020116.x

    Article  CAS  PubMed  Google Scholar 

  7. Deligdisch L, Kalir T, Cohen CJ, de Latour M, Le Bouedec G, Penault-Llorca F (2000) Endometrial histopathology in 700 patients treated with tamoxifen for breast cancer. Gynecol Oncol 78(2):181–186. https://doi.org/10.1006/gyno.2000.5859

    Article  CAS  PubMed  Google Scholar 

  8. Franchi M, Ghezzi F, Donadello N, Zanaboni F, Beretta P, Bolis P (1999) Endometrial thickness in tamoxifen-treated patients: an independent predictor of endometrial disease. Obstet Gynecol 93(6):1004–1008. https://doi.org/10.1016/s0029-7844(98)00561-4

    Article  CAS  PubMed  Google Scholar 

  9. Cheng WF, Lin HH, Torng PL, Huang SC (1997) Comparison of endometrial changes among symptomatic tamoxifen-treated and nontreated premenopausal and postmenopausal breast cancer patients. Gynecol Oncol 66(2):233–237. https://doi.org/10.1006/gyno.1997.4739

    Article  CAS  PubMed  Google Scholar 

  10. Cohen I, Azaria R, Shapira J, Yigael D, Tepper R (2002) Significance of secondary ultrasonographic endometrial thickening in postmenopausal tamoxifen-treated women. Cancer 94(12):3101–3106. https://doi.org/10.1002/cncr.10587

    Article  PubMed  Google Scholar 

  11. Polin SA, Ascher AM (2008) The effect of tamoxifen on the genital tract. Cancer Imaging 8(1):135–145. https://doi.org/10.1102/1470-7330.2008.0020

    Article  PubMed  PubMed Central  Google Scholar 

  12. Fornander T, Cedermark B, Mattsson A, Skoog L, Theve T, Askergren J et al (1989) Adjuvant tamoxifen in early breast cancer: occurrence of new primary cancers. Lancet 333(8630):117–120. https://doi.org/10.1016/s0140-6736(89)91141-0

    Article  Google Scholar 

  13. Markovitch O, Tepper R, Aviram R, Fishman A, Shapira J, Cohen I (2004) The value of sonohysterography in the prediction of endometrial pathologies in asymptomatic postmenopausal breast cancer tamoxifen-treated patients. Gynecol Oncol 94(3):754–759. https://doi.org/10.1016/j.ygyno.2004.06.033

    Article  CAS  PubMed  Google Scholar 

  14. Jeon J, Kim SE, Lee D-Y, Choi D (2020) Factors associated with endometrial pathology during tamoxifen therapy in women with breast cancer: A retrospective analysis of 821 biopsies. Breast Cancer Res Treat 179(1):125–130. https://doi.org/10.1007/s10549-019-05448-w

    Article  CAS  PubMed  Google Scholar 

  15. Cohen I, Perel E, Flex D, Tepper R, Altaras MM, Cordoba M et al (1999) Endometrial pathology in postmenopausal tamoxifen treatment: comparison between gynaecologically symptomatic and asymptomatic breast cancer patients. J Clin Pathol 52(4):278–282. https://doi.org/10.1136/jcp.52.4.278

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Bernstein L, Deapen D, Cerhan JR, Schwartz SM, Liff J, McGann-Maloney E et al (1999) Tamoxifen therapy for breast cancer and endometrial cancer risk. J Natl Cancer Inst 91(19):1654–1662. https://doi.org/10.1093/jnci/91.19.1654

    Article  CAS  PubMed  Google Scholar 

  17. Fleming CA, Heneghan HM, O’Brien D, McCartan DP, McDermott EW, Prichard RS (2018) Meta-analysis of the cumulative risk of endometrial malignancy and systematic review of endometrial surveillance in extended tamoxifen therapy. Br J Surg 105(9):1098–1106. https://doi.org/10.1002/bjs.10899

    Article  CAS  PubMed  Google Scholar 

  18. Hann LE, Giess CS, Bach AM, Tao Y, Baum HJ, Barakat RR (1997) Endometrial thickness in tamoxifen-treated patients: correlation with clinical and pathologic findings. AJR Am J Roentgenol 168(3):657–661. https://doi.org/10.2214/ajr.168.3.9057510

    Article  CAS  PubMed  Google Scholar 

  19. Fung MFK, Reid A, Faught W, Le T, Chenier C, Verma S, Brydon E, Fung KFK (2003) Prospective longitudinal study of ultrasound screening for endometrial abnormalities in women with breast cancer receiving tamoxifen. Gynecol Oncol 91(1):154–159. https://doi.org/10.1016/s0090-8258(03)00441-4

    Article  CAS  PubMed  Google Scholar 

  20. Love CD, Muir BB, Scrimgeour JB, Leonard RC, Dillon P, Dixon JM (1999) Investigation of endometrial abnormalities in asymptomatic women treated with tamoxifen and an evaluation of the role of endometrial screening. J Clin Oncol 17(7):2050–2054. https://doi.org/10.1200/JCO.1999.17.7.2050

    Article  CAS  PubMed  Google Scholar 

  21. Ozşener S, Ozaran A, Itil I, Dikmen Y (1998) Endometrial pathology of 104 postmenopausal breast cancer patients treated with tamoxifen. Eur J Gynaecol Oncol 19(6):580–583

    PubMed  Google Scholar 

  22. Gerber B, Krause A, Müller H, Reimer T, Külz T, Makovitzky J, Kundt G, Friese K (2000) Effects of adjuvant tamoxifen on the endometrium in postmenopausal women with breast cancer: a prospective long-term study using transvaginal ultrasound. J Clin Oncol 18(20):3464–3470. https://doi.org/10.1200/JCO.2000.18.20.3464

    Article  CAS  PubMed  Google Scholar 

  23. Lee M, Piao J, Jeon MJ (2020) Risk factors associated with endometrial pathology in premenopausal breast cancer patients treated with tamoxifen. Yonsei Med J 61(4):317–322. https://doi.org/10.3349/ymj.2020.61.4.317

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. McGurgan P, Taylor LJ, Duff SR, O’Donovan PJ (2006) Are endometrial polyps from pre-menopausal women similar to post-menopausal women? An immunohistochemical comparison of endometrial polyps from pre and post-menopausal women. Maturitas 54(3):277–284. https://doi.org/10.1016/j.maturitas.2005.12.003

    Article  CAS  PubMed  Google Scholar 

  25. Nees LK, Heublein S, Steinmacher S, Juhasz-Böss I, Brucker S, Tempfer CB, Wallwiener M (2022) Endometrial hyperplasia as a risk factor of endometrial cancer. Arch Gynecol Obstet. https://doi.org/10.1007/s00404-021-06380-5

    Article  PubMed  PubMed Central  Google Scholar 

  26. Emons G, Mustea A, Tempfer C (2020) Tamoxifen and endometrial cancer: a janus-headed drug. Cancers (Basel) 12(9):2535. https://doi.org/10.3390/cancers12092535

    Article  CAS  PubMed  Google Scholar 

  27. Ye Y, Wang X, Jeschke U, von Schönfeldt V (2020) COX-2-PGE2-EPs in gynecological cancers. Arch Gynecol Obstet 301(6):1365–1375. https://doi.org/10.1007/s00404-020-05559-6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Hu L, Li M, Ding Y, Pu L, Liu J, Xie J, Cabanero M, Li J, Xiang R, Xiong S (2017) Prognostic value of in cancers: a systematic review and meta-analysis. Oncotarget 8(9):16027–16035. https://doi.org/10.18632/oncotarget.13784

    Article  PubMed  Google Scholar 

  29. Osselaer JC, Jamart J, Scheiff JM (1997) Platelet distribution width for differential diagnosis of thrombocytosis. Clin Chem 43(6):1072–1076

    Article  CAS  PubMed  Google Scholar 

  30. Huang Y, Cui MM, Huang YX, Fu S, Zhang X, Guo H, Wang RT (2018) Preoperative platelet distribution width predicts breast cancer survival. Cancer Biomark 23(2):205–211. https://doi.org/10.3233/CBM-181267

    Article  CAS  PubMed  Google Scholar 

  31. Cheng S, Han F, Wang Y, Xu Y, Qu T, Ju Y, Zhiming Lu (2017) The red distribution width and the platelet distribution width as prognostic predictors in gastric cancer. BMC Gastroenterol 17(1):163. https://doi.org/10.1186/s12876-017-0685-7

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Wen W, Wu P, Li J, Wang H, Sun J, Chen H (2018) Predictive values of the selected inflammatory index in elderly patients with papillary thyroid cancer. J Transl Med 16(1):261. https://doi.org/10.1186/s12967-018-1636-y

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Kurtoglu E, Kokcu A, Celik H, Sari S, Tosun M (2015) Platelet indices may be useful in discrimination of benign and malign endometrial lesions, and early and advanced stage endometrial cancer. Asian Pac J Cancer Prev 16(13):5397–5400. https://doi.org/10.7314/apjcp.2015.16.13.5397

    Article  PubMed  Google Scholar 

  34. Song J, Lai X, Zhang Y, Zheng X, Su J (2019) Preoperative platelet morphology parameters as prognostic predictors for endometrial malignant carcinoma stage and progesterone receptor. Medicine (Baltimore) 98:e17818. https://doi.org/10.1097/MD.0000000000017818

    Article  PubMed  Google Scholar 

  35. Karateke A, Kaplanoglu M, Baloglu A (2015) Relations of platelet indices with endometrial hyperplasia and endometrial cancer. Asian Pac J Cancer Prev 16(12):4905–4908. https://doi.org/10.7314/apjcp.2015.16.12.4905

    Article  PubMed  Google Scholar 

Download references

Funding

No funding was received for this study.

Author information

Authors and Affiliations

  1. Obstetrics & Gynecology Department, University of Health Sciences, Hamidiye Medical Faculty, Haydarpaşa Numune Training and Research Hospital, Tıbbiye cad. No: 40, Üsküdar, 34668, Istanbul, Turkey

    Esma Sarioglu, Fisun Vural & Ayşe Deniz Ertürk Coşkun

Authors
  1. Esma Sarioglu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fisun Vural
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ayşe Deniz Ertürk Coşkun
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

ES: contributed to study design; data management; formal data analysis; interpretation of data; drafting of the manuscript; read and approved the final version of the manuscript. FV: study design; concept; supervision of analyses; revision of the manuscript; read and approved the final version of the manuscript. ADEC: interpretation of data; critical revision of the manuscript for important intellectual content; read and approved the final version of the manuscript.

Corresponding author

Correspondence to Fisun Vural.

Ethics declarations

Conflict of interest

There are no conflicts of interests that are directly or indirectly related to the research including the following: research grants from funding agencies; honoraria for speaking at symposia; financial support for attending symposia; financial support for educational programs; employment or consultation; support from a project sponsor; position on advisory board or board of directors or other type of management relationships; multiple affiliations; financial relationships, for example equity ownership or investment interest; intellectual property rights (e.g., patents, copyrights and royalties from such rights); holdings of spouse and/or children that may have financial interest in the work.

Ethics approval and consent to participate

Informed consent was obtained from all individual participants included in the study. The ethical approval of the study was obtained from the ethics committee of Haydarpaşa Numune Training and Research Hospital(HNEAH-KAEK 2021/KK/14).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sarioglu, E., Vural, F. & Ertürk Coşkun, A.D. The relationship of endometrial pathologies with endometrial thickness and inflammatory markers in breast cancers using tamoxifen. Arch Gynecol Obstet 307, 565–571 (2023). https://doi.org/10.1007/s00404-022-06608-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-022-06608-y

Keywords

Search

Navigation