Investigation of Endometrial Abnormalities in Asymptomatic Women Treated With Tamoxifen and an Evaluation of the Role of Endometrial Screening

PURPOSE: Tamoxifen is the most commonly prescribed adjuvant therapy for women with breast cancer. It has agonist activity on the endometrium and is associated with an increased risk of endometrial cancer. The aim of this study was to evaluate whether screening with transvaginal ultrasound (TV USS) with or without hysteroscopy is worthwhile. PATIENTS AND METHODS: A total of 487 women with breast cancer, 357 treated with tamoxifen and 130 controls, were screened with TV USS, and endometrial thickness was measured. Women with thickened endometrium underwent outpatient hysteroscopy. RESULTS: Length of time on tamoxifen ranged from 5 to 191 months (mean, 66 months), and endometrial thickness ranged from 1 to 38 mm (mean, 7.3 mm). Women treated with tamoxifen had significantly thicker endometrium than did controls (P < .0001). There was a statistically significant (P < .0001) positive correlation between length of time on tamoxifen and endometrial thickness. One hundred forty-five women had endometrium greater than 5 mm on USS, and 134 underwent successful outpatient hysteroscopy, 61 of whom had atrophic endometrium, resulting in a 46% false-positive scan rate. The remaining women all had benign features to explain the USS findings. CONCLUSION: TV USS detects a high incidence (41%) of apparent endometrial thickening in women treated with tamoxifen, although 46% had atrophic endometrium on further assessment, and none of the remaining asymptomatic women had significant lesions. Length of time on tamoxifen relates to endometrial thickening as measured by TV USS. TV USS is a poor screening tool because of the high false-positive rate. The low frequency of significant findings suggests that endometrial screening in asymptomatic women is not worthwhile.

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Comparison of false positive rates for screening breast MRI in high risk women when studies are done stacked versus alternating.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.1512 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 1512-1512

Author(s):

Edress Othman ◽

Jue Wang ◽

Brian Sprague ◽

Yongli Ji ◽

Sally D. Herschorn ◽

...

Keyword(s):

Breast Cancer ◽

High Risk ◽

False Positive ◽

Brca Mutation ◽

False Positive Rate ◽

Menopausal Status ◽

Breast Mri ◽

High Risk Women ◽

Increased Risk ◽

Optimal Screening

1512 Background: Screening breast MRI added to mammography increases screening sensitivity for high risk women. However, false positive rates are high for MRI and the optimal screening schedule is unclear. In this study we compare rates of false positive MRI when studies were performed on a stacked or alternating schedule. Methods: We reviewed charts for women at increased risk for breast cancer who had screening breast MRI between 2004 - 2012 at the University of Vermont. Eligible women had at least 1 MRI and 1 mammogram performed within one year. Charts were abstracted for clinical, radiological, and biopsy data. Screening was considered stacked if both studies were performed within 90 days and alternating if studies were 4-8 months apart. False positive was defined as MRI result of BI-RADS 3-4-5-0 with additional negative imaging within 12 months or benign biopsy. Results: 143 women had screening which met inclusion criteria; 45 per stacked schedule, 52 alternating, 40 mixed and 6 neither. Women in this study had similar characteristics with respect to age, ethnicity, menopausal status and indications for MRI (i.e. family history, BRCA mutation, biopsy history and prior chest irradiation). 371 MRIs were reviewed (165 stacked and 206 alternating). The overall false positive rate was higher in the stacked group vs. alternating [30(18.2%) vs. 21(10.2%), p=0.0264]. Using only BI-RADS 4-5-0 as a positive result that difference was lost. There were significantly more BI-RADS category 3 interpretations in the stacked vs. alternating MRIs [16(9.7%) vs. 6(2.9%), p=0.006]. The rate of BI-RADS category 4-5-0 was not different between the two groups [16(9.7%) vs. 17(8.3%), p= 0.6272]. A similar number of biopsies were performed in both groups Conclusions: MRI added to mammography for women at increased risk for breast cancer was associated with higher rates of false positive interpretations when studies were done on a stacked compared to alternating schedule. In this study the greater number of BI-RADS 3 interpretations with a stacked schedule accounted for this difference. Further studies are needed to identify the optimal screening schedule when adding MRI to mammography.

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Effects of Adjuvant Tamoxifen on the Endometrium in Postmenopausal Women With Breast Cancer: A Prospective Long-Term Study Using Transvaginal Ultrasound

Journal of Clinical Oncology ◽

10.1200/jco.2000.18.20.3464 ◽

2000 ◽

Vol 18 (20) ◽

pp. 3464-3470 ◽

Cited By ~ 124

Author(s):

Bernd Gerber ◽

Annette Krause ◽

Heiner Müller ◽

Toralf Reimer ◽

Thomas Külz ◽

...

Keyword(s):

Breast Cancer ◽

Endometrial Thickness ◽

Transvaginal Ultrasound ◽

False Positive Rate ◽

Postmenopausal Breast Cancer ◽

Diagnostic Procedures ◽

Breast Cancer Patients ◽

Long Term Study ◽

Asymptomatic Patients ◽

Positive Rate

PURPOSE: To study the value of transvaginal ultrasound (TVS) in endometrial screening of postmenopausal breast cancer patients treated with tamoxifen. PATIENTS AND METHODS: In 247 tamoxifen-treated (20 to 30 mg/d for ≥ 2 years) women and 98 controls, the endometrium was prospectively followed-up by means of TVS every 6 months for up to 5 years. Patients with homogeneous endometrium of more than 10-mm thickness were then scanned repeatedly every 3 months. RESULTS: The mean endometrial thickness was 3.5 ± 1.1 mm before treatment and increased to a maximum of 9.2 ± 5.1 mm after 3 years of tamoxifen application (P < .0001), which was significantly (P < .0001) thicker compared with controls. Fifty-two asymptomatic patients with thickened or morphologically suspect endometrium underwent hysteroscopy and dilatation and curettage (D&C), resulting in four uterine perforations. Histopathologically, atrophy was found in 38 patients (73.1%), polyps in nine, hyperplasia in four, and endometrial cancer in one case. In 20 screened patients who reported vaginal bleeding, five atrophies (25%), five polyps, four hyperplasias, and two endometrial cancers were found. Before hysteroscopy and D&C were performed, 36 (69.2%) of 52 asymptomatic and four (20%) of 20 symptomatic patients were scanned by repeated TVS over 2 to 30 months. Invasive diagnostic procedures were significantly (P < .05) more frequent in younger and obese patients. In the controls, one asymptomatic polyp and one symptomatic hyperplasia were found. CONCLUSION: In tamoxifen-treated patients, TVS offered a high false-positive rate, even with a cutoff value of 10 mm for endometrial thickness and repeated TVS scans. Increased iatrogenic morbidity and only one asymptomatic endometrial carcinoma do not warrant endometrial screening by TVS in tamoxifen-treated patients.

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Convolutional Neural Networks for the Segmentation of Microcalcification in Mammography Imaging

Journal of Healthcare Engineering ◽

10.1155/2019/9360941 ◽

2019 ◽

Vol 2019 ◽

pp. 1-9 ◽

Cited By ~ 8

Author(s):

Gabriele Valvano ◽

Gianmarco Santini ◽

Nicola Martini ◽

Andrea Ripoli ◽

Chiara Iacconi ◽

...

Keyword(s):

Breast Cancer ◽

Neural Networks ◽

Deep Learning ◽

Convolutional Neural Networks ◽

False Positive ◽

False Positive Rate ◽

Novel Approach ◽

Positive Rate ◽

Microcalcification Detection ◽

Microcalcification Clusters

Cluster of microcalcifications can be an early sign of breast cancer. In this paper, we propose a novel approach based on convolutional neural networks for the detection and segmentation of microcalcification clusters. In this work, we used 283 mammograms to train and validate our model, obtaining an accuracy of 99.99% on microcalcification detection and a false positive rate of 0.005%. Our results show how deep learning could be an effective tool to effectively support radiologists during mammograms examination.

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Mammographic screening attendance among immigrant and minority women: a systematic review and meta-analysis

Acta Radiologica ◽

10.1177/0284185118758132 ◽

2018 ◽

Vol 59 (11) ◽

pp. 1285-1291 ◽

Cited By ~ 13

Author(s):

Sameer Bhargava ◽

Kåre Moen ◽

Samera Azeem Qureshi ◽

Solveig Hofvind

Keyword(s):

Breast Cancer ◽

Meta Analysis ◽

Mammographic Screening ◽

Minority Women ◽

Health Needs ◽

Attendance Rates ◽

Preventative Health ◽

Increased Risk ◽

Screening Attendance ◽

Asymptomatic Women

Background Groups of immigrant and minority women are more often diagnosed with advanced stage breast cancer than other women. Mammographic screening aims to reduce mortality from breast cancer through early detection in asymptomatic women. Purpose To compare mammographic screening attendance among immigrant and minority women to that of other women. Material and Methods A literature search of PubMed, Embase, Google Scholar, and Cochrane identified 1369 papers published between January 1995 and March 2016. In the review, we included 33 studies investigating mammographic screening attendance among immigrant and/or minority women. In a meta-analysis, we included 19 of the studies that compared attendance among immigrant and/or minority women with that among other women, using a random effects model. Results The review included studies from Europe, North America, and Oceania, with 42,666,093 observations of opportunities for mammographic screening. Attendance was generally lower among immigrant and minority women compared to other women (46.2% vs. 55.0%; odds ratio = 0.64, 95% confidence interval = 0.56–0.73; P < 0.05, I2 = 99.9%). Non-Western immigrants had lower attendance rates than other immigrants. Conclusion Immigrant and minority women had lower mammographic screening attendance than other women, which could potentially put them at increased risk for more advanced breast cancer. This review emphasizes the importance of continued efforts to engage with the preventative health needs of diverse populations in attempts to achieve equality in access to, and use of, care.

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The role of transvaginal ultrasound in early diagnosis of tamoxifen-related endometrial cancer: An Italian experience

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.11021 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 11021-11021

Author(s):

F. Martella ◽

P. G. Giannessi ◽

L. Coltelli ◽

N. Giuntini ◽

V. Safina ◽

...

Keyword(s):

Endometrial Cancer ◽

Endometrial Thickness ◽

Transvaginal Ultrasound ◽

Figo Stage ◽

Published Data ◽

Italian Experience ◽

Increased Risk ◽

Er Positive ◽

Benign Histology ◽

Common Clinical Practice

11021 Background: women treated with tamoxifen for ER-positive early breast cancer are at a two to seven fold increased risk of endometrial cancer. Even though published data fail to support the use of transvaginal ultrasound (TVU) for screening of endometrial cancer, this is still a very common clinical practice in this subset of patients (pts). Methods: we have conducted a retrospective analysis to investigate the value of TVU in early detection of tamoxifen-related endometrial cancer. The screened population consists of pts treated with adjuvant tamoxifen in our institution from January 1999 up to December 2003 receiving a TVU annually or in case of gynaecologic symptoms. Results: 491 evaluated pts performed a total of 1634 TVUs in asymptomatic conditions. FIGO stage I endometrial cancers have been diagnosed in 3 patients (0.32%) who are still alive after total hysterectomy. A vaginal bleeding anticipated the examination in 33 women (3.2%) and represented the first symptom in two cases of tumor. Only one endometrial cancer has been detected with the screening procedure. Median increase of endometrial thickness has been 7.6 mm (range 1–34 mm) and those patients with abnormal images at TVU underwent an hysteroscopy with endometrial biopsies (169) resulting in a benign histology (polyps, cystic atrophy, hyperplasia) in most cases. Conclusions: therefore we have performed more than 1500 transvaginal ultrasound to detect only one asymptomatic cancer so we agree with literature in supporting that women receiving tamoxifen should undergo only an annual gynaecologic examination reserving the TVU to patients with vaginal bleedings or discharges. No significant financial relationships to disclose.

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Efficacy of breast MRI in elderly women

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.608 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 608-608

Author(s):

J. Yu ◽

E. Morris ◽

A. Park ◽

H. Cody ◽

M. L. Gemignani

Keyword(s):

Breast Cancer ◽

False Positive ◽

Elderly Women ◽

False Positive Rate ◽

Breast Mri ◽

Disease Assessment ◽

Mri Findings ◽

History Of ◽

Diagnosis Of Cancer ◽

Extent Of Disease

608 Background: Breast MRI is useful in evaluating extent of disease and screening of high risk patients, especially younger patients with dense breasts. The utility of MRI in the elderly population is currently unknown. The purpose of this study was to review the use of breast MRI and MRI findings in elderly women. Methods: Retrospective review identified women over the age of 70 who underwent breast MRI at our institution between 11/2000 and 12/2005. Clinicopathologic features, MRI results and mammograms (MMG) were reviewed. Results: 228 patients were identified. The mean age was 73.5 years (range 70–91). Forty-three patients (19%) had no history of breast cancer, 99 (43%) had a history of breast cancer, and 86 (38%) had a current diagnosis of breast cancer at the time of MRI. Ninety-two patients (40%) underwent MRI for screening, 49 (21%) as further workup for an abnormal MMG or physical finding, and 78 (34%) for extent of disease assessment. MRI found 49 additional sites of abnormality and 15 additional cancers (14% false positive). Five cancers were detected in women with no current diagnosis of cancer. In patients with a diagnosis of cancer at the time of MRI, 10 additional cancers were found: 7 in the contralateral breast and 3 additional ipsilateral sites. Conclusions: MRI detected an additional 15 mammographically occult breast cancers in this population of women over the age of 70. MRI was efficacious in screening as well as evaluating extent of disease, with a relatively low false-positive rate of 14%. Breast MRI is a useful tool in the evaluation of elderly patients; further study in the use of MRI for screening in this population is needed. [Table: see text] No significant financial relationships to disclose.

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Increased Risk of Developing Breast Cancer after a False-Positive Screening Mammogram

Cancer Epidemiology Biomarkers & Prevention ◽

10.1158/1055-9965.epi-15-0623 ◽

2015 ◽

Vol 24 (12) ◽

pp. 1882-1889 ◽

Cited By ~ 15

Author(s):

Louise M. Henderson ◽

Rebecca A. Hubbard ◽

Brian L. Sprague ◽

Weiwei Zhu ◽

Karla Kerlikowske

Keyword(s):

Breast Cancer ◽

False Positive ◽

Screening Mammogram ◽

Increased Risk

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Mammography in asymptomatic women aged 40-49 years

Revista de Saúde Pública ◽

10.1590/s0034-8910.2014048005349 ◽

2014 ◽

Vol 48 (6) ◽

pp. 931-939 ◽

Cited By ~ 3

Author(s):

Flávio Xavier Silva ◽

Leila Katz ◽

Alex Sandro Rolland Souza ◽

Melania Maria Ramos Amorim

Keyword(s):

Breast Cancer ◽

Mammography Screening ◽

Breast Imaging ◽

Ductal Carcinoma ◽

Cross Sectional Study ◽

Northeastern Brazil ◽

Cross Sectional ◽

Increased Risk ◽

Grade Ii ◽

Asymptomatic Women

OBJECTIVE To assess findings of mammography of and interventions resulting from breast cancer screening in women aged 40-49 years with no increased risk (typical risk) of breast cancer. METHODS This cross-sectional study evaluated women aged 40-49 years who underwent mammography screening in a mastology reference center in Recife, PE, Northeastern Brazil, between January 2010 and October 2011. Women with breast-related complaints, positive findings in the physical examination, or high risk of breast cancer were excluded. RESULTS The 1,000 mammograms performed were classified into the following Breast Imaging-Reporting and Data System (BI-RADS) categories BI-RADS 0, 232; BI-RADS 1, 294; BI-RADS 2, 294; BI-RADS 3, 16; BI-RADS 4A, 2; BI-RADS 5, 1. There was one case of grade II invasive ductal carcinoma and various interventions, including 469 ultrasound scans, 53 referrals to mastologists, 11 cytological examinations, and 8 biopsies. CONCLUSIONS Mammography screening in women aged 40-49 years with typical risk of breast cancer led to the performance of other interventions. However, it also resulted in increased costs without demonstrable efficacy in decreasing mortality.

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Postoperative Troponin Measurement as a Screening Tool for Adverse Cardiac Events in Adult Patients Undergoing Moderate Or Major Non-Cardiac Surgery

Anaesthesia and Intensive Care ◽

10.1177/0310057x1704500606 ◽

2017 ◽

Vol 45 (6) ◽

pp. 683-687

Author(s):

D. Coric ◽

N. A. Smith

Keyword(s):

Cardiac Surgery ◽

False Positive ◽

Screening Tool ◽

False Positive Rate ◽

Routine Practice ◽

Cardiac Events ◽

Tertiary Referral Hospital ◽

Increased Risk ◽

Adverse Cardiac Events ◽

Positive Rate

Elevated troponin levels within three days of surgery are strongly linked to major adverse cardiac events (MACE). However the value of screening with troponin measurements is controversial. The extent to which this is done in routine practice is uncertain. We examined the medical records of all patients ≥45 years of age undergoing moderate or major non-cardiac surgery in our tertiary referral hospital over a six-month period. We determined how many patients had a troponin (TnT) measurement recorded in the first three days postoperatively, how many of these were abnormal, and the occurrence of MACE within 30 days. Two thousand and two hundred patients underwent 2,577 operations that met the study criteria. A postoperative TnT was measured after 4.5% of operations. Thirty-eight percent of patients with a recorded TnT measurement, and 44% of those with an abnormal measurement, experienced a MACE within 30 days. The sensitivity of an abnormal TnT to detect MACE was 86%. The specificity was low at 32% with a false positive rate of 56%. Patients with an abnormal TnT result had an increased risk of MACE (23%). The ‘number needed to measure’ to detect one patient with MACE was 4.4. In our institution, postoperative TnT levels were rarely measured and were used as a diagnostic rather than as a screening tool. The high false positive rate for MACE prediction limits its potential value as a screening tool. The test could be considered useful if it leads to further investigation, and may be best considered as one component of a multivariate approach to cardiac risk evaluation and diagnosis.

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