To Dr Brown; Endometrial biopsy results

Dr Elaine Brown,
This is a follow up question to my previous post you answered( text included below):

As advised by  you, I got my mother's endometrial biopsy done. ( she is on tamoxifen for 2yrs and her ultrasound showed thickened endometrium 20mm with cystic changes.

Biopsy report:
SCANTY FRAGMENTS OF BASAL TYPE BENIGN ENDOMETRIAL GLANDS ENMESHED IN BLOOD CLOTS.
NO EVIDENCE OF MALIGNANCY.

My question is ;
Is this report possibly consistent with ultrasound changes? Does the biopsy need to  be repeated/reviewed?

thanks
--------------------------------------------


My mother, 70 is on tamoxifen 20 mg a day for the last 2 years for the treatment of early ca breast.

Her one year follow up ultrasonogram in 2008 was normal.

Her two year follow up ultrasonogram in 2009 showed the following;

Thickened endometrium 20mm with cystic changes.

Question; Does this require further evaluation/treatment?
Thanks

Doctor's Answer
by Elaine Brown, MD
Mar 25, 2009 02:30PM
To: peace4

HI!
If your mother came to see me, I would recommend an endometrial biopsy.  This is a fairly simple straightforward office procedure, and the reason to do it is to rule out endometrial cancer.  There is an eightfold increase in the risk of endometrial cancer in women who are on tamoxifen.  If endometrial cancer is ruled out, she could continue with the tamoxifen.  I would be concerned though given the findings on ultrasound that she might have hyperplasia--(pre-cancerous changes).  If so one option for treatment would be insertion of a Mirena IUD to release progesterone locally to the uterine lining.
Another option would be to switch her to one of the aromatase inhibitors such as Arimidex.  Obviously, her gyn and her oncologist should agree on the course of action.
I would NOT recommend ignoring the ultrasound findings though--early endometrial cancer is easily curable.

Good luck!
Dr B

[Elaine Brown, MD]

HI!
For legal reasons, I can't comment on your mother's biopsy results, but I CAN tell you what I would do for my own patient in a similar circumstance.  If my patient were asymptomatic, with no bleeding, and if she was comfortable doing so, I would accept the results and do nothing further except continued observation.  I would repeat her ultrasound in 6months-1year and repeat the biopsy then if the lining was still thickened.
Alternatively, if for some reason my patient was extra nervous, or if she began to have problems with bleeding, I would be likely to proceed with a D&C hysteroscopy.

Good luck!
Dr B