| Objective: Long-term use of tamoxifen in breast cancer patients increases the risk of endometrial lesions.There is no research on tamoxifen-induced changes in endometrial elasticity currently.This study is intended to examine endometrium elasticity using real-time shear wave elastography(SWE)and compare the differences in endometrial elasticity between breast cancer patients taking tamoxifen and those in normal women and endometrial cancer patients,in order to explore the feasibility of SWE on evaluating the characteristics of endometrial elasticity and the application value of SWE on evaluating the effect of tamoxifen on endometrium.Methods: A total of 183 women were collected from August 2018 to January 2019 in the study and all cases were divided into two groups:(1)Tamoxifen group: 69 patients with breast cancer were treated with tamoxifen.According to the medication time,tamoxifen group was divided into four groups: 20 cases in the <1 year group,17 cases in the 1-2 years group,18 cases in the 2-5 years group,and 14 cases in the ≥5 years group.According to the age,hormone level and ovarians resection or not,the menstrual status of the breast cancer patients was divided into two groups: 39 cases in the non-menopausal group and 30 cases in the postmenopausal group.(2)Control group:114 women with normal endometrium during routine medical examination.According to the different stages of the menstrual cycle at the time of the examination,the control group was divided into 51 cases of the proliferative group and 63 cases of the secretory group.Elastography of the endometrium of all subjects with the aixplorer of Supersonic Imagine,and adjusted round Q-Box and manually depicting Q-Box Trace methods were used to measure average value of elasticity modulus(Emean),maximum value of elasticity modulus(Emax)and minimum value of elasticity modulus(Emin).Data analysis was performed using the SPSS 21.0 statistical software package(SPSS Company,Chicago,IL,USA).P values <0.05 were considered statistically significant.Results: 1.The elasticity modulus of the endometrium were measured by adjusted round Q-Box and manually depicting Q-Box Trace methods.The median elasticity modulus Emean,Emax,Emin of the endometrium were compared in the control group by two different methods,the difference was not statistically significant(P>0.05).The median elasticity modulus Emean,Emax,Emin of the endometrium were compared in the tamoxifen group by two different methods,and the difference was not statistically significant(P>0.05).The results suggest that the elasticity modulus measured by the two methods can reflect the elastic characteristics of the endometrium equally.For the convenience of analysis,and the data obtained by the Q-Box method will be applied to the comparison of other groups.2.The median elasticity modulus Emean,Emax,Emin of the proliferative endometrium measured by adjusted round Q-Box method were higher than those of the secretory endometrium,and the difference was statistically significant(P<0.05).3.Compared with the control group and its subgroups,the median elasticity modulus Emean,Emax,Emin of the tamoxifen group were higher than those of the control group and the secretory group,and the difference was statistically significant(P<0.05).The median elasticity modulus Emean,Emax,Emin of the tamoxifen group were higher than those of the proliferative group,the difference of Emax between them was statistically significant(P<0.05),and there was no significant difference between Emean and Emin(P>0.05).4.The tamoxifen group was divided into four groups according to the medication time,and the median elasticity modulus Emean,Emax,Emin of the endometrium in these four groups were measured by adjusted round Q-Box method.Each group was compared with the other three groups.There were significant differences between the first group and the other three groups(P<0.05),while there was no significant difference between the other three groups(P>0.05).5.The tamoxifen group was divided into non-menopausal and menopausal group according to the different menstrual status.And there was no significant difference in the median elasticity modulus Emean,Emax,Emin between the non-menopausal group and the menopausal group(P>0.05).6.This study is a part of our research topic on "Real-time shear wave elastography about the diagnosis of endometrial lesions",and another study on "SWE assessment of endometrial cancer" was also available during the same period.The results show that the hardness of endometrial cancer tissue increased significantly,with Emean≥37.9kPa,Emax≥55.2kPa and Esd≥9.90 kPa for standard the diagnostic accuracy can reach 83.3%,79.6% and 78.0%,respectively.The diagnostic accuracy of combined conventional ultrasound can reach 96.8%.The elasticity modulus of the endometrium in patients treated with tamoxifen after breast cancer surgery Emean=31.6 kPa,Emax=49.2 kPa,Esd=5.3 kPa,are all significantly lower than endometrial cancer.This study suggests that there is a difference in the elasticity modulus of the endometrium between patients treated with tamoxifen and endometrial cancer.SWE can assist in the differential diagnosis of endometrial hyperplasia and endometrial cancer caused by tamoxifen.Conclusion: It is feasible to use SWE technology to evaluate the elastic characteristics of the endometrium,and to provide objective and accurate information on elasticity and hardness of the endometrium.Long-term use of tamoxifen in breast cancer patients can lead to increased endometrial stiffness and increased elasticity.On the basis of conventional two-dimensional ultrasound,SWE technology evaluates the endometrial elasticity of patients taking tamoxifen for clinical application in the identification of secondary endometrial cancer. |
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