Cancer de l'endomètre induit : quelle place pour l'échographie ?

Endometrial cancer occurs almost exclusively in postmenopausal women, fostered by acquired or induced (by tamoxifen) estrogenic impregnation. The most common presentation is abnormal postmenopausal vaginal bleeding, which prompt further evaluation. In France, either endometrial sampling (pipelle) or transvaginal ultrasound with an endometrial thickness more than 5 mm indicating histological sampling, can be done as a first procedure. For postmenopausal women on tamoxifen, frequent abnormal endometrial sonographic appearance induced by estrogenic side effect, lower transvaginal ultrasound diagnostic performances. Then, annual transvaginal ultrasound screening for endometrial pathology in tamoxifen-treated breast cancer patients has been stopped. Doppler ultrasound, three-dimensional sonography and saline infusion sonohysterography have been evaluated in order to reduce the false positive cases, but their diagnostic benefice remains debatable. The aim of this review is to highlight transvaginal ultrasound application in France for evaluating postmenopausal vaginal bleeding, pointing out normal and abnormal endometrial findings especially when tamoxifen, and suggesting a diagnostic strategy for care.