COMPARISON OF OCCURRENCE OF ULTRASOUND EXAMINATION Fatty Liver USE IN BREAST CANCER PATIENTS WITH AND WITHOUT tamoxifen therapy
ABSTRACT: Background : Tamoxifen is one of Selective Estrogen Reseptor Modulators (SERMs) that serves as an anti-estrogen agent and aims to block the effects of estrogen on breast cancer tissue making it beneficial to cancerous cells death microscopically. In the liver, tamoxifen interfere s with metabolism of fat in the liver which eventually will lead to the accumulation of fat, especially triglycerides, and cause fatty liver. Ultrasonography is modality of choice and most widely used to detect the presence of fatty liver due to non-invasive, not giving radiation, easily available, and affordable cost with a sensitivity of 82 to 89% and a specificity of 93%. Degree of fatty liver on gray-scale ultrasound divided into degrees 0, 1, 2 and 3. Infiltration of fat in the liver blood vessels causes a decrease in intrahepat ic vascular compliance which can be examined using Doppler hepatic vein spectral ultrasound. Hepatic vein spectral ultrasound can be divided into normal, a triphasic waveform , and abnormal, a biphasic or monophasic waveform. Objectives : to compare the incidency of fatty liver (degree of fatty liver, hepatic vein spectral waveform and its correlation using ultrasound examination in breast cancer patients with and without tamoxifen therapy. Materials and Methods : This is a cross sectional observational study . Sampling technique by consecutive non-random sampling. This study used questionnaires and imaging of grey-scale ultrasound examination of the liver and right hepatic vein spectral Doppler ultrasound. Statistical analysis used was K-S test. Results: Mode breast cancer diagnosed age range was 50-60 y.o. and the youngest age was 28 y.o. None of the subjects was obese. Mode histopathology was infiltrative ductal Ca. The mean use of tamoxifen was 19+5,87 months. There is an increase in the incidency of degree 1 and 3 fatty liver in breast cancer patients with tamoxifen therapy, but this was not statistically significant. Hepatic vein spectral abnormalities with monophasic waveforms also increased in tamoxifen therapy compared with those without tamoxifen therapy , but this was not statistically significant. There was no significant correlation between degree of fatty liver and hepatic vein spectral waveform. Conclusions : Increased incidency of degree 1 and 3 fatty liver and abnormal spectral monophasic waveform in breast cancer patients with tamoxifen were not statistically significant. There was no significant correlation between the incidency of degree of fatty liver and hepatic vein spectral waveform.
