Diagnostic accuracy of MRI in the differential diagnosis between uterine leiomyomas and sarcomas: A systematic review and meta‐analysis

Raffone, Antonio; Raimondo, Diego; Neola, Daniele; Travaglino, Antonio; Giorgi, Matteo; Lazzeri, Lucia; De Laurentiis, Francesco; Carravetta, Carlo; Zupi, Errico; Seracchioli, Renato; Casadio, Paolo; Guida, Maurizio

doi:10.1002/ijgo.15136

Cited by 6 publications

(3 citation statements)

References 60 publications

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“…Statistical heterogeneity among the included studies was evaluated by the inconsistency index I 2 . In detail, heterogeneity was judged as null for I 2 = 0 %, minimal for 0 %<I 2 ≤ 25 %, low for 25 <I 2 ≤ 50 %, moderate for 50 <I 2 ≤ 75 %, and high for I 2 > 75 %, as previously reported [10,11,12,13].…”

Section: Discussionmentioning

confidence: 58%

Prevalence of sonographic signs in women with uterine sarcoma: a systematic review and meta-analysis

et al. 2023

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Objective:To assess the prevalence of sonographic signs in uterine sarcomas women. Materials and Methods:A systematic review and meta-analysis was performed searching 5 electronic databases from inception to June 2022 for all studies that allowed to calculate the prevalence of sonographic signs in uterine sarcomas women. Pooled prevalence with 95% confidence intervals was calculated for each sonographic sign and was a priori defined as “very high” when it was ≥ 80%, “high” when it ranged from 80% to 70%, and less relevant when it was ≤ 70%. Results:6 studies with 317 sarcoma patients were included. Pooled prevalence was: 25.0%(95%CI:15.4-37.9%) for absence of visibility of the myometrium; 80.5%(95%CI:74.8-85.2%) for solid component; 78.3%(95%CI:59.3-89.9%) for inhomogeneous echogenicity of solid component; 47.9%(95%CI:41.1-54.8%) for cystic areas; 80.7%(95%CI:68.3-89.0%) for irregular walls of cystic areas; 72.3%(95%CI:16.7-97.2%) for anechoic cystic areas; 54.8%(95%CI:34.0-74.1%) for absence of shadowing; 73.5%(95%CI:43.3-90.9%) for absence of calcifications; 48.7%(95%CI:18.6-79.8%) for color score 3 or 4; 47.3%(95%CI:37.0-57.8%) for irregular tumor borders; 45.4%(95%CI:27.6-64.3%) for endometrial cavity not visualizable; 10.9%(95%CI:3.5-29.1%) for free pelvic fluid; 6.4%(95%CI:1.1-30.2%) for ascites; 21.2%(95%CI:2.1-76.8%) for intracavitary process; 81.5%(95%CI:56.1-93.8%) for singular lesion. Conclusions:Solid component, irregular walls of cystic areas and singular lesions are signs at very high prevalence, while inhomogeneous echogenicity of solid component, anechoic cystic areas and absence of calcifications are signs at high prevalence. Remaining signs were less relevant.

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Section: Discussionmentioning

confidence: 58%

Prevalence of sonographic signs in women with uterine sarcoma: a systematic review and meta-analysis

et al. 2023

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“…Although ultrasound has only moderate diagnostic accuracy when it comes to differentiating uterine diseases, due to its moderate sensitivity and specificity, it remains the first-line imaging technique as a result of its affordability, non-invasiveness, and reproducibility ( 2 , 3 ). MRI has shown very high accuracy in the differentiation of uterine sarcomas, demonstrating good sensitivity and even better specificity, which supports its use as second-line diagnostic tool after ultrasound ( 4 ). Hysteroscopy can be used as a diagnostic tool to identify a lesion in this unique condition, particularly when curettage fails to diagnose this uncommon condition.…”

Section: Discussionmentioning

confidence: 77%

A rare case report of endometrial adenosarcoma in the cesarean scar diverticulum

Han,

Shi,

Ruan

2024

Transl Cancer Res

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Background Endometrial adenosarcoma is an unusual type of uterine tumor that features a seemingly benign epithelial component, paired with a low-grade sarcomatous component, usually similar in appearance to endometrial stromal sarcoma. To our knowledge, no image of endometrial adenocarcinoma in the cesarean scar diverticulum has been reported previously. Case Description We present a rare case of endometrial adenocarcinoma located in the cesarean scar diverticulum of a 44-year-old patient. The patient was admitted to our hospital complaining of irregular vaginal bleeding that had lasted for over two months. Both B-ultrasound and magnetic resonance imaging confirmed a mass at the junction of the corpus uteri and cervix. After the initial curettage failed to confirm the disease, a hysteroscopy was subsequently performed. Upon further pathological analysis, a diagnosis of endometrial adenosarcoma was confirmed. The patient underwent hysterectomy and salpingo-oophorectomy. The patient was discharged home four days after the surgery and remained recurrence-free for one year after follow-up. Conclusions Hysteroscopy can serve as a valuable diagnostic tool to identify the lesion in this unique scenario, particularly when curettage fails to diagnose this uncommon condition. We hope that this case would bring awareness of this potential scenario, enabling clinicians in the future to identify similar cases more readily.

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“…Novel algorithms that include serum markers such as LDH levels are available and have shown promising results in terms of differential diagnosis and sensitivity/specificity rates [66]. Even a recent meta-analysis demonstrated the high diagnostic accuracy of MRI with respect to US scans for uterine sarcoma detection [67].…”

Section: Oncological Riskmentioning

confidence: 99%

Exploring Surgical Strategies for Uterine Fibroid Treatment: A Comprehensive Review of Literature on Open and Minimally Invasive Approaches

Cianci,

Gulino,

Palmara

et al. 2023

Medicina

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Background and Objectives: Uterine myomas represent one of the most prevalent pathologies affecting the female population. These benign neoplasms originate from the smooth muscular cells of the uterus, and they can be either single or multiple. Often associated with debilitating symptoms such as pelvic heaviness, pain, constipation, and urinary dysfunctions, the surgical management of myomectomy exhibits considerable variability. This diversity in approaches is influenced by factors such as the number and size of myomas, the patient’s age, and overall clinical conditions. This study aims to elucidate and compare the advantages and disadvantages of different surgical approaches, specifically endoscopic procedures versus open surgery, providing valuable insights for clinical decision making. Materials and Methods: A comprehensive bibliographic search spanning from 2013 to 2023 was systematically conducted across databases including Medline, Embase, the Cochrane Database of Systematic Reviews, and ClinicalTrials.gov. The search utilized keywords such as “myomectomy laparoscopic and open”, “myomectomy open and minimally invasive”, “myomectomy open and laparoscopic”, and “myomectomy open vs. laparoscopic.” The research methodology, along with predetermined inclusion and exclusion criteria, was established prior to the search, ensuring a systematic and rigorous approach. Subsequently, data analysis was carried out. Results: Following the study selection process, 25 articles met the eligibility criteria for inclusion in this analysis. The average numbers of myomas were 3.7 (ranging from 1 to 13.7) and 5.4 (ranging from 1 to 13.5) for the minimally invasive surgery and open surgery groups, respectively. In terms of myoma size, the total averages across studies were 7 cm (ranging from 4.8 to 14) for the minimally invasive group and 8 cm (ranging from 3.9 to 11.2) for the open surgery group. The average pregnancy and delivery rates were 29.7% (ranging from 1.8 to 100) for the minimally invasive group and 28.5% (ranging from 1.8 to 100) for the open surgery group. Regarding complications, the average rate was 14.2% (ranging from 0 to 50) for the endoscopic group and 22.3% (ranging from 0 to 60.3) for the laparotomic group. Conclusions: In conclusion, a critical factor influencing the choice of surgical approach is primarily the size and quantity of fibroids. The mini-laparotomic approach emerges as a viable alternative to endoscopy, demonstrating favorable surgical outcomes and aesthetic results. Interestingly, the type of surgical procedure appears to have no significant impact on the pregnancy rate.

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Diagnostic accuracy of MRI in the differential diagnosis between uterine leiomyomas and sarcomas: A systematic review and meta‐analysis

Cited by 6 publications

References 60 publications

Prevalence of sonographic signs in women with uterine sarcoma: a systematic review and meta-analysis

Prevalence of sonographic signs in women with uterine sarcoma: a systematic review and meta-analysis

A rare case report of endometrial adenosarcoma in the cesarean scar diverticulum

Exploring Surgical Strategies for Uterine Fibroid Treatment: A Comprehensive Review of Literature on Open and Minimally Invasive Approaches

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