Diagnostic Accuracy of Ultrasound, Contrast-enhanced CT, and Conventional MRI for Differentiating Leiomyoma From Leiomyosarcoma

Gaetke‐Udager, Kara; McLean, Karen; Sciallis, Andrew P.; Alves, Timothy; Maturen, Katherine E.; Mervak, Benjamin M.; Moore, Andreea G.; Wasnik, Ashish P.; Erba, Jake; Davenport, Matthew S.

doi:10.1016/j.acra.2016.06.004

Cited by 42 publications

(35 citation statements)

References 17 publications

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“…Prior studies have shown variable success in using imaging to accurately risk‐stratify patients for suspicion for LMS. The Gaetke–Udager et al 2016 study, which notably did not use DWI as part of their MR technique, showed an inability to distinguish between fibroids and LMS on preoperative imaging, while several other retrospective studies have shown success in diagnosing LMS with MRI . In our study, MRI proved to be more sensitive and specific for risk stratifying patients compared with laboratory values alone, as evidenced by the large variation of total serum LDH and normal values of LD‐3 fraction of patients with sarcoma.…”

Section: Discussionmentioning

confidence: 49%

“…However, these features often overlap with typical uterine fibroids . CT has been proposed as a screening modality; however, it exposes patients, often of childbearing age, to radiation and has poor contrast in the female pelvis . PET/CT can also potentially be used; however, is costly, has an even higher radiation exposure than CT, and the results are not specific (high overlap between benign fibroids and LMS) …”

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confidence: 99%

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MRI screening for uterine leiomyosarcoma

Tong

Kang

Huang

et al. 2019

Magnetic Resonance Imaging

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Background Uterine fibroids are a common benign tumor and can be symptomatic, necessitating resection. Surgical myomectomy is an effective treatment option with a risk of disseminating occult uterine leiomyosarcoma (LMS), creating a need for an effective presurgical screening protocol. Clinical collaboration with contrast‐enhanced MRI including T2 and diffusion‐weighted imaging (DWI) can be utilized as a screening exam. Purpose To review the accuracy and feasibility of an interdisciplinary prospective contrast‐enhanced MRI pelvis with DWI screening system for LMS prior to fibroid resection. Study Type Retrospective cohort study. Population In all, 1960 adult female patients aged 18–87 undergoing screening MRI pelvis prior to uterine fibroid resection. Field Strength/Sequence T1 and T2‐weighted imaging, DWI, and contrast‐enhanced images were acquired at 1.5 T and 3.0 T. Assessment Each radiologist at the time of clinical study prospectively designated a confidence level of presence of LMS in the impression, which was reviewed retrospectively. A separate retrospective evaluation of the histologically proven LMS and the false positives was performed for the presence of five MRI features of LMS including low ADC values, intermediate/high T2 signal intensity, irregular margins, hemorrhage, and necrosis. A preliminary cost‐effectiveness analysis was performed, comparing the costs of treatment of uterine fibroids with vs. without a collaborative screening protocol using MRI. Statistical Tests Sensitivity, specificity, positive predictive value, and negative predictive value were obtained from the prospective evaluations. Student's t‐tests were used to compare demographics and apparent diffusion coefficient values between LMS and false‐positive results. Results We prospectively identified LMS patients with 100% sensitivity and 97% specificity. Preliminary cost analysis demonstrated that the MR screening protocol increased life expectancy by 0.04 years at a cost of $12,937 per life‐year gained. Data Conclusion MRI is an effective and potentially economic screening test, especially with standardized reporting and coordination with clinicians. Level of Evidence: 3 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2019.

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Section: Discussionmentioning

confidence: 49%

mentioning

confidence: 99%

MRI screening for uterine leiomyosarcoma

Tong

Kang

Huang

et al. 2019

Magnetic Resonance Imaging

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“…Pelvic ultrasound is typically the first-line imaging method to evaluate women for potential uterine pathology. However, the discriminative ability of ultrasound with or without Doppler assessment between leiomyosarcomas and leiomyoma is not reliable (16). On the other hand, some recent studies have shown that MRI may be useful in differentiating sarcomas from myomas preoperatively 14,17 .…”

Section: Discussionmentioning

confidence: 99%

Üreme çağındaki kadınlarda leiomiyosarkoma

Çelik¹,

Karakaya²,

Kokanalı³

et al. 2018

Cukurova Medical Journal

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Öz Purpose: Uterine leiomyosarcomas are exytremely rare tumors. Increased age and postmenopausal status are the potential risk factors of leiomyosarcomas. We aimed to determine the incidence of uterine leiomyosarcoma in women during reproductive period who undergoing hysterectomy or myomectomy for presumed benign leiomyomas. Materials and Methods: This retrospective study was carried out on women in reproductive age who had undergone myomectomy or hysterectomy due to presumed leiomyoma from January 1, 2013 to January 1, 2015. The incidence of leiomyosarcoma was calculated. Patient ages, admitting symptoms, and operative and pathologic findings were analyzed. Results: A total of 919 women in reproductive age underwent surgeries in the period of the study. We found four cases (0.40%) of rare primary sarcomas of uterus. Case-1 and Case-3 were a 40-year old women, Case-2 was a 36-year-old women, and Case-4 was a 39-year-old woman. Abnormal uterine bleeding and pelvic pain were the two symptoms in our malignant cases. 3 of the women underwent myomectomy procedure while one patient had hysterectomy. Conclusion: All women should be informed about quite minimal but potential possibility of malignancy that is present for their presumed leiomyomas during the counseling about the treatment options of leiomyomas.

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“…In 2015, Lin et al found that while contrast-enhanced MRI resulted in a higher accuracy rate of diagnosis for sarcoma than DWI (b-value = 1000 s/mm 2 ), the combination of DWI and ADC values (<1.08 × 10 −3 mm 2 /s) established the diagnosis of sarcoma with accuracy rates equivalent to those of contrast-enhanced MRI. They reported that in patients with decreased renal function for whom contrast-enhanced MRI was difficult, discrimination with DWI was useful [18]. Recently, there have been several reports arguing the usefulness of DWI and ADC values [3,[19][20][21][22].…”

Section: Update On Differential Diagnosis Of Uterine Myoma and Sarcomamentioning

confidence: 99%

Differential Diagnosis of Uterine Leiomyoma and Uterine Sarcoma Using Magnetic Resonance Images: A Literature Review

et al. 2019

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MRI plays an essential role in patients before treatment for uterine mesenchymal malignancies. Although MRI includes methods such as diffusion-weighted imaging and dynamic contrast-enhanced MRI, the differentiation between uterine myoma and sarcoma always becomes problematic. The present paper discusses important findings to ensure that sarcomas are not overlooked in magnetic resonance (MR) images, and we describe the update in the differentiation between uterine leiomyoma and sarcoma with recent reports.

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Diagnostic Accuracy of Ultrasound, Contrast-enhanced CT, and Conventional MRI for Differentiating Leiomyoma From Leiomyosarcoma

Cited by 42 publications

References 17 publications

MRI screening for uterine leiomyosarcoma

MRI screening for uterine leiomyosarcoma

Üreme çağındaki kadınlarda leiomiyosarkoma

Differential Diagnosis of Uterine Leiomyoma and Uterine Sarcoma Using Magnetic Resonance Images: A Literature Review

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