Highly improved accuracy of the revised PREoperative sarcoma score (rPRESS) in the decision of performing surgery for patients presenting with a uterine mass

Abstract

In 2014, we published an article titled “Novel uterine sarcoma preoperative diagnosis score predicts the need for surgery in patients presenting with a uterine mass” on the preoperative diagnosis of uterine sarcoma, in the SpringerPlus (Nagai et al. in SpringerPlus 2014, 3:678. doi:10.1186/2193-1801-3-678). Subsequently, we received several suggestions from readers, which were used to modify the statistical analysis methods and create a more precise preoperative diagnostic scoring system, which we present here as a supplemental report. The subjects were 63 patients who underwent surgical therapy for suspected uterine sarcoma (sarcoma group: 15 patients, benign group: 48 patients). Logistic regression analysis using the exact method was performed considering the subjects’ preoperative age, serum lactate dehydrogenase levels, magnetic resonance imaging findings, and endometrial cytology findings. We then used parameter estimates obtained from this analysis to revise the PREoperative Sarcoma Score (PRESS). The revised PRESS (rPRESS) has a maximum score of 10 points and an optimal cut-off value of 4 points, as derived from a receiver operating characteristic curve. Using this, the accuracy, positive predictive value, and negative predictive value were 93.7, 92.3, and 94.0 %, respectively. The diagnostic precision of the rPRESS is better than that of the original PRESS.

Differentiation of Uterine Leiomyosarcoma from Atypical Leiomyoma: Diagnostic Accuracy of Qualitative MR Imaging Features and Feasibility of Texture Analysis

“…However, the appearance of LM may be affected by degeneration, oedema, and/or unusual patterns of growth, making their differentiation from LMS difficult [8; 9]. Conflicting results from prior studies have led to uncertainty regarding the value of qualitative MRI features for differentiating LMS from unusual/atypical LM (ALM) [9-18]. These studies had small numbers of patients with LMS, included few ALM, and grouped various uterine sarcomas (leiomyosarcoma, endometrial stromal sarcoma, carcinosarcoma, etc.)…”

Management of a giant uterine leiomyoma

“…Predictive factors in PRESS include age above 49 years old, serum LDH above 279 U/L, positive endometrial cytological findings and MRI findings showing high intratumoural signal intensity on T1 weighted images indicating intratumoural haemorrhage and coagulative necrosis, or a heterogenous mass on T2 weighted images. This scoring system was revised in 2015, and a score of four points or greater suggest a higher risk of uterine sarcoma with a proposed accuracy of 93.7%, positive predictive value of 92.3% and negative predictive value of 94.0% 5. Our patient scored at least six points based on age and LDH levels, signifying a high risk of leiomyosarcoma.…”

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in seven patients with peritoneal sarcomatosis from uterine sarcoma

“…Some authors have used a diagnostic algorithm based on patient age, LDH levels, endometrial cytological findings, and MRI to determine if morcellation is appropriate; however, others in a meta‐analysis have indicated that morcellation increases the overall and intra‐abdominal recurrence rate as well as death rate in uterine leiomyosarcomas . Bogani also found that very large masses and masses associated with uterine bleeding correlated with US in about 20% and 42%, respectively .…”

“…Bogani also found that very large masses and masses associated with uterine bleeding correlated with US in about 20% and 42%, respectively . Therefore, comprehensive preoperative workup is desirable including detailed histopathology . If sarcomatosis is suspected, early referral for CRS/HIPEC may improve the prognosis and reduce morbidity .…”