Preoperative evaluation in women with uterine leiomyosarcoma. A nationwide cohort study

Skorstad, Mette; Kent, Andrew; Lieng, Marit

doi:10.1111/aogs.13008

Cited by 50 publications

(36 citation statements)

References 21 publications

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“…Consistently, three cases in our study have a diameter of mass less than 7 cm. In our study, the preoperative endometrial samplings of the cases had benign finding indicating the limited utility of endometrial sampling in detection of uterine leiomyosarcomas, as mentioned previous studies 14,15 .…”

Section: Discussionsupporting

confidence: 70%

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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Section: Discussionsupporting

confidence: 70%

Üreme çağındaki kadınlarda leiomiyosarkoma

Çelik¹,

Karakaya²,

Kokanalı³

et al. 2018

Cukurova Medical Journal

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“…The FDA emphasizes [13] that sarcomas in women undergoing surgeries due to presumed myomas approaches 2-3% in those over 60 years [19][20][21]. It should be highlighted that leyomyosarcomas often are unidentified before surgery as showed the data from the Cancer Registry of Norway [22], and in the Norwegian cohort, power morcellation of LMS has not led to reduced survival. In our study the woman with LMS who underwent power morcellation is 1 of 3 women with the longest survival after LMS recognition from the case series.…”

Section: Discussionmentioning

confidence: 99%

Occult uterine leiomyosarcoma in women undergoing abdominal and minimally invasive surgeries for myomas

2018

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Objectives: To estimate (i) the incidence of occult uterine leiomyosarcoma (LMS) in patients operated on for presumed myomas, and (ii) the proportion of occult LMS to preoperatively diagnosed LMS in a tertiary center. Material and methods: An Institutional Review Board-approved retrospective cohort study was performed. The electronic database of 30,476 patients was searched for women who had undergone surgery due to presumed myomas (N = 2675) as well as those with uterine LMS recognized via histology (N = 10) between January 2010 and December 2016. Results: Six of the 2675 treated women had occult LMS (incidence 1:446; 0.002; CI 0.0-0.013), and one underwent power morcellation (incidence 1:951; 0.001; CI 0.0-0.006). Parallel searching revealed that 6 of the 10 cases (60%) with uterine LMS recognized via histology were diagnosed postoperatively, whereas 4 of the 10 (40%) were diagnosed preoperatively. The incidence of LMS morcellation during laparoscopy was 1:951 and, when all MIS cases were included, 1:1178. The patient who underwent LMS morcellation was operated in the general surgery ward 5 years after laparoscopy (omental recurrence). Conclusions: These results are similar to the first and recent conservative FDA estimations, but two-times lower for procedures with laparoscopic morcellation and all MIS procedures than for abdominal. Because above half of LMS may be recognized after surgery, the risk of occult LMS and the delay of targeted surgical treatment should be included in all informed consent forms for conservative management of presumed myomas without histology.

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“…There is no exposure to radiation and there is high contrast between structures in the female pelvis. Several studies have identified features of LMS on MRI utilizing intravenous contrast and diffusion‐weighted imaging (DWI), which can identify malignant lesions by a combination of intrinsic T 2 intermediate/hyperintensity, irregular margin, low apparent diffusion coefficient (ADC) value, hemorrhage, necrosis, avid enhancement, and/or rapid growth …”

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confidence: 99%

“…Several studies have identified features of LMS on MRI utilizing intravenous contrast and diffusion-weighted imaging (DWI), which can identify malignant lesions by a combination of intrinsic T 2 intermediate/hyperintensity, irregular margin, low apparent diffusion coefficient (ADC) value, hemorrhage, necrosis, avid enhancement, and/or rapid growth. [10][11][12][13][14][15][16][17][18][19][20][21][22] Based on these data, in late 2013 we created a preoperative protocol where we used MRI features to risk-stratify the appearance of fibroids in conjunction with our referring gynecologists, who used additional screening data such as total serum lactate dehydrogenase (LDH) 12 and endometrial biopsies to properly triage patients for appropriate fibroid treatment.…”

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confidence: 99%

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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Preoperative evaluation in women with uterine leiomyosarcoma. A nationwide cohort study

Cited by 50 publications

References 21 publications

Üreme çağındaki kadınlarda leiomiyosarkoma

Üreme çağındaki kadınlarda leiomiyosarkoma

Occult uterine leiomyosarcoma in women undergoing abdominal and minimally invasive surgeries for myomas

MRI screening for uterine leiomyosarcoma

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