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Alomari O, Mokresh ME, Muvaffak E, Bakir RN, Al Shomali R, Akis S, Acar S, Api M. Transvaginal morcellation within an enclosed bag in gynecological surgeries: a comprehensive systematic review and analysis of safety, efficacy, and outcomes. Arch Gynecol Obstet 2024; 310:1857-1876. [PMID: 39097538 PMCID: PMC11393211 DOI: 10.1007/s00404-024-07676-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 07/26/2024] [Indexed: 08/05/2024]
Abstract
PURPOSE This systematic review aims to comprehensively assess the safety and efficacy of transvaginal morcellation within an enclosed bag in gynecological surgeries, with a focus on its benefits, potential risks, and recommendations for its use. METHODS We conducted a comprehensive search of Epistemonikos, Web of Science, Medline (PubMed), Scopus, and Cochrane databases for studies on transvaginal contained morcellation in adult patients undergoing gynecological surgeries. The review included 22 studies that met the inclusion criteria, encompassing diverse surgical procedures, patient profiles, and outcomes. These studies were thoroughly reviewed and analyzed to assess the safety and efficacy of the morcellation technique. RESULTS Key findings from the selected studies indicate that transvaginal morcellation within an enclosed bag offers several advantages in gynecological surgeries, including reduced invasiveness, shorter operative times, and minimal blood loss when compared to conventional methods. The risk of tumor recurrence or dissemination appears to be low when appropriate precautions are taken, emphasizing the technique's safety, especially when performed by experienced surgical teams. While some studies reported complications, these were generally not directly associated with the morcellation technique. CONCLUSION Transvaginal morcellation within an enclosed bag demonstrates potential as a safe and effective option for gynecological surgeries. The technique offers the benefits of minimally invasive procedures, including reduced bleeding, shorter recovery times, and improved cosmetic outcomes. This review also highlights the need for standardization in study methodologies and reporting, as the heterogeneity in outcomes across the selected studies poses challenges in drawing definitive conclusions.
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Affiliation(s)
- Omar Alomari
- Hamidiye International Faculty of Medicine, University of Health Sciences, Istanbul, 34668, Türkiye
| | - Muhammed Edib Mokresh
- Hamidiye International Faculty of Medicine, University of Health Sciences, Istanbul, 34668, Türkiye.
| | - Emir Muvaffak
- Hamidiye International Faculty of Medicine, University of Health Sciences, Istanbul, 34668, Türkiye
| | - Rahime Nurbanu Bakir
- Hamidiye International Faculty of Medicine, University of Health Sciences, Istanbul, 34668, Türkiye
| | - Raghad Al Shomali
- Hamidiye International Faculty of Medicine, University of Health Sciences, Istanbul, 34668, Türkiye
| | - Serkan Akis
- Faculty of Medicine, Department of Gynecologic Oncology, Marmara University, Pendik Training and Research Hospital, Istanbul, Türkiye
| | - Sami Acar
- Faculty of Medicine, Department of General Surgery, Tekirdağ Namık Kemal University, 59100, Terkirdağ, Türkiye
| | - Murat Api
- Department of Gynecologic Oncology, University of Health Sciences Turkey, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Türkiye
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Al Khuri M, Al Salmi I, Al Ajmi H, Al Hadidi A, Alabousi A, Haider E, Vasudev P, Al Salmi A, Jose S, Alrahbi N. Validating the diagnostic accuracy of an MRI-based scoring system for differentiating benign uterine leiomyomas from leiomyosarcomas. Int J Gynecol Cancer 2024; 34:1027-1033. [PMID: 38658016 DOI: 10.1136/ijgc-2023-005220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVE Uterine leiomyomas are the most common benign uterine tumors. They are difficult to distinguish from their malignant counterparts-smooth muscle tumors of unknown malignant potential (STUMP) and leiomyosarcoma. The purpose of this study is to propose and validate the diagnostic accuracy of the MRI-based Oman-Canada Scoring System of Myometrial Masses (OCSSMM) to differentiate uterine leiomyomas from STUMP/leiomyosarcomas. METHODS This is a retrospective study performed at two tertiary care centers. All patients with a pathology-proven uterine mass who underwent pre-operative pelvic MRI between January 2010 and January 2020 were included. Using a 1.5T MRI machine, sequences included were axial/coronal/sagittal T2 and T1 weighted imaging, axial diffusion weighted and apparent diffusion coefficient map, and axial or sagittal dynamic contrast-enhanced sequences. A scoring system was designed based on previously published worrisome MRI features for uterine leiomyosarcoma. Each feature was allocated a score from 0 to 2 according to the strength of association with malignancy. Subsequently, the MR images were blindly and independently reviewed by a fellowship-trained radiologist and a clinical fellow/senior resident. Each uterine mass was scored according to their imaging features. The scores were divided into five categories according to the sum of scores. Category III and above was considered positive for leiomyosarcoma/STUMP. Sensitivity, specificity, and positive and negative predictive values were calculated. RESULTS A total of 244 women were included (age range 20-74 years, mean 40). Of these, 218 patients had benign leiomyoma, 13 had STUMP, and 13 had leiomyosarcoma. The sensitivity and specificity of the scoring system were 92.3% and 64.7%, respectively. The negative predictive value was 98.6%. No leiomyosarcoma was missed using this scoring system. The presence of non-cystic T2 hyperintensity or diffusion restriction in a uterine mass were the most sensitive signs of a leiomyosarcoma/STUMP. CONCLUSION The proposed multi-parametric MRI scoring system may be useful in differentiating benign uterine leiomyomas from leiomyosarcomas/STUMP.
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Affiliation(s)
- Maryam Al Khuri
- Radiology Department, Sohar Hospital, Sohar, Al Batinah North, Oman
- Department of Medical Imaging, McMaster University, Hamilton, Canada
| | - Ishaq Al Salmi
- Radiology Department, The Royal Hospital, Seeb, Muscat, Oman
| | - Hawra Al Ajmi
- Radiology Department, Sohar Hospital, Sohar, Al Batinah North, Oman
| | - Aymen Al Hadidi
- Radiology Department, Khoula Hospital, Mina Al Fahal, Muscat, Oman
| | - Abdullah Alabousi
- Department of Medical Imaging, McMaster University, Hamilton, Canada
- Diagnostic Imaging, St Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Ehsan Haider
- Department of Medical Imaging, McMaster University, Hamilton, Canada
- Diagnostic Imaging, St Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Pooja Vasudev
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
- St Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Ahmed Al Salmi
- Radiology Department, Rustaq Hospital, Rustaq, Al Batinah South, Oman
| | - Sachin Jose
- Research and Studies Department, Oman Medical Speciality Board, Al-Athaiba, Muscat, Oman
| | - Nasser Alrahbi
- Histopathology Department, The Royal Hospital, Seeb, Muscat, Oman
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Kim H, Rha SE, Shin YR, Kim EH, Park SY, Lee SL, Lee A, Kim MR. Differentiating Uterine Sarcoma From Atypical Leiomyoma on Preoperative Magnetic Resonance Imaging Using Logistic Regression Classifier: Added Value of Diffusion-Weighted Imaging-Based Quantitative Parameters. Korean J Radiol 2024; 25:43-54. [PMID: 38184768 PMCID: PMC10788609 DOI: 10.3348/kjr.2023.0760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/17/2023] [Accepted: 10/24/2023] [Indexed: 01/08/2024] Open
Abstract
OBJECTIVE To evaluate the added value of diffusion-weighted imaging (DWI)-based quantitative parameters to distinguish uterine sarcomas from atypical leiomyomas on preoperative magnetic resonance imaging (MRI). MATERIALS AND METHODS A total of 138 patients (age, 43.7 ± 10.3 years) with uterine sarcoma (n = 44) and atypical leiomyoma (n = 94) were retrospectively collected from four institutions. The cohort was randomly divided into training (84/138, 60.0%) and validation (54/138, 40.0%) sets. Two independent readers evaluated six qualitative MRI features and two DWI-based quantitative parameters for each index tumor. Multivariable logistic regression was used to identify the relevant qualitative MRI features. Diagnostic classifiers based on qualitative MRI features alone and in combination with DWI-based quantitative parameters were developed using a logistic regression algorithm. The diagnostic performance of the classifiers was evaluated using a cross-table analysis and calculation of the area under the receiver operating characteristic curve (AUC). RESULTS Mean apparent diffusion coefficient value of uterine sarcoma was lower than that of atypical leiomyoma (mean ± standard deviation, 0.94 ± 0.30 10-3 mm²/s vs. 1.23 ± 0.25 10-3 mm²/s; P < 0.001), and the relative contrast ratio was higher in the uterine sarcoma (8.16 ± 2.94 vs. 4.19 ± 2.66; P < 0.001). Selected qualitative MRI features included ill-defined margin (adjusted odds ratio [aOR], 17.9; 95% confidence interval [CI], 1.41-503, P = 0.040), intratumoral hemorrhage (aOR, 27.3; 95% CI, 3.74-596, P = 0.006), and absence of T2 dark area (aOR, 83.5; 95% CI, 12.4-1916, P < 0.001). The classifier that combined qualitative MRI features and DWI-based quantitative parameters showed significantly better performance than without DWI-based parameters in the validation set (AUC, 0.92 vs. 0.78; P < 0.001). CONCLUSION The addition of DWI-based quantitative parameters to qualitative MRI features improved the diagnostic performance of the logistic regression classifier in differentiating uterine sarcomas from atypical leiomyomas on preoperative MRI.
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Affiliation(s)
- Hokun Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Eun Rha
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Yu Ri Shin
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Eu Hyun Kim
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea
| | - Soo Youn Park
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea
| | - Su-Lim Lee
- Department of Radiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Republic of Korea
| | - Ahwon Lee
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mee-Ran Kim
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Tu W, Yano M, Schieda N, Krishna S, Chen L, Gottumukkala RV, Alencar R. Smooth Muscle Tumors of the Uterus at MRI: Focus on Leiomyomas and FIGO Classification. Radiographics 2023; 43:e220161. [PMID: 37261965 DOI: 10.1148/rg.220161] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Leiomyomas are smooth muscle tumors of the uterus and are the most common uterine neoplasm. Although leiomyomas are usually asymptomatic, they can manifest with symptoms such as pain or uterine bleeding. Leiomyomas are classified on the basis of their anatomic location and morphology. Localization of leiomyomas relative to the endometrium, myometrium, and uterine serosa with use of the International Federation of Gynecology and Obstetrics (FIGO) classification system is helpful for guiding management in symptomatic patients. The FIGO system is a practical and universally accepted approach for classifying leiomyomas to guide radiologists and clinicians in deciding management. The MRI appearance of conventional leiomyomas is related to their tissue contents of smooth muscle and fibrous tissue and is well established. The MRI features of some leiomyoma subtypes and forms of degeneration also have been described. Other smooth muscle tumors of the uterus recognized in the 2020 World Health Organization classification system include intravenous leiomyomatosis, smooth muscle tumors of uncertain malignant potential, and metastasizing leiomyoma. At the far end of the spectrum are leiomyosarcomas, which are frankly malignant and therefore must be managed accordingly. Although MRI features that suggest a diagnosis of leiomyosarcoma have been proposed, these features overlap with those of some leiomyoma subtypes and degeneration. © RSNA, 2023 See the invited commentary by Fennessy and Gargiulo in this issue. Online supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Wendy Tu
- From the Department of Medical Imaging, University of Alberta, 116 St and 85 Ave, Edmonton, Alberta, Canada T6G 2R3 (W.T.); Department of Radiology (M.Y.) and Department of Laboratory Medicine and Pathology (L.C.), Mayo Clinic Arizona, Phoenix, AZ; Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.); Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Toronto, Ontario, Canada (S.K.); and Department of Radiology, Brigham and Women's Hospital, Harvard University, Boston, MA (R.V.G., R.A.1)
| | - Motoyo Yano
- From the Department of Medical Imaging, University of Alberta, 116 St and 85 Ave, Edmonton, Alberta, Canada T6G 2R3 (W.T.); Department of Radiology (M.Y.) and Department of Laboratory Medicine and Pathology (L.C.), Mayo Clinic Arizona, Phoenix, AZ; Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.); Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Toronto, Ontario, Canada (S.K.); and Department of Radiology, Brigham and Women's Hospital, Harvard University, Boston, MA (R.V.G., R.A.1)
| | - Nicola Schieda
- From the Department of Medical Imaging, University of Alberta, 116 St and 85 Ave, Edmonton, Alberta, Canada T6G 2R3 (W.T.); Department of Radiology (M.Y.) and Department of Laboratory Medicine and Pathology (L.C.), Mayo Clinic Arizona, Phoenix, AZ; Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.); Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Toronto, Ontario, Canada (S.K.); and Department of Radiology, Brigham and Women's Hospital, Harvard University, Boston, MA (R.V.G., R.A.1)
| | - Satheesh Krishna
- From the Department of Medical Imaging, University of Alberta, 116 St and 85 Ave, Edmonton, Alberta, Canada T6G 2R3 (W.T.); Department of Radiology (M.Y.) and Department of Laboratory Medicine and Pathology (L.C.), Mayo Clinic Arizona, Phoenix, AZ; Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.); Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Toronto, Ontario, Canada (S.K.); and Department of Radiology, Brigham and Women's Hospital, Harvard University, Boston, MA (R.V.G., R.A.1)
| | - Longwen Chen
- From the Department of Medical Imaging, University of Alberta, 116 St and 85 Ave, Edmonton, Alberta, Canada T6G 2R3 (W.T.); Department of Radiology (M.Y.) and Department of Laboratory Medicine and Pathology (L.C.), Mayo Clinic Arizona, Phoenix, AZ; Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.); Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Toronto, Ontario, Canada (S.K.); and Department of Radiology, Brigham and Women's Hospital, Harvard University, Boston, MA (R.V.G., R.A.1)
| | - Ravi V Gottumukkala
- From the Department of Medical Imaging, University of Alberta, 116 St and 85 Ave, Edmonton, Alberta, Canada T6G 2R3 (W.T.); Department of Radiology (M.Y.) and Department of Laboratory Medicine and Pathology (L.C.), Mayo Clinic Arizona, Phoenix, AZ; Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.); Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Toronto, Ontario, Canada (S.K.); and Department of Radiology, Brigham and Women's Hospital, Harvard University, Boston, MA (R.V.G., R.A.1)
| | - Raquel Alencar
- From the Department of Medical Imaging, University of Alberta, 116 St and 85 Ave, Edmonton, Alberta, Canada T6G 2R3 (W.T.); Department of Radiology (M.Y.) and Department of Laboratory Medicine and Pathology (L.C.), Mayo Clinic Arizona, Phoenix, AZ; Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.); Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Toronto, Ontario, Canada (S.K.); and Department of Radiology, Brigham and Women's Hospital, Harvard University, Boston, MA (R.V.G., R.A.1)
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5
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Suzuki A, Kido A, Matsuki M, Kotani Y, Murakami K, Yamanishi Y, Numoto I, Nakai H, Otani T, Konishi I, Mandai M, Matsumura N. Development of an Algorithm to Differentiate Uterine Sarcoma from Fibroids Using MRI and LDH Levels. Diagnostics (Basel) 2023; 13:diagnostics13081404. [PMID: 37189505 DOI: 10.3390/diagnostics13081404] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/10/2023] [Accepted: 04/10/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND This study aimed to establish an evaluation method for detecting uterine sarcoma with 100% sensitivity using MRI and serum LDH levels. METHODS One evaluator reviewed the MRI images and LDH values of a total of 1801 cases, including 36 cases of uterine sarcoma and 1765 cases of uterine fibroids. The reproducibility of the algorithm was also examined by four evaluators with different imaging experience and abilities, using a test set of 61 cases, including 14 cases of uterine sarcoma. RESULTS From the MRI images and LDH values of 1801 cases of uterine sarcoma and uterine fibroids, we found that all sarcomas were included in the group with a high T2WI and either a high T1WI, an unclear margin, or high LDH values. In addition, when cases with DWI were examined, all sarcomas had high DWI. Among the 36 sarcoma cases, the group with positive findings for T2WI, T1WI, margins, and serum LDH levels all had a poor prognosis (p = 0.015). The reproducibility of the algorithm was examined by four evaluators and the sensitivity of sarcoma detection ranged from 71% to 93%. CONCLUSION We established an algorithm to distinguish uterine sarcoma if tumors in the myometrium with low T2WI and DWI are present.
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Affiliation(s)
- Ayako Suzuki
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kindai University, Osakasayama 589-8511, Japan
| | - Aki Kido
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Mitsuru Matsuki
- Department of Radiology, Faculty of Medicine, Kindai University, Osakasayama 589-8511, Japan
| | - Yasushi Kotani
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kindai University, Osakasayama 589-8511, Japan
| | - Kosuke Murakami
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kindai University, Osakasayama 589-8511, Japan
| | - Yukio Yamanishi
- Department of Obstetrics and Gynecology, Japanese Red Cross Wakayama Medical Center, Wakayama 640-8558, Japan
| | - Isao Numoto
- Department of Radiology, Faculty of Medicine, Kindai University, Osakasayama 589-8511, Japan
| | - Hidekatsu Nakai
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kindai University, Osakasayama 589-8511, Japan
| | - Tomoyuki Otani
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kindai University, Osakasayama 589-8511, Japan
| | - Ikuo Konishi
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto 606-8507, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto 606-8507, Japan
| | - Noriomi Matsumura
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kindai University, Osakasayama 589-8511, Japan
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Hindman N, Kang S, Fournier L, Lakhman Y, Nougaret S, Reinhold C, Sadowski E, Huang JQ, Ascher S. MRI Evaluation of Uterine Masses for Risk of Leiomyosarcoma: A Consensus Statement. Radiology 2023; 306:e211658. [PMID: 36194109 PMCID: PMC9885356 DOI: 10.1148/radiol.211658] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/01/2022] [Accepted: 07/11/2022] [Indexed: 01/26/2023]
Abstract
Laparoscopic myomectomy, a common gynecologic operation in premenopausal women, has become heavily regulated since 2014 following the dissemination of unsuspected uterine leiomyosarcoma (LMS) throughout the pelvis of a physician treated for symptomatic leiomyoma. Research since that time suggests a higher prevalence than previously suspected of uterine LMS in resected masses presumed to represent leiomyoma, as high as one in 770 women (0.13%). Though rare, the dissemination of an aggressive malignant neoplasm due to noncontained electromechanical morcellation in laparoscopic myomectomy is a devastating outcome. Gynecologic surgeons' desire for an evidence-based, noninvasive evaluation for LMS is driven by a clear need to avoid such harms while maintaining the availability of minimally invasive surgery for symptomatic leiomyoma. Laparoscopic gynecologists could rely upon the distinction of higher-risk uterine masses preoperatively to plan oncologic surgery (ie, potential hysterectomy) for patients with elevated risk for LMS and, conversely, to safely offer women with no or minimal indicators of elevated risk the fertility-preserving laparoscopic myomectomy. MRI evaluation for LMS may potentially serve this purpose in symptomatic women with leiomyomas. This evidence review and consensus statement defines imaging and disease-related terms to allow more uniform and reliable interpretation and identifies the highest priorities for future research on LMS evaluation.
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Affiliation(s)
- Nicole Hindman
- From the Departments of Radiology (N.H., S.K.) and Gynecology
(J.Q.H.), NYU Grossman School of Medicine, 660 First Ave, 3rd Floor, New York,
NY 10016; Department of Radiology, Université Paris Cité, AP-HP,
Hôpital Européen Georges Pompidou, PARCC UMRS 970, INSERM, Paris,
France (L.F.); Department of Radiology, Memorial Sloan Kettering Cancer Center,
New York, NY (Y.L.); Department of Radiology, Cancer Institute Montpellier,
Montpellier, France (S.N.); Department of Radiology, McGill University,
Montreal, Quebec, Canada (C.R.); Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (E.S.); and
Department of Radiology, Georgetown University School of Medicine, Washington,
DC (S.A.)
| | - Stella Kang
- From the Departments of Radiology (N.H., S.K.) and Gynecology
(J.Q.H.), NYU Grossman School of Medicine, 660 First Ave, 3rd Floor, New York,
NY 10016; Department of Radiology, Université Paris Cité, AP-HP,
Hôpital Européen Georges Pompidou, PARCC UMRS 970, INSERM, Paris,
France (L.F.); Department of Radiology, Memorial Sloan Kettering Cancer Center,
New York, NY (Y.L.); Department of Radiology, Cancer Institute Montpellier,
Montpellier, France (S.N.); Department of Radiology, McGill University,
Montreal, Quebec, Canada (C.R.); Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (E.S.); and
Department of Radiology, Georgetown University School of Medicine, Washington,
DC (S.A.)
| | - Laure Fournier
- From the Departments of Radiology (N.H., S.K.) and Gynecology
(J.Q.H.), NYU Grossman School of Medicine, 660 First Ave, 3rd Floor, New York,
NY 10016; Department of Radiology, Université Paris Cité, AP-HP,
Hôpital Européen Georges Pompidou, PARCC UMRS 970, INSERM, Paris,
France (L.F.); Department of Radiology, Memorial Sloan Kettering Cancer Center,
New York, NY (Y.L.); Department of Radiology, Cancer Institute Montpellier,
Montpellier, France (S.N.); Department of Radiology, McGill University,
Montreal, Quebec, Canada (C.R.); Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (E.S.); and
Department of Radiology, Georgetown University School of Medicine, Washington,
DC (S.A.)
| | - Yulia Lakhman
- From the Departments of Radiology (N.H., S.K.) and Gynecology
(J.Q.H.), NYU Grossman School of Medicine, 660 First Ave, 3rd Floor, New York,
NY 10016; Department of Radiology, Université Paris Cité, AP-HP,
Hôpital Européen Georges Pompidou, PARCC UMRS 970, INSERM, Paris,
France (L.F.); Department of Radiology, Memorial Sloan Kettering Cancer Center,
New York, NY (Y.L.); Department of Radiology, Cancer Institute Montpellier,
Montpellier, France (S.N.); Department of Radiology, McGill University,
Montreal, Quebec, Canada (C.R.); Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (E.S.); and
Department of Radiology, Georgetown University School of Medicine, Washington,
DC (S.A.)
| | - Stephanie Nougaret
- From the Departments of Radiology (N.H., S.K.) and Gynecology
(J.Q.H.), NYU Grossman School of Medicine, 660 First Ave, 3rd Floor, New York,
NY 10016; Department of Radiology, Université Paris Cité, AP-HP,
Hôpital Européen Georges Pompidou, PARCC UMRS 970, INSERM, Paris,
France (L.F.); Department of Radiology, Memorial Sloan Kettering Cancer Center,
New York, NY (Y.L.); Department of Radiology, Cancer Institute Montpellier,
Montpellier, France (S.N.); Department of Radiology, McGill University,
Montreal, Quebec, Canada (C.R.); Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (E.S.); and
Department of Radiology, Georgetown University School of Medicine, Washington,
DC (S.A.)
| | - Caroline Reinhold
- From the Departments of Radiology (N.H., S.K.) and Gynecology
(J.Q.H.), NYU Grossman School of Medicine, 660 First Ave, 3rd Floor, New York,
NY 10016; Department of Radiology, Université Paris Cité, AP-HP,
Hôpital Européen Georges Pompidou, PARCC UMRS 970, INSERM, Paris,
France (L.F.); Department of Radiology, Memorial Sloan Kettering Cancer Center,
New York, NY (Y.L.); Department of Radiology, Cancer Institute Montpellier,
Montpellier, France (S.N.); Department of Radiology, McGill University,
Montreal, Quebec, Canada (C.R.); Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (E.S.); and
Department of Radiology, Georgetown University School of Medicine, Washington,
DC (S.A.)
| | - Elizabeth Sadowski
- From the Departments of Radiology (N.H., S.K.) and Gynecology
(J.Q.H.), NYU Grossman School of Medicine, 660 First Ave, 3rd Floor, New York,
NY 10016; Department of Radiology, Université Paris Cité, AP-HP,
Hôpital Européen Georges Pompidou, PARCC UMRS 970, INSERM, Paris,
France (L.F.); Department of Radiology, Memorial Sloan Kettering Cancer Center,
New York, NY (Y.L.); Department of Radiology, Cancer Institute Montpellier,
Montpellier, France (S.N.); Department of Radiology, McGill University,
Montreal, Quebec, Canada (C.R.); Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (E.S.); and
Department of Radiology, Georgetown University School of Medicine, Washington,
DC (S.A.)
| | - Jian Qun Huang
- From the Departments of Radiology (N.H., S.K.) and Gynecology
(J.Q.H.), NYU Grossman School of Medicine, 660 First Ave, 3rd Floor, New York,
NY 10016; Department of Radiology, Université Paris Cité, AP-HP,
Hôpital Européen Georges Pompidou, PARCC UMRS 970, INSERM, Paris,
France (L.F.); Department of Radiology, Memorial Sloan Kettering Cancer Center,
New York, NY (Y.L.); Department of Radiology, Cancer Institute Montpellier,
Montpellier, France (S.N.); Department of Radiology, McGill University,
Montreal, Quebec, Canada (C.R.); Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (E.S.); and
Department of Radiology, Georgetown University School of Medicine, Washington,
DC (S.A.)
| | - Susan Ascher
- From the Departments of Radiology (N.H., S.K.) and Gynecology
(J.Q.H.), NYU Grossman School of Medicine, 660 First Ave, 3rd Floor, New York,
NY 10016; Department of Radiology, Université Paris Cité, AP-HP,
Hôpital Européen Georges Pompidou, PARCC UMRS 970, INSERM, Paris,
France (L.F.); Department of Radiology, Memorial Sloan Kettering Cancer Center,
New York, NY (Y.L.); Department of Radiology, Cancer Institute Montpellier,
Montpellier, France (S.N.); Department of Radiology, McGill University,
Montreal, Quebec, Canada (C.R.); Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (E.S.); and
Department of Radiology, Georgetown University School of Medicine, Washington,
DC (S.A.)
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7
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Guo E, Li C, Hu Y, Zhao K, Zheng Q, Wang L. Leiomyoma with Bizarre Nuclei: A Current Update. Int J Womens Health 2022; 14:1641-1656. [PMID: 36457718 PMCID: PMC9707388 DOI: 10.2147/ijwh.s388278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 11/17/2022] [Indexed: 02/12/2024] Open
Abstract
Leiomyoma with bizarre nuclei (LBN), also known as symplastic leiomyoma, is a histological subtype of benign leiomyoma with bizarre cells and nuclear atypia. Differentiating LBN from other benign leiomyoma subtypes, uterine smooth muscle tumors of uncertain malignant potential (STUMP), or leiomyosarcoma (LMS) can be diagnostically challenging owing to overlapping features in clinical presentation and pathologic morphological analysis. The difficulty of distinguishing LBN from other lesions, especially from LMS, and the potential of LBN for subsequent malignant transformation make LBN an important topic of research. Herein, we review the definition, diagnosis, treatment, and prognosis of LBN. Histopathological examination is essential for distinguishing LBN from other diseases. Pathology sampling and morphological examination remain the key to diagnosis. The newly established ancillary immunohistochemical (IHC) and molecular genetic analysis can be useful tools for differential diagnosis. Furthermore, serum biomarkers and imaging examination may also be useful diagnostic tools. Attention should be paid to the differentiation between LBN and LMS because morphological diagnosis may still be challenging in some cases. Some IHC markers of LBN have been identified, which may be helpful for differential diagnosis. Furthermore, the use of IHC panels as diagnostic markers may be advocated. Molecular genetic studies suggest that some genes can aid with the differential diagnosis between LBN and LMS. However, increasing evidence support the idea that LBN and LMS are molecularly related, indicating that LBN may represent a potentially malignant stage of precancerous progression. At present, conservative treatment is recommended for primary LBN, especially for patients desiring to retain fertility, but close follow-up with imaging examinations is required.
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Affiliation(s)
- Enhui Guo
- Department of Gynecology, The Affiliated Hospital of Qingdao University, Qingdao, People’s Republic of China
- Qingdao Medical College, Qingdao University, Qingdao, People’s Republic of China
| | - Chengqian Li
- Qingdao Medical College, Qingdao University, Qingdao, People’s Republic of China
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, People’s Republic of China
| | - Yanjiao Hu
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, People’s Republic of China
| | - Kongyuan Zhao
- Department of Gynecology, The Affiliated Hospital of Qingdao University, Qingdao, People’s Republic of China
- Qingdao Medical College, Qingdao University, Qingdao, People’s Republic of China
| | - Qingmei Zheng
- Department of Gynecology, The Affiliated Hospital of Qingdao University, Qingdao, People’s Republic of China
| | - Liming Wang
- Department of Gynecology, The Affiliated Hospital of Qingdao University, Qingdao, People’s Republic of China
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8
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Lee JS, Kelly CM, Bartlett EK. Management of pelvic sarcoma. Eur J Surg Oncol 2022; 48:2299-2307. [PMID: 36195471 DOI: 10.1016/j.ejso.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 09/07/2022] [Accepted: 09/14/2022] [Indexed: 10/14/2022] Open
Abstract
Pelvic sarcomas are a rare and heterogenous group of tumors divided into two groups: soft tissue sarcomas and bone sarcomas. Soft tissue sarcomas of the pelvis include most commonly liposarcoma, leiomyosarcoma, gastrointestinal stromal tumors, malignant peripheral nerve sheath tumors, and solitary fibrous tumors. Bone sarcomas of the pelvis most commonly include osteosarcoma and chondrosarcoma. Multidisciplinary treatment at a center experienced in the treatment of sarcoma is essential. Management is dictated by histologic type and grade. Surgical resection with wide margins is the cornerstone of treatment for pelvic sarcomas, although this is often challenging due to anatomic constraints of the pelvis. Multimodal treatment is critical due to the high risk of local recurrence in the pelvis.
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Affiliation(s)
- Jay S Lee
- Department of Surgery, Duke University, Durham, NC, USA
| | - Ciara M Kelly
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Edmund K Bartlett
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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9
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Lin Y, Wu RC, Huang YL, Chen K, Tseng SC, Wang CJ, Chao A, Lai CH, Lin G. Uterine fibroid-like tumors: spectrum of MR imaging findings and their differential diagnosis. Abdom Radiol (NY) 2022; 47:2197-2208. [PMID: 35347386 DOI: 10.1007/s00261-022-03431-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 01/03/2023]
Abstract
Uterine leiomyoma, also known as uterine fibroid, is the most common gynecological tumor, affecting almost 80% of women at some point during their lives. In the same time, other fibroid-like tumors have similar clinical presentations and about 0.5% of resected tumors of which were presumed benign fibroids in the preoperative diagnosis revealed as malignant sarcomas in the final histopathological examination. Amid the emergence of nonsurgical or minimally invasive procedures for symptomatic benign uterine fibroids, such as uterine artery embolization, high-intensity-focused ultrasound, or laparoscopic myomectomy, the preoperative diagnosis of uterine tumors through imaging becomes all the more relevant. Preoperative tissue sampling is challenging because of the variable location of the myometrial mass; thus, the preoperative evaluation of size and location is increasingly performed through magnetic resonance imaging. Features in images might also be useful for examining the full spectrum of such growths, from benign fibroids to neoplasms of uncertain behavior and malignant sarcomas. Benign fibroids include usual-type leiomyomas, myomas with degeneration, and mitotically active leiomyomas. Neoplasms of uncertain behavior include smooth muscle tumors of uncertain malignant potential, leiomyomas with bizarre nuclei, and cellular leiomyomas. Malignant sarcomas comprise leiomyosarcomas, endometrial stromal sarcomas, adenosarcomas, and carcinosarcomas. The purpose of this article is to review the spectrum of MRI findings of uterine fibroid-like tumors, from benign variants, uncertain behavior to malignant sarcomas, and update the advanced imaging modalities, including diffusion-weighted imaging, positron emission tomography/computed tomography, combining texture analysis and radiomics, to tackle this important issue.
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Affiliation(s)
- Yenpo Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
- Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
| | - Ren-Chin Wu
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
- Department of Pathology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
| | - Yen-Ling Huang
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
- Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
| | - Kueian Chen
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
- Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
| | - Shu-Chi Tseng
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
- Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
| | - Chin-Jung Wang
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
| | - Angel Chao
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
| | - Chyong-Huey Lai
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
| | - Gigin Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan.
- Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan.
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan.
- Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan.
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10
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Review of uterine fibroids: imaging of typical and atypical features, variants, and mimics with emphasis on workup and FIGO classification. Abdom Radiol (NY) 2022; 47:2468-2485. [PMID: 35554629 DOI: 10.1007/s00261-022-03545-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/23/2022] [Accepted: 04/26/2022] [Indexed: 12/28/2022]
Abstract
Uterine fibroids are the most common gynecologic neoplasm. Although non-degenerated fibroids are easily identifiable on imaging, degenerated fibroids, fibroid variants, and fibroids with unusual growth patterns can constitute a diagnostic dilemma. Identification of these abnormal morphologic features can alter the diagnosis of presumed uterine fibroids and hence change management plans. This article reviews the typical and atypical radiologic imaging features of uterine fibroids, with an emphasis on the pitfalls, mimics, and radiologically identifiable features that can alter clinical management plans.
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11
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Matsuura K, Inoue K, Hoshino E, Yasuda M, Hasegawa K, Okada Y, Baba Y, Kozawa E. Utility of magnetic resonance imaging for differentiating malignant mesenchymal tumors of the uterus from T2-weighted hyperintense leiomyomas. Jpn J Radiol 2021; 40:385-395. [PMID: 34750737 PMCID: PMC8977266 DOI: 10.1007/s11604-021-01217-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 10/28/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE To generate a new discrimination method to distinguish between malignant mesenchymal tumors of the uterus and T2-weighted hyperintense leiomyoma based on magnetic resonance imaging findings and clinical features. MATERIALS AND METHODS Data from 32 tumors of 32 patients with malignant mesenchymal tumors of the uterus and from 34 tumors of 30 patients with T2-weighted hyperintense leiomyoma were analyzed. Clinical parameters, qualitative magnetic resonance imaging features, including computed diffusion-weighted imaging, and quantitative characteristics of magnetic resonance imaging of these two tumor types were compared. Predictive values for malignant mesenchymal tumors of the uterus were calculated using variant discriminant analysis. RESULTS The T1 bright area on qualitative assessment and mean apparent diffusion coefficient value on quantitative assessment yielded the most independent magnetic resonance imaging differentiators of malignant mesenchymal tumors of the uterus and T2-weighted hyperintense leiomyoma. The classification accuracy of the variant discriminant analysis based on three selected findings, i.e., a T1 bright area, computed diffusion-weighted imaging with a b-value of 2000s/mm2 (cDWI2000), and T2-hypointense bands, was 84.8% (56/66), indicating high accuracy. CONCLUSIONS Variant discriminant analysis using the T1 bright area, cDWI2000, and T2-hypointense bands yielded high accuracy for differentiating between malignant mesenchymal tumors of the uterus and T2-weighted hyperintense leiomyoma.
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Affiliation(s)
- Koichiro Matsuura
- Department of Radiology, Saitama Medical University, 38, Morohongo, Moroyamamachi, Saitama, Japan.
| | - Kaiji Inoue
- Department of Radiology, Saitama Medical University, 38, Morohongo, Moroyamamachi, Saitama, Japan
| | - Eri Hoshino
- Department of Radiology, Saitama Medical University, 38, Morohongo, Moroyamamachi, Saitama, Japan
| | - Masanori Yasuda
- Department of Pathology, Saitama Medical University, 38, Morohongo, Moroyamamachi, Saitama, Japan
| | - Kosei Hasegawa
- Department of Gynecologic Oncology, Saitama Medical University, 38, Morohongo, Moroyamamachi, Saitama, Japan
| | - Yoshitaka Okada
- Department of Diagnostic Radiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, Japan
| | - Yasutaka Baba
- Department of Diagnostic Radiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, Japan
| | - Eito Kozawa
- Department of Radiology, Saitama Medical University, 38, Morohongo, Moroyamamachi, Saitama, Japan
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12
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Jagannathan JP, Steiner A, Bay C, Eisenhauer E, Muto MG, George S, Fennessy FM. Differentiating leiomyosarcoma from leiomyoma: in support of an MR imaging predictive scoring system. Abdom Radiol (NY) 2021; 46:4927-4935. [PMID: 34075468 DOI: 10.1007/s00261-021-03132-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/08/2021] [Accepted: 05/19/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to determine the Magnetic Resonance (MR) imaging features that best differentiate leiomyosarcoma (LMS) from leiomyoma, and to explore a scoring system to preoperatively identify those at highest risk of having LMS. METHODS Our Institutional Review Board approved this retrospective HIPAA-compliant study with a waiver for written informed consent. Institutional Research Patient Data Registry identified patients with histopathologically-proven LMS (n = 19) or leiomyoma (n = 25) and a pelvic MRI within six months prior to surgery. Qualitative differentiating MRI features were selected based on prior publications and clinical experience. Patient and MRI characteristics for leiomyomas versus LMS were compared using Wilcoxon rank-sum tests or Fisher's exact tests and using a basic classification tree. Hypothesis testing was two-tailed, with a p value < 0.001 used to determine inclusion of variables into an MR imaging predictive (MRP) score. Diagnostic performance [sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV)] of the MRP in diagnosis of LMS used all possible scores as cutoffs. RESULTS Seven out of 15 MRI features were found to have an association with LMS. The final MRP scores ranged from 0 to 7: a score of 0-3 was associated with 100% NPV for LMS, and a MRP score of 6-7 with 100% PPV for LMS. CONCLUSION Seven qualitative MR imaging features, extracted from a standard MR imaging protocol, allow differentiation of LMS from leiomyoma. An exploratory risk stratification MRP score can be used to determine the likelihood of LMS being present.
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Affiliation(s)
- Jyothi P Jagannathan
- Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Aida Steiner
- Department of Radiology, Turku University Hospital, University of Turku, Kiinamyllynkatu 4-8, 20521, Turku, Finland
| | - Camden Bay
- Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
- Department of Medicine/Biostatistics, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Eric Eisenhauer
- Department of Gynecologic Oncology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02214, USA
| | - Michael G Muto
- Division of Surgical Oncology, Harvard Medical School, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Suzanne George
- Department of Medical Oncology, Harvard Medical School, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Fiona M Fennessy
- Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
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13
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Andrieu PC, Woo S, Kim TH, Kertowidjojo E, Hodgson A, Sun S. New imaging modalities to distinguish rare uterine mesenchymal cancers from benign uterine lesions. Curr Opin Oncol 2021; 33:464-475. [PMID: 34172593 PMCID: PMC8376762 DOI: 10.1097/cco.0000000000000758] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE OF REVIEW Uterine sarcomas are rare and are often challenging to differentiate on imaging from benign mimics, such as leiomyoma. As functional MRI techniques have improved and new adjuncts, such as machine learning and texture analysis, are now being investigated, it is helpful to be aware of the current literature on imaging features that may sometimes allow for preoperative distinction. RECENT FINDINGS MRI, with both conventional and functional imaging, is the modality of choice for evaluating uterine mesenchymal tumors, especially in differentiating uterine leiomyosarcoma from leiomyoma through validated diagnostic algorithms. MRI is sometimes helpful in differentiating high-grade stromal sarcoma from low-grade stromal sarcoma or differentiating endometrial stromal sarcoma from endometrial carcinoma. However, imaging remains nonspecific for evaluating rarer neoplasms, such as uterine tumor resembling ovarian sex cord tumor or perivascular epithelioid cell tumor, primarily because of the small number and power of relevant studies. SUMMARY Through advances in MRI techniques and novel investigational imaging adjuncts, such as machine learning and texture analysis, imaging differentiation of malignant from benign uterine mesenchymal tumors has improved and could help reduce morbidity relating to misdiagnosis or diagnostic delays.
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Affiliation(s)
| | - Sungmin Woo
- Department of Radiology. Memorial Sloan Kettering Cancer Center
| | - Tae-Hyung Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Department of Radiology, Naval Pohang Hospital, Pohang, Korea
| | | | | | - Simon Sun
- Department of Radiology. Hospital for Special Surgery
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14
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Bura V, Pintican RM, David RE, Addley HC, Smith J, Jimenez-Linan M, Lee J, Freeman S, Georgiu C. MRI findings in-between leiomyoma and leiomyosarcoma: a Rad-Path correlation of degenerated leiomyomas and variants. Br J Radiol 2021; 94:20210283. [PMID: 34289327 DOI: 10.1259/bjr.20210283] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Leiomyomas are the most common benign tumors of the uterus. On the opposite side, leiomyosarcomas are rare malignant uterine tumors that account for a significant proportion of uterine cancer deaths. Especially when large and degenerated, leiomyomas and leiomyoma variants can have overlapping imaging characteristics with those of leiomyosarcomas. Although not always possible, it is paramount to be able to differentiate between leiomyomas and leiomyosarcomas on imaging, as the therapeutic management can differ. This pictorial review aims to familiarize radiologists with imaging features of leiomyomas and various types of leiomyoma degeneration and variants, together with their pathology correlates.
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Affiliation(s)
- Vlad Bura
- Department of Radiology, County Clinical Emergency Hospital and Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Department of Radiology, Cambridge University Hospitals NHS Foundation Trust,Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Roxana Maria Pintican
- Department of Radiology, County Clinical Emergency Hospital and Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Reka Emma David
- Department of Radiology, County Clinical Emergency Hospital and Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Helen Clare Addley
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust,Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Janette Smith
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust,Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Mercedes Jimenez-Linan
- Department of Pathology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Janice Lee
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust,Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Susan Freeman
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust,Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Carmen Georgiu
- Department of Pathology, County Clinical Emergency Hospital and Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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15
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Kim J, Heo SH, Shin SS, Jeong YY. MRI Findings and Differential Diagnosis of Benign and Malignant Tumors of the Uterine Corpus. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:1103-1123. [PMID: 36238403 PMCID: PMC9432370 DOI: 10.3348/jksr.2021.0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/12/2021] [Accepted: 08/24/2021] [Indexed: 11/15/2022]
Abstract
자궁은 크게 자궁체부와 자궁경부로 나뉜다. 이 중 자궁내막과 자궁근층으로 이루어진 자궁체부에는 양성에서 악성 종양까지 다양한 질환이 발생한다. 비침습적인 일차적 평가로 초음파와 컴퓨터단층촬영이 있으나 비특이적인 영상 소견으로 감별이 어려운 경우가 있다. 반면높은 해상도와 병리학적 특성 파악이 가능한 자기공명영상은 병변의 위치 확인뿐만 아니라 조직학적 특징, 그 리고 악성 종양의 병기 설정에도 도움을 준다. 이 종설에서는 영상의학과의사들이 알아야 할 자궁체부에서 볼 수 있는 다양한 양성과 악성 종양들의 특징적인 자기공명영상 소견들과 이들의 감별점에 대해 정리했다.
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Affiliation(s)
- Jihyun Kim
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Suk Hee Heo
- Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Sang Soo Shin
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Yong Yeon Jeong
- Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
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16
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Tian S, Niu M, Xie L, Song Q, Liu A. Diffusion-tensor imaging for differentiating uterine sarcoma from degenerative uterine fibroids. Clin Radiol 2020; 76:313.e27-313.e32. [PMID: 33358441 DOI: 10.1016/j.crad.2020.11.115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 11/20/2020] [Indexed: 01/07/2023]
Abstract
AIM To explore the applicability of diffusion-tensor imaging (DTI) sequence quantitative parameters in differentiating uterine sarcoma (USr) from degenerative uterine fibroids (DUF). MATERIALS AND METHODS Fourteen cases of USr and 30 cases of DUF were analysed retrospectively. The diffusion-weighted imaging (DWI) and DTI images were analysed by two observers using Functool software on a ADW4.6 workstation. The images were post-processed to generate an apparent diffusion coefficient (ADC) map of DWI, ADC map of DTI (ADCT map), and fractional anisotropy (FA) map. Three regions of interest (ROI) were selected from the ADC, ADCT, and FA maps to obtain the ADC, ADCT, and FA values. The receiver operating characteristic (ROC) curves of all parameters were used to analyse and compare the diagnostic value of USr and DUF. RESULTS The ADC value, ADCT value, and FA value of USr (1.190 ± 0.262 × 10-3mm2/s, 1.165 ± 0.270 × 10-9mm2/s, 0.168 ± 0.063) were significantly lower compared to the values for DUF (1.525 ± 0.314 × 10-3mm2/s, 1.650 ± 0.332 × 10-9mm2/s, 0.254 ± 0.111; all p<0.001). The diagnostic threshold values for USr were: ADC ≤1.290 × 10-3mm2/s, ADCT ≤1.322 × 10-9mm2/s and FA ≤0.192. The corresponding sensitivities and specificities were 78.6%/90%, 96.7%/92.9%, and 86.7%/85.7%, respectively. The areas under the curve (AUC) were 0.875, 0.974, and 0.831, respectively. CONCLUSIONS DTI quantitative parameters can be used to differentiate USr from DUF. The ADCT value had the highest diagnostic efficacy.
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Affiliation(s)
- S Tian
- The First Affiliated Hospital of Dalian Medical University, Department of Radiology, Dalian, China
| | - M Niu
- The First Affiliated Hospital of Xiamen University, Department of Radiology, Xiamen, China
| | - L Xie
- GE Healthcare, MR Research, Beijing, China
| | - Q Song
- The First Affiliated Hospital of Dalian Medical University, Department of Radiology, Dalian, China
| | - A Liu
- The First Affiliated Hospital of Dalian Medical University, Department of Radiology, Dalian, China.
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17
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The Risk of Uterine Malignancy in a Population Being Evaluated for Uterine Fibroid Embolization. J Comput Assist Tomogr 2020; 44:893-900. [PMID: 33196598 DOI: 10.1097/rct.0000000000001104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to determine the frequency of uterine malignancy in patients evaluated for uterine fibroid embolization (UFE) and the role of magnetic resonance imaging in triage. METHODS Records and imaging studies of 864 UFE consult patients were reviewed for MRI findings suggestive of fibroid malignancy. Pathology was obtained for cases with suspicious baseline MRI's, and the most atypical mass was reanalyzed by an experienced radiologist, blinded to the pathological findings. RESULTS Twenty one of 864 patients had baseline MRI findings concerning for malignancy at consultation and 17 had complete records. Re-evaluation suggested that 5 were malignant. Three were confirmed malignant (0.35%). One malignancy among the 843 without suspicious baseline MRI findings was missed at consultation. CONCLUSIONS In our UFE population, uterine malignancy is rare (4/864, 0.46%), and MRI detected the majority, 3 (75%) of 4 before UFE. The observed prevalence of any malignancy was 0.35%, congruent with current Federal Drug Administration estimates.
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Developing a Preoperative Algorithm for the Diagnosis of Uterine Leiomyosarcoma. Diagnostics (Basel) 2020; 10:diagnostics10100735. [PMID: 32977421 PMCID: PMC7598216 DOI: 10.3390/diagnostics10100735] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/19/2020] [Accepted: 09/19/2020] [Indexed: 02/07/2023] Open
Abstract
Early diagnosis of the rare and life-threatening uterine leiomyosarcoma (LMS) is essential for prompt treatment, to improve survival. Preoperative distinction of LMS from benign leiomyoma remains a challenge, and thus LMS is often diagnosed post-operatively. This retrospective observational study evaluated the predictive diagnostic utility of 32 preoperative variables in 190 women who underwent a hysterectomy, with a postoperative diagnosis of leiomyoma (n = 159) or LMS (n = 31), at the Liverpool Women’s National Health Service (NHS) Foundation Trust, between 2010 and 2019. A total of 7 preoperative variables were associated with increased odds of LMS, including postmenopausal status (p < 0.001, OR 3.08), symptoms of pressure (p = 0.002, OR 2.7), postmenopausal bleeding (p = 0.001, OR 5.01), neutrophil count ≥7.5 × 109/L (p < 0.001, OR 5.72), haemoglobin level <118 g/L (p = 0.037, OR 2.22), endometrial biopsy results of cellular atypia or neoplasia (p = 0.001, OR 9.6), and a mass size of ≥10 cm on radiological imaging (p < 0.0001, OR 8.52). This study has identified readily available and easily identifiable preoperative clinical variables that can be implemented into clinical practice to discern those with high risk of LMS, for further specialist investigations in women presenting with symptoms of leiomyoma.
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Abdel Wahab C, Jannot AS, Bonaffini PA, Bourillon C, Cornou C, Lefrère-Belda MA, Bats AS, Thomassin-Naggara I, Bellucci A, Reinhold C, Fournier LS. Diagnostic Algorithm to Differentiate Benign Atypical Leiomyomas from Malignant Uterine Sarcomas with Diffusion-weighted MRI. Radiology 2020; 297:361-371. [PMID: 32930650 DOI: 10.1148/radiol.2020191658] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Improving the differentiation of uterine sarcomas from atypical leiomyomas remains a clinical challenge and is needed to avoid inappropriate surgery. Purpose To develop a diagnostic algorithm including diffusion-weighted MRI criteria to differentiate malignant uterine sarcomas from benign atypical leiomyomas. Materials and Methods This case-control retrospective study identified women with an atypical uterine mass at MRI between January 2000 and April 2017, with surgery or MRI follow-up after 1 year or longer. A diagnostic algorithm including T2-weighted MRI and diffusion-weighted imaging (DWI) signal and apparent diffusion coefficient (ADC) values was developed to predict for sarcoma. The training set consisted of 51 sarcomas and 105 leiomyomas. Two external validation sets were used to evaluate interreader reproducibility (16 sarcomas; 26 leiomyomas) and impact of reader experience (29 sarcomas; 30 leiomyomas). Wilson confidence intervals (CIs) were calculated for sensitivity and specificity. Results Evaluated were 156 women (median age, 50 years; interquartile range, 44-63 years). Predictive MRI criteria for malignancy were enlarged lymph nodes or peritoneal implants, high DWI signal greater than that in endometrium, and ADC less than or equal to 0.905 × 10-3 mm2/sec. Conversely, a global or focal area of low T2 signal intensity and a low or an intermediate DWI signal less than that in endometrium or lymph nodes allowed readers to confidently diagnose as benign a uterine mass demonstrating one or more of these signs (P < .001) in 100% cases in all three data sets. The sensitivities and specificities of the algorithm for diagnosis of malignancy were 98% (50 of 51 masses; 95% CI: 90%, 100%) and 94% (99 of 105 masses; 95% CI: 88%, 98%) in the training set; 88% (14 of 16 masses; 95% CI: 64%, 97%) and 100% (26 of 26 masses; 95% CI: 87%, 100%) in the validation set; and 83% (24 of 29 masses; 95% CI: 65%, 92%) and 97% (29 of 30 masses; 95% CI: 83%, 99%) for the less experienced reader, respectively. Conclusion A diagnostic algorithm with predictive features including lymphadenopathy, high diffusion-weighted imaging signal with reference to endometrium, and low apparent diffusion coefficient enabled differentiation of malignant sarcomas from atypical leiomyomas, and it may assist inexperienced readers. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Méndez in this issue.
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Affiliation(s)
- Cendos Abdel Wahab
- From the Departments of Radiology (C.A.W., C.B., A.B., L.S.F.), Medical Informatics and Public Health (A.S.J.), Gynecologic and Breast Oncologic Surgery (C.C., A.S.B.), and Pathology (M.A.L.B.), AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, Université de Paris, F-75015 Paris, France; Department of Radiology McGill University Health Centre, Montreal, Canada (P.A.B., C.R.); Department of Radiology, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France (I.T.N.); and Université de Paris, PARCC, INSERM, France (A.B., L.F.)
| | - Anne-Sophie Jannot
- From the Departments of Radiology (C.A.W., C.B., A.B., L.S.F.), Medical Informatics and Public Health (A.S.J.), Gynecologic and Breast Oncologic Surgery (C.C., A.S.B.), and Pathology (M.A.L.B.), AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, Université de Paris, F-75015 Paris, France; Department of Radiology McGill University Health Centre, Montreal, Canada (P.A.B., C.R.); Department of Radiology, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France (I.T.N.); and Université de Paris, PARCC, INSERM, France (A.B., L.F.)
| | - Pietro A Bonaffini
- From the Departments of Radiology (C.A.W., C.B., A.B., L.S.F.), Medical Informatics and Public Health (A.S.J.), Gynecologic and Breast Oncologic Surgery (C.C., A.S.B.), and Pathology (M.A.L.B.), AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, Université de Paris, F-75015 Paris, France; Department of Radiology McGill University Health Centre, Montreal, Canada (P.A.B., C.R.); Department of Radiology, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France (I.T.N.); and Université de Paris, PARCC, INSERM, France (A.B., L.F.)
| | - Camille Bourillon
- From the Departments of Radiology (C.A.W., C.B., A.B., L.S.F.), Medical Informatics and Public Health (A.S.J.), Gynecologic and Breast Oncologic Surgery (C.C., A.S.B.), and Pathology (M.A.L.B.), AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, Université de Paris, F-75015 Paris, France; Department of Radiology McGill University Health Centre, Montreal, Canada (P.A.B., C.R.); Department of Radiology, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France (I.T.N.); and Université de Paris, PARCC, INSERM, France (A.B., L.F.)
| | - Caroline Cornou
- From the Departments of Radiology (C.A.W., C.B., A.B., L.S.F.), Medical Informatics and Public Health (A.S.J.), Gynecologic and Breast Oncologic Surgery (C.C., A.S.B.), and Pathology (M.A.L.B.), AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, Université de Paris, F-75015 Paris, France; Department of Radiology McGill University Health Centre, Montreal, Canada (P.A.B., C.R.); Department of Radiology, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France (I.T.N.); and Université de Paris, PARCC, INSERM, France (A.B., L.F.)
| | - Marie-Aude Lefrère-Belda
- From the Departments of Radiology (C.A.W., C.B., A.B., L.S.F.), Medical Informatics and Public Health (A.S.J.), Gynecologic and Breast Oncologic Surgery (C.C., A.S.B.), and Pathology (M.A.L.B.), AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, Université de Paris, F-75015 Paris, France; Department of Radiology McGill University Health Centre, Montreal, Canada (P.A.B., C.R.); Department of Radiology, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France (I.T.N.); and Université de Paris, PARCC, INSERM, France (A.B., L.F.)
| | - Anne-Sophie Bats
- From the Departments of Radiology (C.A.W., C.B., A.B., L.S.F.), Medical Informatics and Public Health (A.S.J.), Gynecologic and Breast Oncologic Surgery (C.C., A.S.B.), and Pathology (M.A.L.B.), AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, Université de Paris, F-75015 Paris, France; Department of Radiology McGill University Health Centre, Montreal, Canada (P.A.B., C.R.); Department of Radiology, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France (I.T.N.); and Université de Paris, PARCC, INSERM, France (A.B., L.F.)
| | - Isabelle Thomassin-Naggara
- From the Departments of Radiology (C.A.W., C.B., A.B., L.S.F.), Medical Informatics and Public Health (A.S.J.), Gynecologic and Breast Oncologic Surgery (C.C., A.S.B.), and Pathology (M.A.L.B.), AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, Université de Paris, F-75015 Paris, France; Department of Radiology McGill University Health Centre, Montreal, Canada (P.A.B., C.R.); Department of Radiology, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France (I.T.N.); and Université de Paris, PARCC, INSERM, France (A.B., L.F.)
| | - Alexandre Bellucci
- From the Departments of Radiology (C.A.W., C.B., A.B., L.S.F.), Medical Informatics and Public Health (A.S.J.), Gynecologic and Breast Oncologic Surgery (C.C., A.S.B.), and Pathology (M.A.L.B.), AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, Université de Paris, F-75015 Paris, France; Department of Radiology McGill University Health Centre, Montreal, Canada (P.A.B., C.R.); Department of Radiology, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France (I.T.N.); and Université de Paris, PARCC, INSERM, France (A.B., L.F.)
| | - Caroline Reinhold
- From the Departments of Radiology (C.A.W., C.B., A.B., L.S.F.), Medical Informatics and Public Health (A.S.J.), Gynecologic and Breast Oncologic Surgery (C.C., A.S.B.), and Pathology (M.A.L.B.), AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, Université de Paris, F-75015 Paris, France; Department of Radiology McGill University Health Centre, Montreal, Canada (P.A.B., C.R.); Department of Radiology, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France (I.T.N.); and Université de Paris, PARCC, INSERM, France (A.B., L.F.)
| | - Laure S Fournier
- From the Departments of Radiology (C.A.W., C.B., A.B., L.S.F.), Medical Informatics and Public Health (A.S.J.), Gynecologic and Breast Oncologic Surgery (C.C., A.S.B.), and Pathology (M.A.L.B.), AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, Université de Paris, F-75015 Paris, France; Department of Radiology McGill University Health Centre, Montreal, Canada (P.A.B., C.R.); Department of Radiology, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France (I.T.N.); and Université de Paris, PARCC, INSERM, France (A.B., L.F.)
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T2 hyperintense myometrial tumors: can MRI features differentiate leiomyomas from leiomyosarcomas? Abdom Radiol (NY) 2019; 44:3388-3397. [PMID: 31250178 DOI: 10.1007/s00261-019-02097-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE To establish MRI features that help differentiate atypical leiomyomas and leiomyomas with degeneration that show hyperintensity on T2WI from leiomyosarcomas. METHODS AND MATERIALS This retrospective study evaluated 41 women who performed MRI before undergoing hysterectomy and had histologically proven atypical leiomyomas, leiomyomas with degeneration or leiomyosarcomas (21 leiomyomas; 20 leiomyosarcomas); only patients with T2 hyperintense myometrial tumors were included. The association between MRI features (contours; free pelvic fluid; intra-tumoral hemorrhagic areas, T2 heterogeneity; T2 dark areas; flow voids; restriction on diffusion-weighted images; signal intensity and heterogeneity after contrast administration; unenhanced areas, localization of unenhanced areas; necrosis; cystic areas) and the histology (leiomyoma vs. leiomyosarcoma) were calculated using Fisher's exact test. For those features that showed a significant association, a univariate linear regression was performed. RESULTS Five MRI features demonstrated a significant correlation with malignant histology: irregular borders (p = 0.03); "T2 dark" areas (p = 0.02); presence of central necrosis (p = 0.01); presence of high signal on b1000 DWI (p < 0.001); ADC value lower than 0.82 × 10-3 mm2/s; hyperenhancement of the tumor relative to the myometrium on post-contrast images (p = 0.02); and type 3 enhancing curve on DCE. Two of these features demonstrated a significant result predicting a malignant histology: lobulated contours and central necrosis [F(3;34) = 8,95; p < 0.001; R2 = 0.506]. CONCLUSION The presence of lobulated borders, T2 dark areas, necrosis, hyperintensity relative to the myometrium after contrast administration, central necrosis, presence of high signal on b1000 DWI, ADC value lower than 0.82 × 10-3 mm2/s and type 3 enhancing curve on DCE can help distinguish between leiomyoma and leiomyosarcoma. The association of lobulated borders and central necrosis can help predict a malignant histology.
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Sun S, Bonaffini PA, Nougaret S, Fournier L, Dohan A, Chong J, Smith J, Addley H, Reinhold C. How to differentiate uterine leiomyosarcoma from leiomyoma with imaging. Diagn Interv Imaging 2019; 100:619-634. [PMID: 31427216 DOI: 10.1016/j.diii.2019.07.007] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/14/2019] [Accepted: 07/15/2019] [Indexed: 12/16/2022]
Abstract
Uterine leiomyomas, the most frequent benign myomatous tumors of the uterus, often cannot be distinguished from malignant uterine leiomyosarcomas using clinical criteria. Furthermore, imaging differentiation between both entities is frequently challenging due to their potential overlapping features. Because a suspected leiomyoma is often managed conservatively or with minimally invasive treatments, the misdiagnosis of leiomyosarcoma for a benign leiomyoma could potentially result in significant treatment delays, therefore increasing morbidity and mortality. In this review, we provide an overview of the differences between leiomyoma and leiomyosarcoma, mainly focusing on imaging characteristics, but also briefly touching upon their demographic, histopathological and clinical differences. The main indications and limitations of available cross-sectional imaging techniques are discussed, including ultrasound, computed tomography, magnetic resonance imaging (MRI) and positron emission tomography/computed tomography. A particular emphasis is placed on the review of specific MRI features that may allow distinction between leiomyomas and leiomyosarcomas according to the most recent evidence in the literature. The potential contribution of texture analysis is also discussed. In order to help guide-imaging diagnosis, we provide an MRI-based diagnostic algorithm which takes into account morphological and functional features, both individually and in combination, in an attempt to optimize radiologic differentiation of leiomyomas from leiomyosarcomas.
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Affiliation(s)
- S Sun
- Department of Radiology, McGill University Health Centre, 1001 Decarie boulevard, H4A 3J1 Montreal, QC, Canada.
| | - P A Bonaffini
- Department of Radiology, McGill University Health Centre, 1001 Decarie boulevard, H4A 3J1 Montreal, QC, Canada
| | - S Nougaret
- Inserm, U1194, Department of Radiology, Montpellier Cancer Institute, University of Montpellier, 34295 Montpellier, France
| | - L Fournier
- Université de Paris, Descartes-Paris 5, 75006 Paris, France; Department of Radiology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France
| | - A Dohan
- Université de Paris, Descartes-Paris 5, 75006 Paris, France; Department of Radiology A, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - J Chong
- Department of Radiology, McGill University Health Centre, 1001 Decarie boulevard, H4A 3J1 Montreal, QC, Canada
| | - J Smith
- Department of Radiology, Cambridge University Hospitals, NHS Foundation Trust, CB2 0QQ Cambridge, United Kingdom
| | - H Addley
- Department of Radiology, Cambridge University Hospitals, NHS Foundation Trust, CB2 0QQ Cambridge, United Kingdom
| | - C Reinhold
- Department of Radiology, McGill University Health Centre, 1001 Decarie boulevard, H4A 3J1 Montreal, QC, Canada
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Gadducci A, Zannoni GF. Uterine smooth muscle tumors of unknown malignant potential: A challenging question. Gynecol Oncol 2019; 154:631-637. [PMID: 31326137 DOI: 10.1016/j.ygyno.2019.07.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/26/2019] [Accepted: 07/01/2019] [Indexed: 12/11/2022]
Abstract
Uterine smooth muscle tumors of unknown malignant potential [STUMP]s are neoplasms with pathological features that preclude an equivocal diagnosis of leiomyosarcoma, but that do not fulfill the criteria for leiomyoma or its variants, and raise concerns that the tumors may behave in a malign fashion. Total hysterectomy with or without bilateral salpingo-oophorectomy is the standard treatment if fertility is completed, whereas myomectomy alone can be taken into consideration in young patients who desire to preserve childbearing potential. A careful surveillance every 6 months for 5 years and then yearly is strongly warranted. Patients with STUMP can relapse as either STUMP or leiomyosarcoma in approximately 11-13% of the cases, and their 5-year overall survival ranges from 92 to 100%. The present paper reviews the clinicopathological features of uterine STUMPs with a particular focus on most commonly accepted histopathological criteria for the diagnosis and on biological behaviour of these controversial neoplasms.
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Affiliation(s)
- Angiolo Gadducci
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Italy.
| | - Gian Franco Zannoni
- Division of Anatomic Pathology and Histology - Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore School of Medicine, Rome, Italy
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Clinical utility of susceptibility-weighted MR sequence for the evaluation of uterine sarcomas. Clin Imaging 2019; 53:143-150. [DOI: 10.1016/j.clinimag.2018.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/13/2018] [Accepted: 10/12/2018] [Indexed: 01/14/2023]
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Huang YT, Huang YL, Ng KK, Lin G. Current Status of Magnetic Resonance Imaging in Patients with Malignant Uterine Neoplasms: A Review. Korean J Radiol 2018; 20:18-33. [PMID: 30627019 PMCID: PMC6315066 DOI: 10.3348/kjr.2018.0090] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 07/17/2018] [Indexed: 12/13/2022] Open
Abstract
In this study, we summarize the clinical role of magnetic resonance imaging (MRI) in the diagnosis of patients with malignant uterine neoplasms, including leiomyosarcoma, endometrial stromal sarcoma, adenosarcoma, uterine carcinosarcoma, and endometrial cancer, with emphasis on the challenges and disadvantages. MRI plays an essential role in patients with uterine malignancy, for the purpose of tumor detection, primary staging, and treatment planning. MRI has advanced in scope beyond the visualization of the many aspects of anatomical structures, including diffusion-weighted imaging, dynamic contrast enhancement-MRI, and magnetic resonance spectroscopy. Emerging technologies coupled with the use of artificial intelligence in MRI are expected to lead to progressive improvement in case management of malignant uterine neoplasms.
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Affiliation(s)
- Yu-Ting Huang
- Department of Medical Imaging and Intervention, Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan.,Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yen-Ling Huang
- Department of Medical Imaging and Intervention, Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Koon-Kwan Ng
- Department of Medical Imaging and Intervention, Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan.,Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Gigin Lin
- Department of Medical Imaging and Intervention, Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,Clinical Metabolomic Core Laboratory, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan.,Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
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Uterine Leiomyosarcoma: Can MRI Differentiate Leiomyosarcoma From Benign Leiomyoma Before Treatment? AJR Am J Roentgenol 2018; 211:1405-1415. [PMID: 30354268 DOI: 10.2214/ajr.17.19234] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The purpose of this article is to provide background on the epidemiologic, clinical, and economic impact of uterine leiomyomas, summarize the concerns associated with treating women with potential occult leiomyosarcomas (LMSs), and review the known and emerging imaging features of typical and atypical leiomyomas and explain how to differentiate them from LMSs. CONCLUSION Surgical management of presumed benign uterine leiomyomas received popular media attention when a case of disseminated LMS occurred after laparoscopic power morcellator-assisted hysterectomy. A subsequent U.S. Food and Drug Administration review found a higher prevalence of unsuspected uterine sarcoma and LMS among patients undergoing myomectomy or hysterectomy for presumed benign leiomyomas than was previously reported. This heightened concern has led to increased pressure on radiologists to distinguish LMSs from leiomyomas.
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26
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Chen Q, Shi H, Lu W, Lu B. Unexpected uterine sarcomas in 4478 patients with electric power morcellation for leiomyomas. Eur J Obstet Gynecol Reprod Biol 2018; 230:85-89. [PMID: 30245442 DOI: 10.1016/j.ejogrb.2018.09.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 08/28/2018] [Accepted: 09/12/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Our objective is to investigate the prevalence, pathology and prognosis of uterine sarcomas in laparoscopic hysterectomy/myomectomy with electric power morcellation for presumed leiomyomas. STUDY DESIGN We retrospectively reviewed patients with laparoscopic power morcellation (LPM) for presumed leiomyomas in a Chinese tertiary institution by chart review from September 1, 2013 to December 31, 2016. RESULTS Twenty-four in 4478 patients (0.54%) with LPM for presumed leiomyomas had unexpected cancers. The patients showed the highest frequency of occult cancers (10/375, 2.6%) at 51-60 years and lowest (0/255) before 30 years. The pathology included 14 endometrial stromal sarcomas (ESS) (low-grade 12 and high-grade 2), 9 leiomyosarcomas, and 1 malignant mixed mesodermal tumor. The patients underwent abdominal re-exploration including total hysterectomy with bilateral salpingo-oophorectomy and staging surgery. Three patients were at advanced FIGO stage (IIIb-IVb) and 21 at stage I. Seven patients recurred within 1-25 (mean 6.29) months including 5 leiomyosarcomas, 1 high-grade and 1 low-grade ESS. Four recurrent patients with leiomyosarcomas and one with high-grade ESS died of disease in 1-3 months. Seventeen patients had no relapse and were alive for 6-41 (mean 24) months. CONCLUSIONS Our study suggests that patients with LPM for presumed leiomyomas appear to have a considerable risk of unexpected cancers. Moreover, morcellation is potentially associated with adverse prognosis in patients with high-grade sarcomas. Informed consent on unexpected cancers that should be discussed before morcellation.
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Affiliation(s)
- Qin Chen
- Department of Surgical Pathology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Haiyan Shi
- Department of Surgical Pathology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Weiguo Lu
- Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China; Center for Uterine Cancer Diagnosis & Therapy of Zhejiang Province, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China.
| | - Bingjian Lu
- Department of Surgical Pathology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China; Center for Uterine Cancer Diagnosis & Therapy of Zhejiang Province, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China.
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Presurgical Identification of Uterine Smooth Muscle Malignancies through the Characteristic FDG Uptake Pattern on PET Scans. CONTRAST MEDIA & MOLECULAR IMAGING 2018; 2018:7890241. [PMID: 30018513 PMCID: PMC6029472 DOI: 10.1155/2018/7890241] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/09/2018] [Indexed: 12/22/2022]
Abstract
The unidentified presence of uterine smooth muscle malignancies poses a tremendous risk in women planning surgery for presumed benign leiomyomas. We sought to investigate whether preoperative FDG PET may be useful to identify leiomyosarcomas (LMS) and smooth muscle tumors of uncertain malignant potential (STUMP). Methods. We investigated patients with rapidly growing uterine masses which were suspected of being malignant on ultrasound or MRI. Among the 21 patients who underwent FDG PET, we identified 7 LMS, 1 STUMP, and 13 leiomyomas. PET-derived parameters and FDG uptake patterns were analyzed retrospectively. Results. The SUVmax values of LMS/STUMP (range: 3.7–11.8) were significantly higher than those observed in leiomyomas (range: 2.0–9.4; P=0.003) despite a significant overlap. The metabolic tumor/necrosis ratio was significantly higher in LMS/STUMP than in leiomyomas (P < 0.001), with no significant intergroup overlaps. All LMS/STUMP revealed a characteristic pattern of FDG uptake, identifying a specific “hollow ball” sign (corresponding to areas of coagulative tumor necrosis). In contrast, this sign was invariably absent in patients with leiomyomas. Conclusion. The characteristic FDG uptake pattern instead of SUV on PET images allows identifying LMS/STUMP in patients with rapidly growing uterine masses, avoiding the deleterious consequences of regular surgery for presumed benign leiomyomas.
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PREOPERATIVE MAGNETIC RESONANCE IMAGING DIAGNOSTIC FEATURES OF UTERINE LEIOMYOSARCOMAS: A SYSTEMATIC REVIEW. Int J Technol Assess Health Care 2018; 34:172-179. [DOI: 10.1017/s0266462318000168] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objectives: There are no current established pathognomonic diagnostic features for uterine leiomyosarcomas in the pre- or perioperative setting. Recent inadvertent upstaging of this rare malignancy during laparoscopic morcellation of a presumed fibroid has prompted widespread debate among clinicians regarding the safety of current surgical techniques for management of fibroids. This study aims to conduct a systematic review investigating significant diagnostic features in magnetic resonance imaging (MRI) of uterine leiomyosarcomas.Methods: A comprehensive database search was conducted guided by PRISMA recommendations for peer-reviewed publications to November 2017. Parameters available in MRI were compared for reliability and accuracy of diagnosis of leiomyosarcomas. A decision tree algorithm classifier model was constructed to investigate whether T1 and T2 MRI signal intensities are useful indicators.Results: Nine eligible studies were identified for analysis. There appears to be a significant relationship between histopathological type and T1 and T2 intensity signals (p < .05). A decision tree model analyzing T1 and T2 signal intensity readings supports this trend, with a diagnostic specificity of 77.78 percent for uterine leiomyosarcomas. The apparent diffusion coefficient (ADC) values were not observed to have a significant relationship with tumor pathology (p = .18).Conclusions: Various studies have investigated pre- and perioperative techniques in differentiating uterine leiomyosarcoma from benign fibroids. Given the rarity of the malignancy and lack of pathognomonic diagnostic parameters, there is difficulty in establishing definitive criteria. A decision tree model is proposed to aid diagnosis based on MRI signal intensities.
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Abstract
Leiomyosarcoma (LMS) is one of the most common subtypes of soft tissue sarcoma in adults and can occur in almost any part of the body. Uterine leiomyosarcoma is the most common subtype of uterine sarcoma. Increased awareness of this unique histology has allowed for the development of drugs that are specific to LMS and has begun to shed light on the similarities and possible unique aspects of soft tissue and uterine LMS. In this review, we summarize the current understanding of the epidemiology, diagnosis, genomics, and treatment options for LMS.
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Affiliation(s)
- Suzanne George
- Suzanne George, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; César Serrano, Vall d’Hebron Institute of Oncology, Vall d’Hebron University Hospital, Barcelona, Spain; Martee L. Hensley, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY; and Isabelle Ray-Coquard, Centre Leon Berard and University Claude-Bernard, Lyon, France
| | - César Serrano
- Suzanne George, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; César Serrano, Vall d’Hebron Institute of Oncology, Vall d’Hebron University Hospital, Barcelona, Spain; Martee L. Hensley, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY; and Isabelle Ray-Coquard, Centre Leon Berard and University Claude-Bernard, Lyon, France
| | - Martee L. Hensley
- Suzanne George, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; César Serrano, Vall d’Hebron Institute of Oncology, Vall d’Hebron University Hospital, Barcelona, Spain; Martee L. Hensley, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY; and Isabelle Ray-Coquard, Centre Leon Berard and University Claude-Bernard, Lyon, France
| | - Isabelle Ray-Coquard
- Suzanne George, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; César Serrano, Vall d’Hebron Institute of Oncology, Vall d’Hebron University Hospital, Barcelona, Spain; Martee L. Hensley, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY; and Isabelle Ray-Coquard, Centre Leon Berard and University Claude-Bernard, Lyon, France
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Kim TH, Kim JW, Kim SY, Kim SH, Cho JY. What MRI features suspect malignant pure mesenchymal uterine tumors rather than uterine leiomyoma with cystic degeneration? J Gynecol Oncol 2018; 29:e26. [PMID: 29400019 PMCID: PMC5920213 DOI: 10.3802/jgo.2018.29.e26] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 12/09/2017] [Accepted: 12/26/2017] [Indexed: 12/15/2022] Open
Abstract
Objective To retrospectively assess conventional magnetic resonance imaging (MRI) features that differentiate malignant pure mesenchymal uterine tumors (MPMUT); endometrial stromal sarcoma (ESS) and leiomyosarcoma (LMS) from uterine leiomyoma with cystic degeneration (ULCD). Methods We retrospectively reviewed magnetic resonance (MR) images of 30 patients with ULCD, 18 with ESS, and 15 with LMS, to assess tumor location, margin, T2 signal intensity (SI), speckled appearance, and peripheral band using univariate and multivariate analyses. Results ULCD more frequently showed subserosal location (53.3%), well-defined margin (96.7%), and speckled appearance (90.0%) compared with ESS (0%, 33.3%, and 33.3%, respectively) or LMS (20.0%, 33.3%, and 60.0%, respectively). In quantitative T2 SI comparisons, the T2 SI ratio of the main solid tumor portion to gluteus maximus muscle differed significantly among the three groups, with ULCD showing a lower SI ratio (0.62) compared with ESS (2.44) and LMS (1.13). On multivariate analysis, an ill-defined margin (odds ratio [OR]=44.885; p=0.003) and high T2 SI (OR=4.396; p=0.046) were the significant MR differentiators. Conclusion An ill-defined tumor margin and high T2 SI ratio of the main solid tumor-to-gluteus maximus muscle were useful MRI features in the differentiation of MPMUT from ULCD.
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Affiliation(s)
- Tae Hyung Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Weon Kim
- Department of Obstetrics and Gynecology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Youn Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Hyup Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Yeon Cho
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
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Abstract
Uterine sarcomas comprise a group of rare tumors with differing tumor biology, natural history and response to treatment. Diagnosis is often made following surgery for presumed benign disease. Currently, preoperative imaging does not reliably distinguish between benign leiomyomas and other malignant pathology. Uterine leiomyosarcoma is the most common sarcoma, but other subtypes include endometrial stromal sarcoma (low grade and high grade), undifferentiated uterine sarcoma and adenosarcoma. Clinical trials have shown no definite survival benefit of adjuvant radiotherapy or chemotherapy and have been hampered by the rarity and heterogeneity of these disease types. There is a role of adjuvant treatment in carefully selected cases following multidisciplinary discussion at sarcoma reference centers. In patients with metastatic disease, systemic chemotherapy can then be considered. There is activity of a number of agents, including doxorubicin, trabectedin, gemcitabine-based chemotherapy, eribulin and pazopanib. Patients should be considered for clinical trial entry where possible. Close international collaboration is important to allow progress in this group of diseases.
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Affiliation(s)
| | - Aisha B Miah
- Sarcoma Unit, Royal Marsden Hospital
- Department of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
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Barral M, Placé V, Dautry R, Bendavid S, Cornelis F, Foucher R, Guerrache Y, Soyer P. Magnetic resonance imaging features of uterine sarcoma and mimickers. Abdom Radiol (NY) 2017; 42:1762-1772. [PMID: 28246921 DOI: 10.1007/s00261-017-1076-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Uterine myometrial tumors are predominantly benign conditions that affect one-third of women and represent the main indication for hysterectomy. Preoperative imaging is of utmost importance for characterization and for precise mapping of myometrial tumors to best guide therapeutic strategy. New minimally invasive therapeutic strategies including morcellation, myolysis, uterine artery embolization and image-guided radiofrequency or focused ultrasound ablation have been developed for the treatment of uterine leiomyoma. However, preoperative differentiation between atypical leiomyomas and leiomyosarcomas is critical on imaging as uterine sarcoma requires a specific surgical technique to prevent dissemination. A single, rapidly growing uterine tumor, associated with endometrial thickening and ascites, in post-menopausal women is suspicious of uterine endometrial stromal sarcoma and carcinosarcoma. Suggestive magnetic resonance imaging features have been described, but overlap in imaging appearance between uterine leiomyosarcomas and cellular leiomyomas makes it challenging to ascertain the diagnosis. This review aims to illustrate the imaging features of uterine sarcomas and potential mimickers to make the reader more familiar with this serious condition which needs special consideration.
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Affiliation(s)
- Matthias Barral
- Sorbonne Paris Cité, Hôpital Lariboisière, Université Paris Diderot, Paris, France.
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance Publique- Hôpitaux de Paris, 2 rue Ambroise Paré, 75475, Paris, France.
- Inserm U-965, CART, Carcinose Angiogénèse et recherche translationnelle, 41 bvd de La Chapelle, 75010, Paris, France.
| | - Vinciane Placé
- Sorbonne Paris Cité, Hôpital Lariboisière, Université Paris Diderot, Paris, France
| | - Raphaël Dautry
- Sorbonne Paris Cité, Hôpital Lariboisière, Université Paris Diderot, Paris, France
| | - Sandra Bendavid
- Sorbonne Paris Cité, Hôpital Lariboisière, Université Paris Diderot, Paris, France
| | - Françoise Cornelis
- Department of Pathology, Hôpital Lariboisière, Assistance Publique- Hôpitaux de Paris, 2 rue Ambroise Paré, 75475, Paris, France
| | - Romain Foucher
- Sorbonne Paris Cité, Hôpital Lariboisière, Université Paris Diderot, Paris, France
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance Publique- Hôpitaux de Paris, 2 rue Ambroise Paré, 75475, Paris, France
| | - Youcef Guerrache
- Sorbonne Paris Cité, Hôpital Lariboisière, Université Paris Diderot, Paris, France
| | - Philippe Soyer
- Sorbonne Paris Cité, Hôpital Lariboisière, Université Paris Diderot, Paris, France
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance Publique- Hôpitaux de Paris, 2 rue Ambroise Paré, 75475, Paris, France
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Wright JD, Schorge JO, Kilcoyne A, Tambouret RH. Case 16-2017 - A 69-Year-Old Woman with Urinary Incontinence. N Engl J Med 2017; 376:2066-2073. [PMID: 28538116 DOI: 10.1056/nejmcpc1616398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Jason D Wright
- From the Department of Obstetrics and Gynecology, New York Presbyterian Hospital, and the Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons - both in New York (J.D.W.); and the Departments of Obstetrics and Gynecology (J.O.S.), Radiology (A.K.), and Pathology (R.H.T.), Massachusetts General Hospital, and the Departments of Obstetrics and Gynecology (J.O.S.), Radiology (A.K.), and Pathology (R.H.T.), Harvard Medical School - both in Boston
| | - John O Schorge
- From the Department of Obstetrics and Gynecology, New York Presbyterian Hospital, and the Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons - both in New York (J.D.W.); and the Departments of Obstetrics and Gynecology (J.O.S.), Radiology (A.K.), and Pathology (R.H.T.), Massachusetts General Hospital, and the Departments of Obstetrics and Gynecology (J.O.S.), Radiology (A.K.), and Pathology (R.H.T.), Harvard Medical School - both in Boston
| | - Aoife Kilcoyne
- From the Department of Obstetrics and Gynecology, New York Presbyterian Hospital, and the Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons - both in New York (J.D.W.); and the Departments of Obstetrics and Gynecology (J.O.S.), Radiology (A.K.), and Pathology (R.H.T.), Massachusetts General Hospital, and the Departments of Obstetrics and Gynecology (J.O.S.), Radiology (A.K.), and Pathology (R.H.T.), Harvard Medical School - both in Boston
| | - Rosemary H Tambouret
- From the Department of Obstetrics and Gynecology, New York Presbyterian Hospital, and the Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons - both in New York (J.D.W.); and the Departments of Obstetrics and Gynecology (J.O.S.), Radiology (A.K.), and Pathology (R.H.T.), Massachusetts General Hospital, and the Departments of Obstetrics and Gynecology (J.O.S.), Radiology (A.K.), and Pathology (R.H.T.), Harvard Medical School - both in Boston
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Cui RR, Wright JD, Hou JY. Uterine leiomyosarcoma: a review of recent advances in molecular biology, clinical management and outcome. BJOG 2017; 124:1028-1037. [PMID: 28128524 DOI: 10.1111/1471-0528.14579] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2017] [Indexed: 12/22/2022]
Abstract
Uterine leiomyosarcoma (LMS) are rare but aggressive tumours with poor clinical outcomes regardless of stage. Most tumours are identified by histopathology at time of surgery, and pre-operative diagnosis remains a clinical challenge. Management of early-stage LMS relies on surgical resection. Cytotoxic chemotherapy remains the mainstay of therapy for advanced-stage, recurrent or metastatic LMS, and includes single or combination doxorubicin-, ifosfamide- or gemcitabine-based regimens. Recent interest in genetic biomarkers led to developments of targeted therapies for LMS, although more research is needed to understand the molecular complexities underlying LMS to guide the development of novel treatment strategies. TWEETABLE ABSTRACT The diagnosis and treatment of uterine LMS is challenging. Novel biomarkers offer hope for future therapies.
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Affiliation(s)
- R R Cui
- Department of Obstetrics and Gynecology and Herbert Irving Comprehensive Cancer Center, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - J D Wright
- Department of Obstetrics and Gynecology and Herbert Irving Comprehensive Cancer Center, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - J Y Hou
- Department of Obstetrics and Gynecology and Herbert Irving Comprehensive Cancer Center, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Lakhman Y, Veeraraghavan H, Chaim J, Feier D, Goldman DA, Moskowitz CS, Nougaret S, Sosa RE, Vargas HA, Soslow RA, Abu-Rustum NR, Hricak H, Sala E. Differentiation of Uterine Leiomyosarcoma from Atypical Leiomyoma: Diagnostic Accuracy of Qualitative MR Imaging Features and Feasibility of Texture Analysis. Eur Radiol 2016; 27:2903-2915. [PMID: 27921159 DOI: 10.1007/s00330-016-4623-9] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 09/03/2016] [Accepted: 09/26/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE To investigate whether qualitative magnetic resonance (MR) features can distinguish leiomyosarcoma (LMS) from atypical leiomyoma (ALM) and assess the feasibility of texture analysis (TA). METHODS This retrospective study included 41 women (ALM = 22, LMS = 19) imaged with MRI prior to surgery. Two readers (R1, R2) evaluated each lesion for qualitative MR features. Associations between MR features and LMS were evaluated with Fisher's exact test. Accuracy measures were calculated for the four most significant features. TA was performed for 24 patients (ALM = 14, LMS = 10) with uniform imaging following lesion segmentation on axial T2-weighted images. Texture features were pre-selected using Wilcoxon signed-rank test with Bonferroni correction and analyzed with unsupervised clustering to separate LMS from ALM. RESULTS Four qualitative MR features most strongly associated with LMS were nodular borders, haemorrhage, "T2 dark" area(s), and central unenhanced area(s) (p ≤ 0.0001 each feature/reader). The highest sensitivity [1.00 (95%CI:0.82-1.00)/0.95 (95%CI: 0.74-1.00)] and specificity [0.95 (95%CI:0.77-1.00)/1.00 (95%CI:0.85-1.00)] were achieved for R1/R2, respectively, when a lesion had ≥3 of these four features. Sixteen texture features differed significantly between LMS and ALM (p-values: <0.001-0.036). Unsupervised clustering achieved accuracy of 0.75 (sensitivity: 0.70; specificity: 0.79). CONCLUSIONS Combination of ≥3 qualitative MR features accurately distinguished LMS from ALM. TA was feasible. KEY POINTS • Four qualitative MR features demonstrated the strongest statistical association with LMS. • Combination of ≥3 these features could accurately differentiate LMS from ALM. • Texture analysis was a feasible semi-automated approach for lesion categorization.
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Affiliation(s)
- Yulia Lakhman
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Harini Veeraraghavan
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joshua Chaim
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Diana Feier
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Radiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Debra A Goldman
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chaya S Moskowitz
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stephanie Nougaret
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Radiology, Institut Régional du Cancer de Montpellier, Montpellier, France
| | - Ramon E Sosa
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Robert A Soslow
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nadeem R Abu-Rustum
- Gynecologic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Evis Sala
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Abstract
PURPOSE The purpose of the study was to assess the diagnostic performance of qualitative and quantitative diffusion-weighted imaging (DWI) in differentiating benign from malignant ovarian and uterine masses. MATERIALS AND METHODS Institutional review board approval was obtained for this HIPAA-compliant retrospective study, with waiver of informed consent. DWI MRIs of 222 women acquired over 1.5 years were evaluated. Reference standard was pathology or follow-up imaging. For qualitative assessment, two radiologists independently reviewed DWI and apparent diffusion coefficient (ADC) images for diffusion restriction. Differences were resolved by consensus. For quantitative assessment, a single reader measured ADC values. Readers were blinded to the reference standard. RESULTS 222 lesions, 121 ovarian (99 benign and 22 malignant) and 101 uterine (54 benign and 47 malignant), were included. Final diagnosis was established with pathology in 129 (58%) or with imaging follow-up in 93 (42%). Mean (range) follow-up interval was 27 (13-48) months. Qualitative assessment yielded sensitivity (ratio, 95% CI), specificity, PPV and NPV of 100% (22/22, 85-100), 68% (68/99, 58-76), 41% (22/54, 27-54), and 100% (68/68, 94-100) for ovarian and 94% (44/47, 83-98), 91% (49/54, 80-96), 90% (44/49, 78-95) and 94% (49/52, 84-98) for uterine malignancies. ADC (mean ± SD) between benign ovarian [(1.11 ± 0.76) × 10-3 mm2/s] vs. malignant [(0.71 ± 0.26) × 10-3 mm2/s] lesions was significantly different (p < 0.001). ADC cutoff value of 1.55 × 10-3 mm2/s for ovarian lesions resulted in 99.9% confidence for the absence of malignancy. ADC (mean ± SD) of benign uterine [(0.64 ± 0.38) × 10-3 mm2/s] vs. malignant [(0.68 ± 0.19) × 10-3 mm2/s] lesions was not significantly different (P < 0.54). CONCLUSION Quantitative and qualitative DWI assessment can be used to confidently characterize a subset of ovarian lesions as benign. With uterine lesions, although DWI is useful in differentiating benign from malignant lesions, the technique does not allow for definitive quantitative characterization.
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Abstract
Symptomatic fibroids are a common indication for hysterectomy or myomectomy. Although rare, unexpected gynecologic malignancies in presumed fibroids have been documented. In cases where tissue retrieval is performed through morcellation, there is increasing concern that intra-abdominal dispersion of occult uterine malignancies may lead to peritoneal dissemination and worse outcomes. We examined the available literature to determine the prevalence of all uterine cancers in women undergoing hysterectomy or myomectomy for benign uterine disease, with attention to the risk of morcellating occult uterine sarcomas. We also reviewed the available tools for preoperative discrimination between benign and malignant uterine disease.
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Gaetke-Udager K, McLean K, Sciallis AP, Alves T, Maturen KE, Mervak BM, Moore AG, Wasnik AP, Erba J, Davenport MS. Diagnostic Accuracy of Ultrasound, Contrast-enhanced CT, and Conventional MRI for Differentiating Leiomyoma From Leiomyosarcoma. Acad Radiol 2016; 23:1290-7. [PMID: 27396800 DOI: 10.1016/j.acra.2016.06.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 06/03/2016] [Accepted: 06/07/2016] [Indexed: 02/06/2023]
Abstract
RATIONALE AND OBJECTIVES This study aimed to determine whether uterine leiomyoma can be distinguished from uterine leiomyosarcoma on ultrasound (US), computed tomography (CT), and/or magnetic resonance imaging (MRI) without diffusion-weighted imaging. MATERIALS AND METHODS Institutional review board approval was obtained and informed consent was waived for this Health Insurance Portability and Accountability Act-compliant retrospective case-control diagnostic accuracy study. All subjects with resected uterine leiomyosarcoma diagnosed over a 17-year period (1998-2014) at a single institution for whom pre-resection US (n = 10), CT (n = 11), or MRI (n = 7) was available were matched by tumor size and imaging modality with 28 subjects with resected uterine leiomyoma. Six blinded radiologists (three attendings, three residents) assigned 5-point Likert scores for the following features: (1) margins, (2) necrosis, (3) hemorrhage, (4) vascularity, (5) calcifications, (6) heterogeneity, and (7) likelihood of malignancy (primary end point). Mean suspicion scores were calculated and receiver operating characteristic curves were generated. The ability of individual morphologic features to predict malignancy was assessed with logistic regression. RESULTS Mean suspicion scores were 2.5 ± 1.2 (attendings) and 2.4 ± 1.3 (residents) for leiomyoma, and 2.7 ± 1.3 (attendings) and 2.7 ± 1.4 (residents) for leiomyosarcoma. The areas under the receiver operating characteristic curves (range: 0.330-0.685) were not significantly different from chance, either overall (P = .36-.88) or by any modality (P = .28-.96), for any reader. Reader experience had no effect on diagnostic accuracy. No morphologic parameter was significantly predictive of malignancy (P = .10-.97). CONCLUSIONS Uterine leiomyoma cannot be differentiated accurately from leiomyosarcoma on US, CT, or MRI without diffusion-weighted imaging.
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Lynam S, Young L, Morozov V, Rao G, Roque DM. Risk, risk reduction and management of occult malignancy diagnosed after uterine morcellation: a commentary. ACTA ACUST UNITED AC 2015; 11:929-44. [PMID: 26673851 DOI: 10.2217/whe.15.63] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Minimally invasive surgical techniques compared with laparotomy offer the advantages of less intraoperative blood loss, shorter hospitalization, fewer wound complications and faster return to baseline activity for both hysterectomy and myomectomy. While morcellation allows for the laparoscopic removal of large specimens, it may result in intraperitoneal dissemination of benign disease or upstaging of occult malignancy leading to compromised survival. There has been heightened scrutiny over appropriate patient selection and preoperative assessment in light of recent warnings against power morcellation issued by the US FDA. This commentary therefore summarizes the magnitude of such risks associated with uterine morcellation, current national regulatory statements and potential merits of risk-reducing approaches such as contained morcellation. The importance of patient counseling is underscored.
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Affiliation(s)
- Sarah Lynam
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Laura Young
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Vadim Morozov
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD 21201, USA.,Center of Excellence in Minimally Invasive Gynecology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Gautam Rao
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD 21201, USA.,Division of Gynecologic Oncology, Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Dana M Roque
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD 21201, USA.,Division of Gynecologic Oncology, Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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Yamashita Y, Murayama S, Okada M, Watanabe Y, Kataoka M, Kaji Y, Imamura K, Takehara Y, Hayashi H, Ohno K, Awai K, Hirai T, Kojima K, Sakai S, Matsunaga N, Murakami T, Yoshimitsu K, Gabata T, Matsuzaki K, Tohno E, Kawahara Y, Nakayama T, Monzawa S, Takahashi S. The essence of the Japan Radiological Society/Japanese College of Radiology Imaging Guideline. Jpn J Radiol 2015; 34:43-79. [DOI: 10.1007/s11604-015-0499-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Lin G, Yang LY, Huang YT, Ng KK, Ng SH, Ueng SH, Chao A, Yen TC, Chang TC, Lai CH. Comparison of the diagnostic accuracy of contrast-enhanced MRI and diffusion-weighted MRI in the differentiation between uterine leiomyosarcoma / smooth muscle tumor with uncertain malignant potential and benign leiomyoma. J Magn Reson Imaging 2015; 43:333-42. [DOI: 10.1002/jmri.24998] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 06/23/2015] [Indexed: 12/14/2022] Open
Affiliation(s)
- Gigin Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital and Institute for Radiological Research; Chang Gung University, Linkou Medical Center; Guishan Taoyuan Taiwan
| | - Lan-Yan Yang
- Clinical Trial Center; Chang Gung Memorial Hospital and Chang Gung University, Linkou Medical Center; Guishan Taoyuan Taiwan
| | - Yu-Ting Huang
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital and Institute for Radiological Research; Chang Gung University, Linkou Medical Center; Guishan Taoyuan Taiwan
| | - Koon-Kwan Ng
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital and Institute for Radiological Research; Chang Gung University, Linkou Medical Center; Guishan Taoyuan Taiwan
| | - Shu-Hang Ng
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital and Institute for Radiological Research; Chang Gung University, Linkou Medical Center; Guishan Taoyuan Taiwan
| | - Shir-Hwa Ueng
- Department of Pathology; Chang Gung Memorial Hospital and Chang Gung University, Linkou Medical Center; Guishan Taoyuan Taiwan
| | - Angel Chao
- Department of Obstetrics and Gynecology, Gynecology Oncology Research Center; Chang Gung Memorial Hospital and Chang Gung University, Linkou Medical Center; Guishan Taoyuan Taiwan
| | - Tzu-Chen Yen
- Department of Nuclear Medicine and Center for Advanced Molecular Imaging and Translation; Chang Gung Memorial Hospital and Chang Gung University, Linkou Medical Center; Guishan Taoyuan Taiwan
| | - Ting-Chang Chang
- Department of Obstetrics and Gynecology, Gynecology Oncology Research Center; Chang Gung Memorial Hospital and Chang Gung University, Linkou Medical Center; Guishan Taoyuan Taiwan
| | - Chyong-Huey Lai
- Department of Obstetrics and Gynecology, Gynecology Oncology Research Center; Chang Gung Memorial Hospital and Chang Gung University, Linkou Medical Center; Guishan Taoyuan Taiwan
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Hall T, Lee SI, Boruta DM, Goodman A. Medical Device Safety and Surgical Dissemination of Unrecognized Uterine Malignancy: Morcellation in Minimally Invasive Gynecologic Surgery. Oncologist 2015; 20:1274-82. [PMID: 26382742 DOI: 10.1634/theoncologist.2015-0061] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 08/07/2015] [Indexed: 12/22/2022] Open
Abstract
UNLABELLED There is a risk of dissemination of uterine malignancies during minimally invasive hysterectomies when morcellation is used. Although the technique of uterine power morcellation allows timely removal of large benign tumors through small laparoscopic incisions, there are concerns about iatrogenic spread of cancers and reduced survival for women with preoperatively unrecognized malignancies. This review examines the literature on intraperitoneal spread and implantation of mechanically disrupted malignant tissue, discusses the current diagnostic tools for preoperative assessment of uterine tumors, and summarizes the current recommendations of the Society of Gynecologic Oncologists, the American College of Obstetricians and Gynecologists, and the American Association of Gynecologic Laparoscopists. Recommendations include informed consent of the risk of disseminating an otherwise contained malignancy, appropriate preoperative evaluation for malignancy, and development of alternatives to intracorporeal morcellation. IMPLICATIONS FOR PRACTICE Preoperative assessment of uterine masses or abnormal uterine bleeding must include understanding of the limitations of an endometrial biopsy and imaging studies to evaluate the possibility of a uterine malignancy. Minimally invasive surgery using morcellation of benign uterine growths is well established and safe; however, alternative surgical techniques to morcellation must be considered when the malignant potential of a uterine mass is uncertain. Morcellation carries the risk of widespread peritoneal seeding of an unrecognized uterine malignancy. Gynecologic surgeons must weigh the unlikely occurrence of disseminating an undiagnosed uterine sarcoma with the much more common surgical risks of abdominal surgery.
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Affiliation(s)
- Tracilyn Hall
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Susanna I Lee
- Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - David M Boruta
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Annekathryn Goodman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
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Horta M, Cunha TM, Oliveira R, Magro P. Hydropic leiomyoma of the uterus presenting as a giant abdominal mass. BMJ Case Rep 2015; 2015:bcr-2015-211929. [PMID: 26351316 DOI: 10.1136/bcr-2015-211929] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We describe a case of a 35-year-old woman with a pedunculated uterine leiomyoma with diffuse hydropic degeneration presenting as a giant abdominal mass. The patient was admitted in the emergency department because of diffuse abdominal bloating and discomfort. Ultrasonography (US) showed a heterogeneous abdominopelvic mass. Magnetic resonance imaging (MRI) was performed to further characterise and revealed a myometrial pedunculated tumour. Despite its marked T2-signal heterogeneity and volume, there were no other suspicious findings to suggest a malignant nature; therefore, fertility-sparing myomectomy was performed. Leiomyomas frequently undergo degenerative changes altering their imaging appearances. Leiomyomas with uncommon degenerative changes may be difficult to differentiate from malignant myometrial tumours, based solely on imaging. To the best of our knowledge, a diffuse hydropic degeneration imaging appearance has only been described twice in the literature. We describe the imaging appearance of this rare form of leiomyoma drawing attention to its differential diagnosis.
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Affiliation(s)
- Mariana Horta
- Department of Radiology, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Teresa Margarida Cunha
- Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Rita Oliveira
- Department of Pathology, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Paula Magro
- Department of Surgery, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
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Gynecologic Cancer InterGroup (GCIG) consensus review: uterine and ovarian leiomyosarcomas. Int J Gynecol Cancer 2015; 24:S61-6. [PMID: 25341583 DOI: 10.1097/igc.0000000000000261] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES The Gynecologic Cancer InterGroup aimed to provide an overview of uterine and ovarian leiomyosarcoma management. METHODS Published articles and author experience were used to draft management overview. The draft manuscript was circulated to international members of the Gynecologic Cancer InterGroup for review and comment, and appropriate revisions were made. RESULTS The approach to management of uterine and ovarian leiomyosarcoma management is reviewed. CONCLUSIONS Uterine and ovarian leiomyosarcomas are rare and aggressive cancers that require specialized expertise for optimal management.
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Chen I, Hopkins L, Firth B, Boucher J, Singh SS. Incidence of Tissue Morcellation During Surgery for Uterine Sarcoma at a Canadian Academic Centre. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015; 37:421-425. [DOI: 10.1016/s1701-2163(15)30256-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Stoelinga B, Huirne J, Heymans MW, Reekers JA, Ankum WM, Hehenkamp WJ. The estimated volume of the fibroid uterus: a comparison of ultrasound and bimanual examination versus volume at MRI or hysterectomy. Eur J Obstet Gynecol Reprod Biol 2015; 184:89-96. [DOI: 10.1016/j.ejogrb.2014.11.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 10/29/2014] [Accepted: 11/11/2014] [Indexed: 11/15/2022]
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Incidental gynecologic neoplasms in morcellated uterine specimens: a case series with follow-up. Hum Pathol 2014; 45:2311-7. [DOI: 10.1016/j.humpath.2014.07.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 06/30/2014] [Accepted: 07/09/2014] [Indexed: 11/22/2022]
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Sudderuddin S, Helbren E, Telesca M, Williamson R, Rockall A. MRI appearances of benign uterine disease. Clin Radiol 2014; 69:1095-104. [PMID: 25017452 DOI: 10.1016/j.crad.2014.05.108] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 05/23/2014] [Indexed: 10/25/2022]
Abstract
Benign uterine disease is a common entity affecting women of all ages. Ultrasound has historically been the predominant imaging method used in the evaluation of benign gynaecological disease, magnetic resonance imaging (MRI) being reserved for use in the staging of malignant uterine and cervical disease. MRI is now increasingly used in the diagnosis of benign uterine disease as well as a tool for problem-solving in cases of diagnostic dilemma. It allows detailed assessment of benign conditions, such as endometrial lesions, leiomyomas, and adenomyosis, and can be helpful in the stratification of patients to different treatment modalities, including surgical resection, uterine artery embolization, and medical therapies. In this article, we review the MRI findings in the common benign uterine diseases.
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Affiliation(s)
- S Sudderuddin
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK.
| | - E Helbren
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - M Telesca
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - R Williamson
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - A Rockall
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
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