Sonographic assessment of features suspicious of uterine sarcoma. Evaluation of their use in preoperatvive prediction of malignancy

Introduction In the management of uterine fibroids, morcellation enables a minimal invasive surgery. However, cases of unsuspected uterine sarcomas dissemination have been reported. To evaluate the risk of uterine sarcoma, we assessed sonographic criteria (Leuven Score, LS).

Material and methods We prospectively evaluated patients planned for surgery between 2015-2019-for uterine lesions with following ultrasound criteria: rapid growth in past 3 months, high blood flow, atypical growth, irregular lining, central necrosis and oval solitary lesion.

Results We included 394 patients. In the sarcoma group (25), 19 patients were postmenopausal (76 %) and 6 premenopausal (24 %), while in the myoma group (369), 279 patient were premenopausal (75 %). The LS was negative in 83.2 % of patients with myomas (NPV 98.1 %, PPV 25.3 %, sensitivity 76 %, specificity 84.4 %). The most common sonographic criteria leading to a false positive score was a growth in past 3 months.

Conclusion LS could distinguish between benign uterus myomatosus and sarcoma, with a high probability of benignity if the score is negative. When ≥ 1 criteria is present in postmenopausal women, we do not recommend morcellation. For premenopausal women a score ≥ 3 increases accuracy. We suggest the use of the LS routinely in preoperative triage.

Publication History

Article published online:
07 October 2020