Benign uterine mass—discrimination from leiomyosarcoma by a preoperative risk score: a multicenter cohort study

Köhler, Günter; Vollmer, Marcus; Nath, Neetika; Hessler, PA; Dennis, Katarina; Lehr, A.; Köller, M.; Riechmann, C; Bralo, Helena; Trojnarska, Dominika; Lehnhoff, H; Krichbaum, Johann; Krichbaum, Manfred; Evert, Katja; Evert, Matthias; Zygmunt, Marek; Kaderali, Lars

doi:10.1007/s00404-019-05344-0

Cited by 23 publications

(28 citation statements)

References 33 publications

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“…Clinical presentations of, for example, abnormal uterine bleeding, abdominal pain, and rapid tumor growth, encourage suspicions of LMS, but these manifestations can also occur in patients with LM. A preoperative LMS risk scoring system based on sonography findings and basic clinical characteristics has been reported, 15 and the authors recommended the adoption of stepwise diagnostic procedures, such as endometrial biopsy, serum LDH, Doppler sonography, or MRI in patients at perceived risk of LMS.…”

Section: Discussionmentioning

confidence: 99%

“…4 This enzyme is involved in the metabolism of cancer cells and causes these cells to suppress and evade the immune system by altering tumor microenvironments. 26 Although studies have reported significant differences between LDH levels in LM and LMS patients, 4,15,21 the cutoff values used varied and no LDH value has been defined for LMS. In these studies, LDH levels of level ≥ 193 U/L, > 279 U/L, and ≥ 300 U/L were reported to independently predict the presence of uterine sarcoma preoperatively.…”

Section: Discussionmentioning

confidence: 99%

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Preoperative Blood Inflammatory Markers for the Differentiation of Uterine Leiomyosarcoma from Leiomyoma

Suh

Song

Roh

et al. 2021

CMAR

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Preoperative diagnosis of uterine leiomyosarcoma (LMS) is challenging because the disease can mimic benign leiomyoma (LM). The objective of the present study was to investigate the role of preoperative clinical characteristics and hematologic parameters to differentiate uterine LMS and LM. Methods: Preoperative clinical and laboratory variables were reviewed retrospectively in patients with LMS or LM, and the significances of intergroup differences were assessed. Receiver operating characteristic (ROC) curves were used to determine optimal cut-off values for each variable. Logistic regression analysis was applied to identify variables predicting the presence of LMS. Results: The preoperative clinical and laboratory variables of 336 patients with uterine tumor were analyzed. Seventy-nine patients had LMS and 257 had LM. A significant difference was observed between LMS and LM in terms of the median value of age at diagnosis, menopausal status, white blood cell (WBC) count, absolute neutrophil count (ANC), C-reactive protein (CRP), lactate dehydrogenase (LDH), and neutrophil-tolymphocyte ratio (NLR) (all P < 0.001). Multivariate analyses showed that menopausal status (odds ratio [OR] = 3.40, P= 0.002), WBC count (OR = 2.09, P = 0.012), ANC (OR = 3.17, P < 0.001), CRP (OR = 21.74, P < 0.001), LDH (OR = 10.77, P < 0.001), and NLR (OR = 2.58, P = 0.001) predicted the presence of LMS. Conclusion:Our results suggest that in older or postmenopausal patients, high WBC count, ANC, CRP, LDH, and NLR could be useful biomarkers for the differentiation of LMS and LM, which indicate that serum markers might be useful, cost-effective, and broadly available diagnostic markers for uterine LMS.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Preoperative Blood Inflammatory Markers for the Differentiation of Uterine Leiomyosarcoma from Leiomyoma

Suh

Song

Roh

et al. 2021

CMAR

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“…Concerns about occult sarcomas have changed practice in recent years, and although improved imaging techniques for distinguishing them from noncancers are emerging, they remain limited in diagnostic scope, [11,12] and predictive modeling has not yet been sufficiently successful [13]. However, other pathologies may also be present in presumed benign disease [14−18].…”

Section: Discussionmentioning

confidence: 99%

Incidence of Gynecologic Cancers in Women after Uterine Artery Embolization

Bronico¹,

Matthews²,

Perkins³

et al. 2021

Journal of Minimally Invasive Gynecology

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Study Objective: To characterize the short-term incidence of gynecologic cancer after undergoing uterine artery embolization (UAE). Design: Retrospective cohort study. Setting: Commercial insurance claims database. Patients: Total of 15 393 United States women aged 18 to 64 years who underwent UAE between 2007 and 2017.Interventions: We used the IBM MarketScan (Armonk, NY) claims to identify adult women without previous gynecologic cancer diagnoses undergoing UAE between 2007 and 2017. Database queries identified women with any diagnostic or procedure codes related to gynecologic malignancies occurring in the first 3 years after UAE. A malignancy diagnosis was suggested by recurrent malignancy-related claims not linked exclusively to diagnostic testing (e.g., transvaginal ultrasound) and malignancy codes linked to tissue pathology claims. Incidence of malignancy diagnosis was calculated. Rates of endometrial sampling in the year before UAE were identified. Measurements and Main Results: Thirty-one women undergoing UAE had gynecologic cancer diagnoses within 3 years of the procedure (22 of 31, 71% uterine cancers; 7 of 31, 23% ovarian cancers; and 2 of 31, 6% cervical cancers). On average, cancer diagnoses were made 1.1 § 0.9 years after UAE. One in 497 women undergoing UAE was diagnosed with a gynecologic malignancy within 3 years, with an incidence of 1.1 malignancies per 1000 person-years. Cancer incidence increased with age at the time of UAE: short-term malignancy diagnoses were made in 1 in 377 women aged 45 to 54 years, and 1 in 79 women aged 55 to 64 years. In the year before UAE, 28% (4311 of 15 362) of women without cancer, and 23% (5 of 22) of women diagnosed with uterine cancer had preprocedural endometrial sampling. Conclusion: These data can inform risk/benefit counseling and shared decision-making regarding UAE and its alternatives. Short-term malignancies after UAE highlight the importance of preprocedure evaluation in symptomatic women and women with age-related risk.

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“…In summary, LMS may present typical vascularization features that are not specific enough when considered alone for the differential diagnosis with benign conditions. Doppler findings should be evaluated in conjunction with other ultrasound features (tumor dimension, inhomogeneous echogenicity, internal irregular cystic areas, absence of shadows, and absence of calcifications (Ludovisi et al, 2019), symptoms (abnormal uterine bleeding), and laboratory exams (neutrophilto-lymphocyte ratio), number of platelets, and LDH (Kohler et al, 2019;Zhang et al, 2020).…”

Section: Differential Diagnosismentioning

confidence: 99%

Uterine fibroid vascularization: from morphological evidence to clinical implications

Ciarmela

Carpini

Greco

et al. 2022

Reproductive BioMedicine Online

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Uterine fibroids are the most common cause of solid pelvic tumors, occurring in 20-30% of fertile women and presenting clinical complications that seriously impact women's health. They commonly cause severe symptoms such as heavy, prolonged menstrual bleeding and anaemia.The study of both microscopic and macroscopic vascular aspects of uterine fibroids is of crucial importance to understand the clinical manifestations of uterine fibroids, to predict the effectiveness of alternative therapies to surgery (such as uterine artery embolization), to improve surgery outcomes, to perform a differential diagnosis with other benign conditions (e.g., adenomyosis) or malignancy (e.g., leiomyosarcoma), and to develop new therapeutic approaches.We conducted this review to explore the current knowledge about how the vascular network and the angiogenesis are implied in the formation of uterine fibroids, in the pathogenesis of the related symptoms, and to summarize the evidence about the role of ultrasound in evaluating fibroids vascularization. This review combines anatomic, morphological, and biomolecular information related to angiogenic mechanisms with diagnostic and clinical information, highlighting the various interconnections.Uterine and fibroid vascularization are crucial aspects that need to be further investigated to deeply understand the pathogenetic elements that bring the formation of the uterine fibroids and their clinical manifestations.

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Benign uterine mass—discrimination from leiomyosarcoma by a preoperative risk score: a multicenter cohort study

Cited by 23 publications

References 33 publications

Preoperative Blood Inflammatory Markers for the Differentiation of Uterine Leiomyosarcoma from Leiomyoma

Preoperative Blood Inflammatory Markers for the Differentiation of Uterine Leiomyosarcoma from Leiomyoma

Incidence of Gynecologic Cancers in Women after Uterine Artery Embolization

Uterine fibroid vascularization: from morphological evidence to clinical implications

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