Diagnostic Algorithm to Differentiate Benign Atypical Leiomyomas from                    Malignant Uterine Sarcomas with Diffusion-weighted MRI

Wahab, Cendos Abdel; Jannot, Anne‐Sophie; Bonaffini, Pietro Andrea; Bourillon, Camille; Cornou, Caroline; Lefrère-Belda, Marie-Aude; Bats, Anne-Sophie; Thomassin‐Naggara, Isabelle; Bellucci, Ângela Delete; Reinhold, Caroline; Fournier, Laure

doi:10.1148/radiol.2020191658

Cited by 64 publications

(40 citation statements)

References 21 publications

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“…Preservation of fertility is often preferred in premenopausal women, and conservative surgical treatment such as myomectomy for leiomyomas may be offered, which is the case of our patient who presented to the clinic with fertility wishes [ 1 ]. Our patient manifested irregular menstrual cycles and lower abdominal pain during examination associated with infertility.…”

Section: Discussionmentioning

confidence: 99%

“…Leiomyoma tissue is poorly vascularized, containing smooth muscle fiber bundles and extracellular matrix material (ECM) composed of collagen, fibronectin, laminin, and proteoglycans [ 2 ]. Although this patient’s MRI with IV contrast reported a para uterine tumor highly vascularized, it is noteworthy that perfusion images do not distinguish between atypical leiomyomas and sarcomas, since even benign leiomyomas could be highly vascular [ 1 ]. In contrast, color Doppler US helps distinguish focal adenomyosis from leiomyomas, which tend to displace vessels and show circumferential flow, the usual pattern observed in this case [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…Uterine fibroid is a frequent benign tumor condition of the uterus, which is found in 70-80% of women above 50 years of age [ 1 ]. The causes and pathogenetic mechanisms of the development of leiomyomas are not fully understood.…”

Section: Introductionmentioning

confidence: 99%

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Highly Cellular Leiomyoma Mixed With a Focus of Adenomyosis

Nava¹

2022

Cureus

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The purpose of this case presentation was to highlight the importance of an adequate evaluation of images when suspicious of atypical leiomyoma and the importance of performing an extemporaneous biopsy during surgery to ensure the lesion is a benign muscular cell tumor. Here, we present a case of a 34-year-old nulliparous woman who presented with a history of infertility and irregular menstrual cycles. A highly vascularized pelvic mass was visualized by Doppler ultrasound and a contrast MRI suggestive of uterine fibroid. Intraoperatively, the lesion was found adjacent to the uterus, with a second lesion deeper into the myometrium. The pathology reported a highly cellular leiomyoma with a focus of adenomyosis. Both lesions were extirpated without complications. The patient recuperated favorably within three months of follow-up. This case shows an example of a variety of the typical histology that can be found in uterine fibroids. Although the management of atypical leiomyomas could vary in different scenarios, conservative treatment is recommended if fertility wishes are present. In all cases, it is mandatory to exclude any possibilities of malignancy, like sarcoma, which would completely change the intraoperative management.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Highly Cellular Leiomyoma Mixed With a Focus of Adenomyosis

Nava¹

2022

Cureus

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“…Given the overlap of MRI imaging features of leiomyosarcoma and fibroids, a combination of conventional and DWI imaging features are to be particularly useful to avoid overlooking the malignant sarcomas for benign fibroids, and DWI improves accuracy of MRI to 92% [ 12 , 13 ]. MRI algorithm has been proposed using high DWI signal as compared to endometrium, low ADC values, and lymphadenopathy, and was found to be useful for differentiating leiomyosarcoma and uterine fibroids [ 14 ].…”

Section: Clinical Applications In Gynecological Non-malignant Conditionsmentioning

confidence: 99%

Utility of the Diffusion Weighted Sequence in Gynecological Imaging: Review Article

Bonde

Lago

Foster

et al. 2022

Cancers

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Functional imaging with diffusion-weighted imaging (DWI) is a complementary tool to conventional diagnostic magnetic resonance imaging sequences. It is being increasingly investigated to predict tumor response and assess tumor recurrence. We elucidate the specific technical modifications of DWI preferred for gynecological imaging, including the different b-values and planes for image acquisition. Additionally, we discuss the problems and potential pitfalls encountered during DWI interpretation and ways to overcome them. DWI has a wide range of clinical applications in malignant and non-malignant gynecological conditions. It provides supplemental information helpful in diagnosing and managing tubo-ovarian abscess, uterine fibroids, endometriosis, adnexal torsion, and dermoid. Similarly, DWI has diverse applications in gynecological oncology in diagnosis, staging, detection of recurrent disease, and tumor response assessment. Quantitative evaluation with apparent diffusion coefficient (ADC) measurement is being increasingly evaluated for correlation with various tumor parameters in managing gynecological malignancies aiding in preoperative treatment planning. Newer advanced DWI techniques of diffusion tensor imaging (DTI) and whole body DWI with background suppression (DWIBS) and their potential uses in pelvic nerve mapping, preoperative planning, and fertility-preserving surgeries are briefly discussed.

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“…7,8 Conventional MRI sequences combined with advanced techniques, such as diffusion-weighted images (DWI) and apparent diffusion coefficient (ADC) calculation, may also help in the differential diagnosis with malignant tumors, such as leiomyosarcoma. 9-12 In addition, adequate characterization of fibroid volume and location is relevant to and influences therapeutic planning. The classification system suggested by Munro et al 13 and adopted by the International Federation of Gynecology and Obstetrics (FIGO) aims at assisting this assessment.…”

Section: Introductionmentioning

confidence: 99%

Reproducibility of MRI Features of Uterine Leiomyomas: A Study on Interobserver Agreement and Inter-Method Agreement With Surgery

et al. 2021

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Purpose: To evaluate interobserver agreement in the interpretation of different MRI features of uterine leiomyomas (UL) according to observers’ experience, and to assess the inter-method reproducibility (MRI versus surgery) regarding the International Federation of Gynecology and Obstetrics (FIGO) classification. Methods: Retrospective study including UL patients who underwent MRI and surgical treatment. Four blinded observers (2 vs >10 years of experience) assessed UL regarding dimensions and volume; inner and outer mantles; FIGO classification; vascularization; degeneration; and diffusion-weighted imaging features. Uterine dimensions and volume were calculated. FIGO classification as ascertained by observers was compared to surgical findings. Intraclass correlation coefficient (ICC) estimates were used for interobserver comparison of numerical variables, and kappa statistic for categorical variables. Results: Thirty-five patients (26y-73y) with 61 UL were included in the interobserver analyses, and 31 patients (54 UL) had available data allowing retrospective surgical FIGO classification for assessment of inter-method reproducibility. Both groups of observers had good to excellent agreement in assessing UL (ICC = 0.980-0.994) and uterine volumes (ICC = 0.857-0.914), mantles measurement (ICC = 0.797-0.920), and apparent diffusion coefficient calculation (ICC = 0.787-0.883). There was substantial agreement for both groups regarding FIGO classification (κ = 0.645-0.767). Vascularization, degeneration and restricted diffusion had lower agreement, varying from reasonable to moderate. Inter-method agreement was reasonable (κ = 0.341-0.395). Conclusions: Interobserver agreement of MRI for UL was higher for quantitative than qualitative features, with a little impact of observers’ experience for most features. MRI agreement with surgery was reasonable. Further efforts should be taken to improve interobserver and inter-method reproducibility for MRI in this scenario.

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Diagnostic Algorithm to Differentiate Benign Atypical Leiomyomas from Malignant Uterine Sarcomas with Diffusion-weighted MRI

Cited by 64 publications

References 21 publications

Highly Cellular Leiomyoma Mixed With a Focus of Adenomyosis

Highly Cellular Leiomyoma Mixed With a Focus of Adenomyosis

Utility of the Diffusion Weighted Sequence in Gynecological Imaging: Review Article

Reproducibility of MRI Features of Uterine Leiomyomas: A Study on Interobserver Agreement and Inter-Method Agreement With Surgery

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