Ultrasound-Guided Trans-Uterine Cavity Core Needle Biopsy of Uterine Myometrial Tumors to Differentiate Sarcoma from a Benign Lesion—Description of the Method and Review of the Literature

Abstract

Uterine sarcomas are rare, aggressive tumors with poor prognosis that can be further negatively affected by inadequate surgical approaches such as morcellation. There are no clinical and radiologic criteria for differentiating leiomyoma from malignant uterine tumors. However, some ultrasonography and magnetic resonance imaging findings may be informative. We present a technique of ultrasound-guided trans-uterine cavity (UG-TUC) core needle biopsy for uterine lesions. As the procedure is an in-organ biopsy, there is no risk of needle canal contamination. The technique also enables the biopsy of lesions inaccessible by the transvaginal tru-cut biopsy. The core needle of the automatic biopsy system is inserted via the cervical canal into the uterine cavity and is directed and activated at the myometrial lesion under ultrasound control. The standard local treatment of localized uterine sarcomas is en bloc total hysterectomy; for fibroids, there are multiple options including conservative management or tumorectomy and tumor morcellation using minimally invasive techniques. Fragmentation of the sarcoma significantly worsens oncologic outcomes and should therefore be avoided. The UG-TUC core needle biopsy of uterine lesions can complement imaging to obtain sufficient material for histologic and molecular analyses of suspected or undetermined lesions, thus facilitating treatment planning and decreasing the risk of unsuspected sarcomas.

Genomic profile analysis of leiomyomas with bizarre nuclei and fumarate hydratase deficient leiomyomas: Strengths, weaknesses, and limitations of array‐CGH interpretation

“…A close relationship has been demonstrated between genomic complexity (assessed by GI) and clinical outcome in smooth muscle tumors with conventional (spindle cell) morphology. 12,13,19 Therefore, Array- been confirmed by recent meta-analysis encompassing 12 studies and 433 patients resulting in a 1.9% risk of recurrence. 18 Hence, they represent challenging differential diagnoses in GYN smooth muscle tumors.…”

“…Those features, whilst being suggestive, are often times not sufficient for diagnosis, and the use of FH and 2SC immunohistochemistry is advised to confirm diagnosis of FHLM 12 . FH deficiency's features can appear worrisome and lead to the diagnosis of smooth muscle tumor of uncertain malignant potential (STUMP) 13 . However, FHLM shows benign clinical course, In rare cases altered FH allele is inherited in an autosomal dominant manner defining Reed's syndrome, also called Hereditary Leiomyomatosis and Renal Cell Carcinoma.…”

“…Based on the observation that genomic complexity correlates with risk of recurrence in a large series of uterine smooth muscle tumors encompassing LM, STUMP, and LMS, [14][15][16] and on the evolution of clinical practice toward feasibility of microbiopsy and preoperative diagnosis of uterine tumor to tailor surgical strategy, 13 we wanted to explore the genomic landscape of those subtypes of LM, that were not included in our previous analyses. The goal of this study is to assess the relevance of Genomic Index in this context of morphologically challenging subtypes of LM encompassing the morphological spectrum of FHLM and LMBN.…”

“…12 FH deficiency's features can appear worrisome and lead to the diagnosis of smooth muscle tumor of uncertain malignant potential (STUMP). 13 However, FHLM shows benign clinical course, In rare cases altered FH allele is inherited in an autosomal dominant manner defining Reed's syndrome, also called Hereditary Leiomyomatosis and Renal Cell Carcinoma.…”

Sonographic and Magnetic Resonance Characteristics of Gynecological Sarcoma

“…As it requires an invasive procedure and an experienced examiner, the core-needle biopsy is currently not part of the guidelines of the preoperative workup. The overall diagnostic accuracy is described between 93% and 98%, although data on patients with sarcoma is very rare [ 19 ].…”