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.
Highlights
Uterine leiomyomas, more commonly known as fibroids, are benign smooth muscle tumours of the uterus, which may cause pressure, heavy menstrual bleeding, pelvic pain, or be asymptomatic [1].Usually identified in women of reproductive age, leiomyomas are common, with a reported prevalence ranging from 25 to 77% [2], and their incidence increases with advancing age [3]
The main aim of this study was to evaluate the clinical predictive value of routinely and universally available preoperative variables to differentiate between malignant uterine LMS and benign leiomyomas in a cohort of women undergoing hysterectomy for symptomatic leiomyoma, and we subsequently identified 7 preoperative variables which can be used to stratify their risk of a diagnosis of malignant
2019 (n = 31), and group 2 consisted of all consecutive women who underwent hysterectomy due to symptomatic leiomyoma, confirmed on histology, over a 12 month period from January to December in 2016 (n = 159)
Summary
More commonly known as fibroids, are benign smooth muscle tumours of the uterus, which may cause pressure, heavy menstrual bleeding, pelvic pain, or be asymptomatic [1]. Identified in women of reproductive age, leiomyomas are common, with a reported prevalence ranging from 25 to 77% [2], and their incidence increases with advancing age [3]. A rare uterine malignancy, uterine leiomyosarcoma (LMS) shares many common features with benign uterine leiomyomas. LMS accounts for approximately 1–2% of uterine malignancies with a prevalence of. 0.64 per 100,000 women [4]. The incidence of LMS in women undergoing a hysterectomy for suspected leiomyoma is much higher, at 1 per 1000 [5]. LMS occurs more frequently in postmenopausal women, in premenopausal women, key LMS-associated symptoms include vaginal
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