Cabezas Nieves, López-Picazo Ana, Diaz Patricia, Valero Beatriz, Rodriguez María José, Redondo Ana, Díaz-de la Noval Begoña, Pascual Maria Angela, Ajossa Silvia, Guerriero Stefano, Alcázar Juan Luis
Department of Obstetrics and Gynecology, University Hospital Virgen Macarena, 41009 Seville, Spain.
Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, 31008 Pamplona, Spain.
Diagnostics (Basel). 2023 Jan 30;13(3):501. doi: 10.3390/diagnostics13030501.
Uterine myomas may resemble uterine sarcomas in some cases. However, the rate of benign myomas appearing as sarcomas at an ultrasound examination is not known. The objective of this study is to determine the percentage of benign myomas that appear suspicious for uterine sarcoma on ultrasound examination. This is a prospective observational multicenter study (June 2019-December 2021) comprising a consecutive series of patients with histologically proven uterine myoma after hysterectomy or myomectomy who underwent transvaginal and/or transabdominal ultrasound prior to surgery. All ultrasound examinations were performed by expert examiners. MUSA criteria were used to describe the lesions (1). Suspicion of sarcoma was established when three or more sonographic features, described by Ludovisi et al. as "frequently seen in uterine sarcoma", were present (2). These features are no visible myometrium, irregular cystic areas, non-uniform echogenicity, irregular contour, "cooked" appearance, and a Doppler color score of 3-4. In addition, the examiners had to classify the lesion as suspicious based on her/his impression, independent of the number of features present. Eight hundred and ten women were included. The median maximum diameter of the myomas was 58.7 mm (range: 10.0-263.0 mm). Three hundred and forty-nine (43.1%) of the patients had more than one myoma. Using the criterion of >3 suspicious features, 40 (4.9%) of the myomas had suspicious appearance. By subjective impression, the examiners considered 40 (4.9%) cases suspicious. The cases were not exactly the same. We conclude that approximately 5% of benign uterine myomas may exhibit sonographic suspicion of sarcoma. Although it is a small percentage, it is not negligible.
子宫肌瘤在某些情况下可能类似于子宫肉瘤。然而，超声检查时良性肌瘤表现为肉瘤的发生率尚不清楚。本研究的目的是确定在超声检查中表现出子宫肉瘤可疑特征的良性肌瘤的百分比。这是一项前瞻性观察性多中心研究（2019年6月至2021年12月），纳入了一系列在子宫切除或肌瘤切除术后经组织学证实为子宫肌瘤的患者，这些患者在手术前接受了经阴道和/或经腹超声检查。所有超声检查均由专业检查人员进行。采用MUSA标准描述病变（1）。当出现三个或更多Ludovisi等人描述为“子宫肉瘤中常见”的超声特征时，判定为可疑肉瘤（2）。这些特征包括无可见肌层、不规则囊性区域、不均匀回声、不规则轮廓、“煮熟”样外观以及多普勒彩色评分3 - 4。此外，检查人员必须根据自己的判断将病变分类为可疑，而不考虑出现的特征数量。共纳入810名女性。肌瘤的最大直径中位数为58.7 mm（范围：10.0 - 263.0 mm）。349名（43.1%）患者有不止一个肌瘤。采用>3个可疑特征的标准，40个（4.9%）肌瘤有可疑表现。根据主观判断，检查人员认为40例（4.9%）可疑。这些病例并不完全相同。我们得出结论，约5%的良性子宫肌瘤可能在超声检查中表现出肉瘤可疑特征。虽然这一比例较小，但并非可以忽略不计。
