Camponovo Carolina, Neumann Stephanie, Zosso Livia, Mueller Michael D, Raio Luigi
Department of Obstetrics and Gynecology, University Hospital Insel, University of Bern, 3010 Bern, Switzerland.
Faculty of Medicine, University of Bern, 3012 Bern, Switzerland.
Diagnostics (Basel). 2023 Mar 23;13(7):1223. doi: 10.3390/diagnostics13071223.
Gynecological sarcomas are rare malignant tumors with an incidence of 1.5-3/100,000 and are 3-9% of all malignant uterine tumors. The preoperative differentiation between sarcoma and myoma becomes increasingly important with the development of minimally invasive treatments for myomas, as this means undertreatment for sarcoma. There are currently no reliable laboratory tests or imaging-characteristics to detect sarcomas. The objective of this article is to gain an overview of sarcoma US/MRI characteristics and assess their accuracy for preoperative diagnosis.
A systematic literature review was performed and 12 studies on ultrasound and 21 studies on MRI were included.
For the ultrasound, these key features were gathered: solid tumor > 8 cm, unsharp borders, heterogeneous echogenicity, no acoustic shadowing, rich vascularization, and cystic changes within. For the MRI, these key features were gathered: irregular borders; heterogeneous; high signal on T2WI intensity; and hemorrhagic and necrotic changes, with central non-enhancement, hyperintensity on DWI, and low values for ADC.
These features are supported by the current literature. In retrospective analyses, the ultrasound did not show a sufficient accuracy for diagnosing sarcoma preoperatively and could also not differentiate between the different subtypes. The MRI showed mixed results: various studies achieved high sensitivities in their analysis, when combining multiple characteristics. Overall, these findings need further verification in prospective studies with larger study populations.
妇科肉瘤是罕见的恶性肿瘤，发病率为1.5 - 3/10万，占所有子宫恶性肿瘤的3 - 9%。随着子宫肌瘤微创治疗的发展，术前鉴别肉瘤和肌瘤变得越来越重要，因为这可能意味着对肉瘤治疗不足。目前尚无可靠的实验室检查或影像学特征来检测肉瘤。本文的目的是概述肉瘤的超声/磁共振成像（MRI）特征，并评估其术前诊断的准确性。
进行了一项系统的文献综述，纳入了12项关于超声的研究和21项关于MRI的研究。
对于超声，收集到的关键特征包括：实性肿瘤>8 cm、边界不清、回声不均匀、无声影、血管丰富以及内部有囊性改变。对于MRI，收集到的关键特征包括：边界不规则；不均匀；T2加权像（T2WI）上信号高；有出血和坏死改变，中心无强化，扩散加权成像（DWI）上呈高信号，表观扩散系数（ADC）值低。
这些特征得到了当前文献的支持。在回顾性分析中，超声术前诊断肉瘤的准确性不足，也无法区分不同亚型。MRI的结果不一：多项研究在综合多个特征进行分析时获得了较高的敏感性。总体而言，这些发现需要在更大样本量的前瞻性研究中进一步验证。
