Ceska Gynekol. 2024;89(4):319-328. doi: 10.48095/cccg2024319.
The narrative review article is focused on the strengths and limitations of modern imaging methods in the preoperative differential diagnosis of uterine mesenchymal tumours. In order to tailor the surgical procedures, imaging methods, namely ultrasound and magnetic resonance imaging (MRI), should be taken into account as well as clinical symptoms, age, and fertility plans. On ultrasound scans, uterine sarcomas have the appearance of large, usually solitary tumours of non-homogenous structure with irregular cysts, ill-defined outline borders (interrupted capsule), absence of calcifications with acoustic shadowing, and moderate to rich internal vascularisation. Rapid growth between follow-ups or atypical growth in peri- or post-menopause is also a sign of malignancy. On MRI, uterine sarcomas are characterized by irregular borders, hyperintense areas on T1-weighted and T2- weighted images, and central non-enhancing necrotic areas. On diffusion-weighted imaging (DWI/MRI), sarcomas exhibit markedly restricted diffusion but there is a significant overlap with some variants of fibroids. Core-needle or hysteroscopic biopsy can be used preoperatively if suspicious features are detected on ultrasound or MRI scans, particularly before myomectomy if fertility preservation is required or when conservative management is considered in asymptomatic women. Other imaging methods, such as positron emission tomography fused with CT (PET-CT) or computed tomography (CT) have limited role to distinguish uterine sarcomas from myomas and are suitable only for staging purposes. The importance of tumour markers including lactate dehydrogenase in preoperative work-up have not been verified yet. Conclusion: Uterine sarcomas can be distinguished from much more common myomas based on a combination of malignant features on ultrasound or MR imaging. In these suspicious cases the type and extent of surgery should be adjusted, avoiding intraperitoneal morcellation, which could lead to iatrogenic tumour spread and worsening of the patient's prognosis.
这篇叙述性综述文章聚焦于现代影像学方法在子宫间质性肿瘤术前鉴别诊断中的优势和局限性。为了定制手术方案，除了临床症状、年龄和生育计划外，还应考虑影像学方法，如超声和磁共振成像（MRI）。在超声检查中，子宫肉瘤表现为大的、通常是单发的、结构不均匀的肿瘤，有不规则的囊肿，边界轮廓不清（包膜中断），无钙化伴声影，中等至丰富的内部血管化。随访期间快速生长或绝经前后生长不典型也是恶性的标志。在 MRI 上，子宫肉瘤的特点是边界不规则，T1 加权和 T2 加权图像上呈高信号区，以及中央无强化的坏死区。在弥散加权成像（DWI/MRI）上，肉瘤表现为明显受限的弥散，但与一些纤维瘤变异有很大的重叠。如果在超声或 MRI 扫描中发现可疑特征，特别是在需要保留生育能力或在无症状妇女中考虑保守治疗时，在肌瘤切除术前可以进行核心针或宫腔镜活检。其他影像学方法，如正电子发射断层扫描与 CT（PET-CT）或 CT 融合，在区分子宫肉瘤与肌瘤方面作用有限，仅适用于分期目的。肿瘤标志物，包括乳酸脱氢酶在术前检查中的重要性尚未得到证实。结论：基于超声或 MR 成像上的恶性特征，可以将子宫肉瘤与更常见的肌瘤区分开来。在这些可疑病例中，应调整手术类型和范围，避免腹腔内分碎，这可能导致医源性肿瘤扩散和患者预后恶化。
