Yamanishi Yukio, Kotani Yasushi, Kido Aki, Otani Tomoyuki, Himoto Yuki, Kurata Yasuhisa, Murakami Kosuke, Takaya Hisamitsu, Sumitomo Masahiro, Emoto Ikuko, Matsubara Motonori, Horikawa Naoki, Akagi Kana, Ishida Kentaro, Takaori Aya, Sakurai Azusa, Abiko Kaoru, Yamanoi Koji, Mandai Masaki, Matsumura Noriomi
Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan.
Department of Radiology, University of Toyama, Toyama, Japan.
J Gynecol Oncol. 2025 Jul;36(4):e58. doi: 10.3802/jgo.2025.36.e58. Epub 2025 Apr 4.
In the differential diagnosis between uterine fibroids and uterine sarcomas, real-world magnetic resonance imaging (MRI) diagnostic information is scarce; furthermore, high diagnostic sensitivity is important in clinical practice. We previously developed a diagnostic algorithm to detect uterine sarcoma with high sensitivity using simple MRI images and serum lactate dehydrogenase (LDH) levels. In this multicenter study, we investigated the preoperative diagnosis of sarcoma in the real world and further validated the usefulness of our diagnostic algorithm.
Of 154 uterine sarcomas and 154 uterine fibroids treated at 15 centers between January 2006 and December 2020, 139 sarcomas (16 smooth muscle tumors of uncertain malignant potential) and 141 fibroids with diffusion-weighted imaging information were included in the analysis. The diagnostic algorithm was validated by 3 radiologists who were blinded to the clinical information and pathologic diagnoses and who read the MRIs.
The sensitivity/specificity of preoperative diagnosis was 77.7%/92.9% for the preoperative report; 92.1%/72.3% for algorithm A; and 82.0%/85.8% for algorithm B (McNemar's test p<0.05). Comparison of overall survival rates among 3 groups (Group 1: negative A, Group 2: positive A and negative B; Group 3: positive B) using algorithms A and B showed p=0.012. On multivariate analysis, stage, and serum LDH level were independent prognostic factors.
MRI is useful for preoperative diagnosis of uterine sarcoma, and the sarcoma diagnostic algorithm presented in this study is an option for diagnosing sarcoma with greater sensitivity. This information should be shared with patients.
在子宫肌瘤与子宫肉瘤的鉴别诊断中，真实世界的磁共振成像（MRI）诊断信息匮乏；此外，高诊断敏感性在临床实践中至关重要。我们之前开发了一种诊断算法，利用简单的MRI图像和血清乳酸脱氢酶（LDH）水平来高敏感性地检测子宫肉瘤。在这项多中心研究中，我们调查了真实世界中肉瘤的术前诊断情况，并进一步验证了我们诊断算法的有效性。
在2006年1月至2020年12月期间，15个中心治疗的154例子宫肉瘤和154例子宫肌瘤中，分析纳入了139例肉瘤（16例恶性潜能不确定的平滑肌肿瘤）和141例有扩散加权成像信息的肌瘤。由3名对临床信息和病理诊断不知情且阅读MRI的放射科医生对诊断算法进行验证。
术前报告的术前诊断敏感性/特异性为77.7%/92.9%；算法A为92.1%/72.3%；算法B为82.0%/85.8%（McNemar检验p<0.05）。使用算法A和B比较3组（第1组：A为阴性，第2组：A为阳性且B为阴性；第3组：B为阳性）的总生存率显示p=0.012。多因素分析显示，分期和血清LDH水平是独立的预后因素。
MRI对子宫肉瘤的术前诊断有用，本研究中提出的肉瘤诊断算法是一种诊断敏感性更高的肉瘤诊断选择。该信息应与患者共享。
