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2022-RA-779-ESGO How frequently benign uterine myomas appear as suspicious sarcomas on ultrasound examination
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  1. Nabil Manzour1,
  2. Stefano Guerriero2,
  3. Nieves Cabezas3,
  4. Patricia Diaz4,
  5. Ana Lopez-Pincazo1,
  6. Ana Redondo3,
  7. Serena Springer5,
  8. Mariachiara Pagliuca2,
  9. Maria Angela Pazcual6,
  10. Enrique Chacon7,
  11. Felix Boria8,
  12. Jose Angel Minguez1,
  13. Teresa Castellanos8,
  14. Daniel Vazquez8,
  15. Julio Vara1,
  16. Isabel Brotons1,
  17. Juan Gonzalez de Canales1,
  18. Luis Chiva8 and
  19. Juan Luis Alcazar1
  1. 1Gynecology, Clinica Universidad de Navarra, Pamplona, Spain
  2. 2University of Cagliari, Cagliari, Italy
  3. 3Hospital Universitario Virgen Macarena, Sevilla, Spain
  4. 4Fundación Hospital Calahorra, Calahorra, Spain
  5. 5Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
  6. 6Institut Universitari Dexeus, Barcelona, Spain
  7. 7Gynecology, Clinca Universidad de Navarra, Pamplona, Spain
  8. 8Gynecology, Clinica Universidad de Navarra, Madrid, Spain

Abstract

Introduction/Background To determine the percentage of benign myomas that appear as suspicious for uterine sarcoma on ultrasound examination

Methodology 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. Suspicion of sarcoma was established when three or more sonographic features described by Ludovisi et al as frequently present in uterine sarcoma were present. These features were no myometrium visible, irregular cystic areas, non-uniform echogenicity, irregular contour, cooked appearance and color score 3–4. In addition, the examiners had to classify the lesion as suspicious by her/his impression, independently of the number of features present.

Results 651 women were included. Median maximum diameter of the myomas was 48 mm (range: 10- 263 mm). 266 (41%) of the patients had more than one myoma. Using the criterion of > 3 suspicious features, 24 (3.7%) of the myomas had suspicious appearance. If we had used a criterion of > 2 features, this figure increased to 62 (9.5%) cases. By subjective impression, the examiners considered as suspicious 35 (5.4%) cases (18 cases had > 3 suspicious features and 29 cases had > 2 suspicious features)

Conclusion About 4–10% of benign uterine myomas may exhibit sonographic suspicion of sarcoma. This figure is not negligible.

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