BACKGROUND AND PURPOSE:

• Preoperative diagnosis of leiomyosarcoma (LMS) is difficult, as it often mimics the appearance of benign leiomyomas
  • Endometrial sampling detects epithelial endometrial carcinomas, but the predictive value for leiomyosarcoma (LMS) is unknown
• Kho et al. (Journal of Minimally Invasive Gynecology, 2021) assessed the effectiveness of endometrial sampling for preoperative detection of LMS in women undergoing hysterectomy

METHODS:

• Retrospective cohort study
• Data sources (from 2003 to 2015)
  • New York Statewide Planning and Research Cooperative System (SPARCS)
  • New York State Cancer Registry
• Participants
  • LMS diagnosis
  • Underwent a hysterectomy and a preoperative endometrial sampling within 90 days of surgery
  • Exclusion: Preexisting diagnosis of LMS before the date of endometrial sampling | Had other cancers before the diagnosis of LMS | LMS diagnosed more than 3 months after hysterectomy (and therefore may not have been present at time of endometrial sampling)
• Exposure
  • Endometrial sampling
• Primary outcome
  • Missed LMS diagnosis
• Secondary outcomes
  • Association between missed diagnosis and patient outcomes (e.g., inappropriate surgical approach and survival)

RESULTS:

• 79 patients with LMS
  • Diagnosed preoperatively: 58.2%
  • Diagnosed postoperatively: 41.8%
  • No significant differences in age, race/ethnicity, bleeding symptoms, or comorbidities between above 2 groups
• Endometrial sampling
  • With hysteroscopy: 75.9%
  • Without hysteroscopy: 24.1%
• Endometrial sampling with vs without  hysteroscopy had a higher likelihood of preoperative diagnosis
  • Adjusted risk ratio 3.03 (95% CI, 1.43 to 6.42)
• Patients were less likely to be diagnosed preoperatively if they had
  • Localized stage (vs distant stage)
    • aRR 0.50 (95% CI, 0.28 to 0.89)
  • Tumor size >11 cm (vs <8 cm)
    • aRR 0.54 (95% CI, 0.30 to 0.99)
• Supracervical hysterectomy was only performed on patients with LMS diagnosed postoperatively (P=0.002)
  • Preoperatively diagnosed LMS: 0
  • Postoperatively diagnosed LMS: 21.2%
• All patients diagnosed preoperatively had total/radical hysterectomy at the index surgery

CONCLUSION:

• LMS was diagnosed preoperatively in 58.2% of patients who underwent endometrial sampling
• Using hysteroscopy with endometrial sampling was associated with an improved likelihood of preoperative diagnosis
• Larger tumor size was less likely to result in a preoperative diagnosis possibly due to cavity distortion
• Patients who had a missed diagnosis had a higher risk of undergoing supracervical hysterectomy, a suboptimal index surgical strategy
• The authors state

…the additional benefit of hysteroscopy for the detection of LMS, which is a deep muscle tumor, had not been previously shown

Our study addressed this important gap and demonstrated that hysteroscopy used in conjunction with biopsy or D&C improved the likelihood of LMS detection by threefold

Learn More – Primary Sources:

Endometrial Sampling for Preoperative Diagnosis of Uterine Leiomyosarcoma

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