Magnetic Resonance Imaging to Rule out Leiomyosarcoma in Patients Undergoing Surgery for Leiomyomas: A Real World Experience in an Unenhanced Patient Population

Veronica Lerner, Nancy Ringel, Jessica Meyer, Genevieve Bennett, Leslie Boyd

Research output: Contribution to journalArticle

Abstract

Objective: Surgery for leiomyomas is common; yet, no reliable test can help distinguish a benign leiomyoma and malignant leiomyosarcoma (LMS). Materials and Methods: This retrospective observational cohort study evaluated patients before and after implementation of a protocol to identify LMS, which included magnetic resonance imaging (MRI) with diffusion-weighted imaging. Results: This study revealed the incidence of uterine pathology, as well as MRI, lactate dehydrogenase (LDH), and pathology results, in 1085 patients - 479 before and 606 after implementation of the protocol. Two cases of LMS were identified in the postprotocol cohort, and 70% of the patients underwent MRI. Test statistics for MRI to detect LMS in this cohort were: sensitivity of 100%; specificity of 67%; positive predictive value of 1%; negative predictive value of 100%; false-positive rate of 33%; and false-negative rate of 0%. For patients with both MRI and LDH results (358/606, 59%), 56.7% had normal MRI and LDH, 9.8% had negative MRI but high LDH, 6.4% had abnormal MRI and high LDH, and 27.1% had abnormal MRI and normal LDH. Conclusion: Preoperative MRI for detecting LMS had high a sensitivity and a high false-positive rate, which warrants caution in interpreting MRI results, particularly in women of childbearing age.

Original languageEnglish (US)
Pages (from-to)363-369
Number of pages7
JournalJournal of Gynecologic Surgery
Volume35
Issue number6
DOIs
StatePublished - Dec 2019

Fingerprint

Leiomyosarcoma
Leiomyoma
Magnetic Resonance Imaging
L-Lactate Dehydrogenase
Population
Cohort Studies
Pathology
Diffusion Magnetic Resonance Imaging
Observational Studies

Keywords

  • fibroids
  • hysterectomy
  • leiomyosarcoma
  • morcellation
  • myomectomy
  • pre-operative MRI

ASJC Scopus subject areas

  • Surgery
  • Obstetrics and Gynecology

Cite this

Magnetic Resonance Imaging to Rule out Leiomyosarcoma in Patients Undergoing Surgery for Leiomyomas : A Real World Experience in an Unenhanced Patient Population. / Lerner, Veronica; Ringel, Nancy; Meyer, Jessica; Bennett, Genevieve; Boyd, Leslie.

In: Journal of Gynecologic Surgery, Vol. 35, No. 6, 12.2019, p. 363-369.

Research output: Contribution to journalArticle

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abstract = "Objective: Surgery for leiomyomas is common; yet, no reliable test can help distinguish a benign leiomyoma and malignant leiomyosarcoma (LMS). Materials and Methods: This retrospective observational cohort study evaluated patients before and after implementation of a protocol to identify LMS, which included magnetic resonance imaging (MRI) with diffusion-weighted imaging. Results: This study revealed the incidence of uterine pathology, as well as MRI, lactate dehydrogenase (LDH), and pathology results, in 1085 patients - 479 before and 606 after implementation of the protocol. Two cases of LMS were identified in the postprotocol cohort, and 70{\%} of the patients underwent MRI. Test statistics for MRI to detect LMS in this cohort were: sensitivity of 100{\%}; specificity of 67{\%}; positive predictive value of 1{\%}; negative predictive value of 100{\%}; false-positive rate of 33{\%}; and false-negative rate of 0{\%}. For patients with both MRI and LDH results (358/606, 59{\%}), 56.7{\%} had normal MRI and LDH, 9.8{\%} had negative MRI but high LDH, 6.4{\%} had abnormal MRI and high LDH, and 27.1{\%} had abnormal MRI and normal LDH. Conclusion: Preoperative MRI for detecting LMS had high a sensitivity and a high false-positive rate, which warrants caution in interpreting MRI results, particularly in women of childbearing age.",
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