Restricted accessResearch articleFirst published online 2019-12
Magnetic Resonance Imaging to Rule out Leiomyosarcoma in Patients Undergoing Surgery for Leiomyomas: A Real World Experience in an Unenhanced Patient Population
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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