Occult Uterine Malignancy Found at Surgery for Uterine Fibroids: An Updated Systematic Review and Meta-Analysis

Abstract

Objective:

The aim of this systematic review and meta-analysis was to obtain an estimate of the prevalence of occult uterine malignancies of any subtype found at surgery for uterine fibroids.

Methods

: MEDLINE^® was searched for peer-reviewed articles about uterine surgeries, including morcellated or nonmorcellated hysterectomies, with occult uterine malignancies. Articles selected had data on occult malignancy found during hysterectomies specifically for uterine fibroids. One author screened and extracted data, and another author resolved study-suitability questions. Search terms included occult malignancy or occult uterine pathology, AND morcellation OR hysterectomy. A Freeman–Tukey double-arcsine transformation was used to compute the weighted pooled estimate of the occult uterine malignancy prevalence and to perform back-transformation on the pooled estimate.

Results:

Of 233 articles, 53 met review criteria; 8 studies with specific data were used for meta-analysis. Of 105,890 patients, 578 had occult uterine malignancies. The pooled prevalence of uterine cancer was 0.17% (95% confidence interval [CI]: 0.00%–0.49%). With substantial heterogeneity across the studies (I² = 93.94%; Q χ² [7] = 115.50; p < 0.001), there were pooled prevalences of 0.54% for population-based studies and 0.12% for retrospective case series.

Conclusions:

The prevalence of occult uterine cancer of all subtypes combined found during surgery for fibroids is likely higher than estimates from previous studies that focused exclusively on leiomyosarcomas.