Abstract：
OBJECTIVE: Timely and accurate preoperative diagnosis of uterine sarcoma will increase patient survival. The primary aim of this study was to describe the ultrasound features of uterine sarcoma compared with those of uterine leiomyoma based on the terms and definitions of the Morphological Uterus Sonographic Assessment (MUSA) group. A secondary aim was to assess the interobserver agreement for reporting on ultrasound features according to MUSA terminology.
METHODS: This was a retrospective cohort study of patients with uterine sarcoma or uterine leiomyoma treated in a single tertiary center during the periods 1997-2019 and 2016-2019, respectively. Demographic characteristics, presenting symptoms and surgical outcomes were extracted from patients\' files. Ultrasound images were re-evaluated independently by two sonologists using MUSA terms and definitions. Descriptive statistics were calculated and interobserver agreement was assessed using Cohen\'s κ (with squared weights) or intraclass correlation coefficient, as appropriate.
RESULTS: A total of 107 patients were included, of whom 16 had a uterine sarcoma and 91 had a uterine leiomyoma. Abnormal uterine bleeding was the most frequent presenting symptom (69/107 (64%)). Compared with leiomyoma cases, patients with uterine sarcoma were older (median age, 65 (interquartile range (IQR), 60-70) years vs 48 (IQR, 43-52) years) and more likely to be postmenopausal (13/16 (81%) vs 15/91 (16%)). In the uterine sarcoma cohort, leiomyosarcoma was the most frequent histological type (6/16 (38%)), followed by adenosarcoma (4/16 (25%)). On ultrasound evaluation, according to Observers 1 and 2, the tumor border was irregular in most sarcomas (11/16 (69%) and 13/16 (81%) cases, respectively), but regular in most leiomyomas (65/91 (71%) and 82/91 (90%) cases, respectively). Lesion echogenicity was classified as non-uniform in 68/91 (75%) and 51/91 (56%) leiomyomas by Observers 1 and 2, respectively, and 15/16 (94%) uterine sarcomas by both observers. More than 60% of the uterine sarcomas showed acoustic shadows (11/16 (69%) and 10/16 (63%) cases by Observers 1 and 2, respectively), whereas calcifications were reported in a small minority (0/16 (0%) and 2/16 (13%) cases by Observers 1 and 2, respectively). In uterine sarcomas, intralesional vascularity was reported as moderate to abundant in 13/16 (81%) cases by Observer 1 and 15/16 (94%) cases by Observer 2, while circumferential vascularity was scored as moderate to abundant in 6/16 (38%) by both observers. Interobserver agreement for the presence of cystic areas, calcifications, acoustic shadow, central necrosis, color score (overall, intralesional and circumferential) and maximum diameter of the lesion was moderate. The agreement for shape of lesion, tumor border and echogenicity was fair.
CONCLUSIONS: A postmenopausal patient presenting with abnormal uterine bleeding and a new or growing mesenchymal mass with irregular tumor borders, moderate-to-abundant intralesional vascularity, cystic areas and an absence of calcifications on ultrasonography is at a higher risk of having a uterine sarcoma. Interobserver agreement for most MUSA terms and definitions is moderate. Future studies should validate the abovementioned clinical and ultrasound findings on uterine mesenchymal tumors in a prospective multicenter fashion. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
METHODS: This was a retrospective cohort study of patients with uterine sarcoma or uterine leiomyoma treated in a single tertiary center during the periods 1997-2019 and 2016-2019, respectively. Demographic characteristics, presenting symptoms and surgical outcomes were extracted from patients\' files. Ultrasound images were re-evaluated independently by two sonologists using MUSA terms and definitions. Descriptive statistics were calculated and interobserver agreement was assessed using Cohen\'s κ (with squared weights) or intraclass correlation coefficient, as appropriate.
RESULTS: A total of 107 patients were included, of whom 16 had a uterine sarcoma and 91 had a uterine leiomyoma. Abnormal uterine bleeding was the most frequent presenting symptom (69/107 (64%)). Compared with leiomyoma cases, patients with uterine sarcoma were older (median age, 65 (interquartile range (IQR), 60-70) years vs 48 (IQR, 43-52) years) and more likely to be postmenopausal (13/16 (81%) vs 15/91 (16%)). In the uterine sarcoma cohort, leiomyosarcoma was the most frequent histological type (6/16 (38%)), followed by adenosarcoma (4/16 (25%)). On ultrasound evaluation, according to Observers 1 and 2, the tumor border was irregular in most sarcomas (11/16 (69%) and 13/16 (81%) cases, respectively), but regular in most leiomyomas (65/91 (71%) and 82/91 (90%) cases, respectively). Lesion echogenicity was classified as non-uniform in 68/91 (75%) and 51/91 (56%) leiomyomas by Observers 1 and 2, respectively, and 15/16 (94%) uterine sarcomas by both observers. More than 60% of the uterine sarcomas showed acoustic shadows (11/16 (69%) and 10/16 (63%) cases by Observers 1 and 2, respectively), whereas calcifications were reported in a small minority (0/16 (0%) and 2/16 (13%) cases by Observers 1 and 2, respectively). In uterine sarcomas, intralesional vascularity was reported as moderate to abundant in 13/16 (81%) cases by Observer 1 and 15/16 (94%) cases by Observer 2, while circumferential vascularity was scored as moderate to abundant in 6/16 (38%) by both observers. Interobserver agreement for the presence of cystic areas, calcifications, acoustic shadow, central necrosis, color score (overall, intralesional and circumferential) and maximum diameter of the lesion was moderate. The agreement for shape of lesion, tumor border and echogenicity was fair.
CONCLUSIONS: A postmenopausal patient presenting with abnormal uterine bleeding and a new or growing mesenchymal mass with irregular tumor borders, moderate-to-abundant intralesional vascularity, cystic areas and an absence of calcifications on ultrasonography is at a higher risk of having a uterine sarcoma. Interobserver agreement for most MUSA terms and definitions is moderate. Future studies should validate the abovementioned clinical and ultrasound findings on uterine mesenchymal tumors in a prospective multicenter fashion. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
摘要：
目的：子宫肉瘤的及时正确的术前诊断将提高患者的生存率。我们研究的主要目的是根据MUSA（形态学子宫超声检查评估）术语和定义描述与子宫平滑肌瘤相比的子宫肉瘤的超声特征。次要目的是评估MUSA超声特征的观察者之间的一致性。
方法：这项回顾性队列研究评估了1997年至2019年的子宫肉瘤和2016年至2019年的子宫平滑肌瘤，分别在一个三级中心治疗。患者人口统计学，从患者档案中提取患者的症状和结果.超声图像由两名声科医生使用MUSA术语和定义独立地重新评估。根据变量的类型，计算描述性统计数据，并使用Cohen的Kappa（具有平方权重）或类内相关系数评估观察者之间的一致性。
结果：共纳入了7名患者，其中16人患有子宫肉瘤，91人患有子宫平滑肌瘤。异常子宫出血是最常见的症状（69/107，65％）。与平滑肌瘤病例相比，子宫肉瘤患者年龄较大（平均年龄65岁（IQR60-70岁）与（vs.)48岁(IQR43-52岁)，大部分是绝经后(13/16(81%)vs.15/91（16%））。在子宫肉瘤队列中，平滑肌肉瘤是最常见的组织学类型（6/16（38％），其次是腺肉瘤（4/16（25％））。关于超声评价，根据观察者1和2，大多数肉瘤的肿瘤边界是不规则的（在11/16（69％）和13/16（81％），分别)，而平滑肌瘤最常见（65/91（71％）和82/91（90％），分别)。观察者将病变回声性归类为不均匀，在子宫肌瘤的68/91（75％）和51/91（56％）和子宫肉瘤的15/16（94％）中。超过60％的子宫肉瘤显示出声阴影（分别为11/16（69％）和10/16（62％）），而其中一小部分报告了钙化（分别为0/16（0％）和2/16（13％））。在子宫肉瘤中，据报道,病灶内血管分布分别在13/16(81%)和15/16(94%)为中等至丰富,而周向血管分布在6/16(38%)为高.关于存在囊性区域的观察员之间的协议，钙化,声影和中央坏死，颜色得分(总体，病灶内和圆周)，和病变的最大直径，是温和的。病变肿瘤边界和回声的一致性是公平的。
结论：一名绝经后患者，在超声检查中表现为异常子宫出血和新的或生长的间质肿块，肿瘤边界不规则，中度至丰富的病灶内血管，存在囊性区域和无钙化，患子宫肉瘤的风险更高。对于大多数MUSA术语和定义，观察员之间的共识是适度的。未来的研究应该在子宫间充质肿瘤的前瞻性多中心收集中验证上述临床和超声发现。本文受版权保护。保留所有权利。
方法：这项回顾性队列研究评估了1997年至2019年的子宫肉瘤和2016年至2019年的子宫平滑肌瘤，分别在一个三级中心治疗。患者人口统计学，从患者档案中提取患者的症状和结果.超声图像由两名声科医生使用MUSA术语和定义独立地重新评估。根据变量的类型，计算描述性统计数据，并使用Cohen的Kappa（具有平方权重）或类内相关系数评估观察者之间的一致性。
结果：共纳入了7名患者，其中16人患有子宫肉瘤，91人患有子宫平滑肌瘤。异常子宫出血是最常见的症状（69/107，65％）。与平滑肌瘤病例相比，子宫肉瘤患者年龄较大（平均年龄65岁（IQR60-70岁）与（vs.)48岁(IQR43-52岁)，大部分是绝经后(13/16(81%)vs.15/91（16%））。在子宫肉瘤队列中，平滑肌肉瘤是最常见的组织学类型（6/16（38％），其次是腺肉瘤（4/16（25％））。关于超声评价，根据观察者1和2，大多数肉瘤的肿瘤边界是不规则的（在11/16（69％）和13/16（81％），分别)，而平滑肌瘤最常见（65/91（71％）和82/91（90％），分别)。观察者将病变回声性归类为不均匀，在子宫肌瘤的68/91（75％）和51/91（56％）和子宫肉瘤的15/16（94％）中。超过60％的子宫肉瘤显示出声阴影（分别为11/16（69％）和10/16（62％）），而其中一小部分报告了钙化（分别为0/16（0％）和2/16（13％））。在子宫肉瘤中，据报道,病灶内血管分布分别在13/16(81%)和15/16(94%)为中等至丰富,而周向血管分布在6/16(38%)为高.关于存在囊性区域的观察员之间的协议，钙化,声影和中央坏死，颜色得分(总体，病灶内和圆周)，和病变的最大直径，是温和的。病变肿瘤边界和回声的一致性是公平的。
结论：一名绝经后患者，在超声检查中表现为异常子宫出血和新的或生长的间质肿块，肿瘤边界不规则，中度至丰富的病灶内血管，存在囊性区域和无钙化，患子宫肉瘤的风险更高。对于大多数MUSA术语和定义，观察员之间的共识是适度的。未来的研究应该在子宫间充质肿瘤的前瞻性多中心收集中验证上述临床和超声发现。本文受版权保护。保留所有权利。
