Transcervical Biopsy May Prevent Unneeded Hysterectomy
Laurie Barclay, MD
NEW YORK (MedscapeWire) Apr 05
Transcervical biopsy has a 100% negative predictive value in ruling out uterine sarcoma, based on a study in the March 15 issue of Cancer.
"The clinical differential diagnosis between uterine sarcoma and benign leiomyoma is difficult even with magnetic resonance imaging (MRI)," write Naoki Kawamura, MD, and colleagues from Osaka City University Graduate School of Medicine in Japan. "A considerable number of patients have undergone hysterectomies due to an indication of 'suspected malignancy' based on tumor size alone."
Leiomyomas occur in 20% to 25% of women younger than 30 years and account for 30% of hysterectomies, of which 80% turn out on retrospective review to have been recommended inappropriately.
Of 435 patients who had transcervical needle biopsy for diagnosis of uterine myoma-like tumors, 7 had uterine sarcomas, 4 of which were scored as 4 points or higher by histopathologic criteria of Bell and colleagues and were diagnosed as "sarcoma" by needle biopsy alone. Gold standards included histopathology of surgical specimens and clinical outcome after 2 years of follow-up.
No patients with a score of 0 had sarcoma. The optimal cut-off score for distinguishing uterine leiomyosarcoma from uterine leiomyoma was 2, which yielded sensitivity of 100%, specificity of 98.6%, positive predictive value of 58%, and negative predictive value of 100%.
"Transcervical needle biopsy using histopathologic scoring is a reliable diagnostic test for the differential diagnosis between uterine sarcoma and leiomyoma," the authors write.
"This diagnostic method, combined with MRI screening, could reduce the number of patients currently undergoing unnecessary surgery."
Abstract # 5105
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