KHẢO SÁT ĐẶC ĐIỂM SARCÔM TỬ CUNG TRÊN SIÊU ÂM

Abstract

Objective: To describe the ultrasound characteristics of uterine sarcomas and assess the sensitivity of ultrasound in uterine sarcoma diagnosis. Matherials and Methods: 78 patients with 2D and color Doppler ultrasound results done at Tu Du Hospital, of which images were stored on the system, were confirmed as uterine sarcomas after surgery from January 1, 2020 to December 31, 2023. The subjects were divided into groups including age at the time of diagnosis, general medical history and obstetric history in specific, and ultrasound characteristics of uterine tumors: quantity, location, FIGO tumor classification, size, the echogenicity of solid tissue, internal cystic change, dorsal shadow, calcification, border, "Cooked appearance" sign, color score, typical fibroid lesions, endometrium thickness, cul-de-sac fluid, abdominal fluid, regional lymph nodes. Results: The average age of the subjects was 52.2 ± 11.6 years old and the highest proportion was 51-60 years old. Most of the patients had ever had sex (93.6%) and had ever been pregnant (89.7%). The proportion of premenopausal and postmenopausal patients was 53.8% and 46.2% respectively. Medial history was noted including history of fibroids and no fibroids (46.2% and 53.8% respectively), no history of endometriosis (94.9%), no history of endometrial pathology (91%) and no history of ovarian tumors (96.2%). None of the patients were diagnosed due to routine examination. Appoximately 2/3 of the patients had symptoms of vaginal bleeding. Pelvic pain was reported in 16.7% of the patients. 2/5 of the patients reexamined previous diagnosed uterine fibroids. Ultrasound features showed normal myometrium (87.2%), one fibroid (84.6%), heterogeneous tumor echogenicity (76.9%), no shadowing (65.4%), no calcification (93.6%), regular and irregular tumor margins with similar proportions (51.3% and 48.7% respectively), no "cooked appearance" (91.0%), atypical fibroid lesions (89.7%), no cul-de-sac fluid and no abdominal fluid (96.2%), no regional lymph nodes (97.4%). In 2/3 of the patients, normal endometrium could not be observed. The most common location of sarcoma tumors was in the uterine cavity (43.6%). The least common location was entire uterus (7.7%) and at one side of the uterine (7.7%). The average tumor size was 84.3 ± 32.5 mm. Vascularity characteristics on color Doppler ultrasound varied. There were 56.4% of cases suspected malignancy on routine ultrasound and 88.5% of cases without typical signs of benign tumors. Meanwhile, MRI recorded characteristics of malignancy or suspicious malignancy in 87.5% of cases. The most common type of sarcoma was leiomyosarcoma confirmed in 50% of the patients. Conclusion: Routine ultrasound had a sensitivity of 56.4% and a positive predictive value of 100% in our research. Both ultrasound consultation and MRI had a high sensitivity (88.5% and 87.5% respectively) and a positive predictive value of 100%.