Analysis Of The Clinical Characteristics And Preoperative Diagnostic Methods Of Uterine Sarcoma

Objective:To compare and analyze the clinical data of patients with uterine sarcoma and uterine myoma retrospectively and evaluate the differences of preoperative clinical features and auxiliary examination methods between the two groups of patients,to provide the evidence for preoperative diagnosis of uterine sarcoma in clinical practice.Methods:The 26 patients with uterine sarcoma who underwent surgery and diagnosed by pathology in the First Affiliated Hospital of Dalian Medical University from January2012 to December 2020 were selected,and 104 patients with uterine myoma as control who underwent surgery and confirmed by pathology during the same time were selected randomly.The general information,clinical manifestations,and the results of pelvic ultrasound,MRI,LDH as well as NLR of the two groups were retrospectively analyzed,and the differences of the above indicators between the two groups were compared.The statistical analysis software SPSS 26.0 was used to analyze the data.Measurement data was measured by t test or Mann-Whitney U test.Count data was expressed by rate.The comparison of rate was performed by Chi-square（χ2）test or Fisher’s accurate probability method,and ROC curve was adopted to analyze the cut-off value and diagnostic value of LDH and NLR.P<0.05 was considered statistically significant.Results:1.26 patients with uterine sarcoma were 40～74 years old,with a median age of 48years old.The pathological types included:12 cases of leiomyosarcoma,12 cases of endometrial stromal sarcoma,and 2 cases of adenosarcoma.The clinical manifestations included:abdominal pain and bloating 42.3%（11/26）,compressed symptom 7.7%（2/26）,increased menstrual volume or prolonged menstrual duration 46.2%（12/26）,irregular vaginal bleeding 15.4%（4/26）,and no symptom 0.0%（0/26）.104 cases of uterine myoma were 25～66 years old,with a median age of 45 years old.The pathological types included:59 cases of leiomyoma,43 cases of leiomyoma with degeneration,2 cases of cellular leiomyoma.The clinical manifestations included:abdominal pain and bloating 17.3%（18/104）,compressed symptom 16.3%（17/104）,increased menstrual volume or prolonged menstrual duration 42.3%（44/104）,no irregular vaginal bleeding 7.7%（8/104）,and no symptom 25.0%（26/104）.Uterine sarcoma patients compared with uterine myoma patients,their age,clinical manifestations of abdominal pain and bloating,and no symptom were statistically different（P<0.05）.2.The results of pelvic ultrasound showed that the average size of the uterine sarcoma lesions was 82.68±32.38mm,of which 53.8%（14/26）were single lesion and46.2%（12/26）were multiple lesions;the echo types included:26.9%（7/26）with hypoechoic,73.1%（19/26）with mixed echo;the richness of blood flow included:57.7%（15/26）without blood flow,30.8%（8/26）with less or punctate blood flow,and11.5%（3/26）with rich blood flow.The average size of the uterine myoma was69.79±26.59 mm,of which 38.5%（40/104）were single lesion and 61.5%（64/104）were multiple lesions;the echo types included:51.0%（53/104）with hypoechoic,49.0%（51/104）with mixed echo;the richness of blood flow included:72.1%（75/104）without blood flow,15.4%（20/104）with less or punctate blood flow,and 8.7%（9/104）with rich blood flow.Uterine sarcoma compared with uterine myoma,the ultrasound showed the echo type of uterine sarcoma lesion was mainly mixed echo,which was statistically different from the latter（P<0.05）.3.The results of pelvic MRI showed the uterine sarcoma lesions were 85.7%（5/7）with low signal and 28.6%（2/7）with high signal of T₁WI;28.6%（2/7）with low signal,42.9%（3/7）with high signal,and 28.6%（2/7）with mixed signal of T₂WI;the contrast scan was 42.9%（3/7）with weak enhancement,42.9%（3/7）with irregular enhancement,and 14.3%（1/7）with regular enhancement.Uterine myoma showed 44.0%（11/25）with iso-signal,32.0%（8/25）with low signal,12.0%（3/25）with high signal,and 12.0%（3/25）with mixed signal of T₁WI;4.0%（1/25）with iso-signal,32.0%（8/25）with low signal,32.0%（8/25）with high signal,and 32.0%（8/25）with mixed signal of T₂WI;contrast scan was 20.0%（5/25）with weak enhancement,60.0%（15/25）with regular enhancement,and 20.0%（5/25）with irregular enhancement.There was no statistically difference of MRI parameter between the two groups of uterine sarcoma and uterine myoma（P>0.05）.4.The value of blood LDH of patients with uterine sarcoma was 188.50（157.00,250.00）U/L,the NLR value was 2.25（1.41,3.41）.The value of blood LDH of patients with uterine myoma was 152.00（140.50,169.00）U/L,and the NLR value was 1.59（1.33,1.99）.The value of blood LDH and NLR of patients with uterine sarcoma were significantly higher than the latter（P<0.01）.The AUC of LDH was 0.758,the cut-off was 176.00 U/L,the AUC of NLR was 0.672,the cut-off was 2.21.Defined LDH≥176.00 U/L or NLR≥2.21 were positive,the sensitivity of LDH positive for diagnosis of uterine sarcoma was 66.7%,the specificity was 81.4%,the sensitivity of NLR positive for diagnosis of uterine sarcoma was 53.8%,the specificity was 86.5%.The sensitivity,specificity,positive predictive value,and negative predictive value of LDH and NLR in simultaneous positive diagnosis of uterine sarcoma were 33.3%,100%,100%and 85.8%,respectively.Conclusions:1.Compared with uterine myoma,patients with uterine sarcoma had a higher age of onset,and abdominal pain and bloating were the more common clinical manifestations of uterine sarcoma patients.2.Compared with uterine myoma,the pelvic ultrasound echo type of uterine sarcoma was mainly mixed echo.3.Compared with uterine myoma,blood LDH≥176.00 U/L,NLR≥2.21 or the combination of them have clinical auxiliary diagnostic value for uterine sarcoma.