Preoperative Diagnostic Scoring System And Misdiagnosis Analysis Of Uterine Sarcoma

Objective:Uterine sarcoma is a rare malignant tumor.At present,lacking of the specific tumor markers and auxiliary examination methods,preoperative diagnosis of uterine sarcoma is difficult,often misdiagnosed as benign tumors of uterus,such as uterine leiomyoma,adenomyosis(tumor),which delay treatment or cause improper operation,so that seriously affect the prognosis and quality of life of patients.This paper analyzes the uterine sarcoma group and control group(uterine benign tumor group)statistical of different indexes before operation,and make preoperative diagnosis of uterine sarcoma scoring system(Preoperative Sarcoma Score,PSS),in order to improve the diagnosis rate of uterine sarcoma before operation;and through the analysis of the clinical data of misdiagnosis,to avoid misunderstanding and wrong treatment.Methods:1.Using retrospective analysis and group control,we collected from January2003 to June 2016 by the pathological diagnosis of uterine sarcoma and uterine benign tumor cases.After strict screening criteria were selected into the group,cases study group of uterine sarcoma group 48 cases,control group 90 cases.By univariate and multivariate Logistic regression analysis of the clinical data,to establish the system of PSS and calculate the area under the ROC curve test performance of the scoring system [39].2.Select 15 misdiagnosed cases from January 2003 to June 2016,which is the first or external hospital into ours hospital,the misdiagnosis cases are divided into laparoscopic group and laparotomy group,then analyse of clinical data and follow-up prognosis.Results: 1.Comparing two groups of clinical data by univariate analysis,the significant indicators are age,C125,LDH,ultrasound characteristics(internal blood flow,abundant blood flow,boundary,internal echo,tumor maximum diameter),further by two yuan Logistic regression analysis,the LDH,unclear boundary and heterogeneous or mixed echo are independent risk factors for diagnosis of uterine sarcoma,then making preoperative diagnosis of uterine sarcoma scoring system.The scoring system score of 0to 4,the prediction of goo d consistency(P=0.438).The area of receiver operating characteristic(ROC)is 0.961(95%CI [0.922,0.999]),description of dividing the scoring system is good,the best cut-off value was 1.5,the specificity was 97.8%,sensitivity83.3%,accurate 92.8%,the negative predictive value was 91.7%,the positive predictive value of 95.2%.2.patients with misdiagnosis of age structure mainly in childbearing age;15 cases were preoperatively considered myoma of uterus;postoperative pathology in 5cases(33%)are wrong;pelvic metastasis rate of uterine sarcoma(75%,3/4)and recurrence rate(75%,3/4)in laparoscopic group are significantly higher than those in laparotomy group(27.3%,50%).Conclusion: 1.The scoring system for differential diagnosis of benign and malignant uterine tumors(PSS),can be better for the patients of benign and malignant risk stratification and provide a preliminary diagnosis basis.2.Misdiagnosis causes there are pathological report errors,ignoring the young unmarried patients,inappropriate surgery in postmenopausal women;the application of laparoscopic morcellation may have caused unexpected risk of uterine sarcoma abdominal implantation metastasis and increase the chance of relapse after surgery,clinicians should pay more attention to.