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Аннотация
Введение. Мезенхимальные опухоли тела матки занимают лидирующее место в структуре онкогинекологической патологии. Предоперационная дифференциальная диагностика данных неоплазий имеет ключевое значение в выборе тактики ведения пациенток, поскольку ошибочный диагноз приводит к нерадикальному лечению и впоследствии снижению выживаемости, возникновению местного рецидива или метастазированию опухоли. Сложности клинической оценки, отсутствие специфических дифференциальных критериев и низкая вероятность верификации патологии на предоперационном этапе приводят к необходимости поиска новых инструментов для диагностики мезенхимальных опухолей тела матки.
Цель. Изучить данные отечественной и зарубежной литературы по теме дифференциальной диагностики мезенхимальных опухолей тела матки на предоперационном этапе.
Материалы и методы. Проведен систематический поиск литературы в базах данных PubМed/MEDLINE, UpToDate, e-Library, Scopus, а также в ресурсах ESUR, ACR, ESGO, ESMO, NCCN за период с 2014 по 2024 гг. Изучены и обобщены все опубликованные работы, посвященные клиническому течению, современным подходам в лабораторной и инструментальной диагностике мезенхимальных опухолей тела матки. Для анализа были включены полнотекстовые исследования и литературные обзоры по изучаемой нозологии.
Результаты. Представлены актуальные подходы, диагностические возможности и трудности в диагностике мезенхимальных опухолей тела матки. Учитывая отсутствие валидированных клинико-лабораторных маркеров, сложность морфологической верификации опухоли, основополагающая роль в предоперационной дифференциальной диагностике отводится визуализационным методам, которые в совокупности с клиническими данными позволяют определять предполагаемый объем лечения пациентов.
Заключение. Морфологическая гетерогенность мезенхимальных опухолей, приводящая к трудностям дифференциальной диагностики в настоящий момент, требует дальнейших исследований с целью разработки новых подходов и оптимизации тактики ведения пациенток.
Библиографические ссылки
Lax S.F. Mesenchymal and mixed uterine tumors: Current overview and practical aspects. Pathologe. 2019; 40(1): 36–45.-DOI: https://dx.doi.org/10.1007/s00292-019-0567-6.
Sparić R., Andjić M., Babović I., et al. Molecular insights in uterine leiomyosarcoma: A systematic review. Int J Mol Sci. 2022; 23(17): 9728.-DOI: https://dx.doi.org/10.3390/ijms23179728.
Stewart E.A., Cookson C.L., Gandolfo R.A., et al. Epidemiology of uterine fibroids: a systematic review. BJOG. 2017; 124(10): 1501–12.-DOI: https://dx.doi.org/10.1111/1471-0528.14640.
Урманчеева А.Ф., Ульрих Е.А. Принципы лечения сарком матки. Практическая онкология. 2008; 9 (3): 132-136.-EDN: QCRWIT. -URL: https://www.practical-oncology.ru/articles/261.pdf. [Urmancheeva A.F., Ul'rih E.A. Principles of uterine sarcoma treatment. Prakticheskaja Onkologija = Practical Oncology. 2008; 9 (3): 132-136. EDN: QCRWIT.-URL: https://www.practical-oncology.ru/articles/261.pdf (In Rus)].
Ульрих Е.А. Особенности лечения сарком матки. Практическая онкология. 2013; 14(2): 127-134.-EDN: QCRWXT.-URL: https://practical-oncology.ru/articles/110.pdf. [Ulrikh E.A. Treatment of uterine sarcomas. Prakticheskaya Onkologiya = Practical Oncology. 2013; 14(2): 127-134.-EDN: QCRWXT.-URL: https://practical-oncology.ru/articles/110.pdf (In Rus)].
Mallmann P. Uterine sarcoma — difficult to diagnose, hard to treat. Oncol Res Treat. 2018; 41(11): 674.-DOI: https://dx.doi.org/10.1159/000494393.
Zouzoulas D., Tsolakidis D., Pavlidi O., et al. Rate of leiomyosarcomas during surgery for uterine fibroids: 8-year experience of a single center. J Clin Med. 2023; 12(24).-DOI: https://dx.doi.org/10.3390/jcm12247555.
Borella F., Mancarella M., Preti M., et al. Uterine smooth muscle tumors: a multicenter, retrospective, comparative study of clinical and ultrasound features. Int J Gynecol Cancer. 2024; 34(2): 244–50.-DOI: https://dx.doi.org/10.1136/ijgc-2023-004880.
Höhn A.K., Brambs C.E., Hiller G.G.R., et al. 2020 WHO classification of female genital tumors. Geburtshilfe Frauenheilkd. 2021; 81(10): 1145–53.-DOI: https://dx.doi.org/10.1055/a-1545-4279.
Richaud C., Jochum F., Journo G., et al. Impact of guideline adherence and expert center referral on the early management and outcomes of uterine sarcoma patients: A retrospective analysis from the French NETSARC network. Eur J Surg Oncol. 2024; 50(2): 107319.-DOI: https://dx.doi.org/10.1016/j.ejso.2023.107319.
Raffone A., Raimondo D., Neola D., et al. Diagnostic accuracy of MRI in the differential diagnosis between uterine leiomyomas and sarcomas: A systematic review and meta-analysis. Int J Gynaecol Obstet. 2024; 165(1): 22–33.-DOI: https://doi.org/10.1002/ijgo.15136.
Sun S., Bonaffini P.A., Nougaret S., et al. How to differentiate uterine leiomyosarcoma from leiomyoma with imaging. Diagn Interv Imaging. 2019; 100(10): 619–34.-DOI: https://dx.doi.org/10.1016/j.diii.2019.07.007.
Kostov S., Kornovski Y., Ivanova V., et al. New aspects of sarcomas of uterine corpus-a brief narrative review. Clin Pract. 2021; 11(4): 878–900.-DOI: https://dx.doi.org/10.3390/clinpract11040103.
U.S. Food and Drug Administration. FDA updated assessment of the use of laparoscopic power morcellators to treat uterine fibroids. Silver Spring. 2017.-URL: https://www.fda.gov/media/109018/download.
U.S. Food and Drug Administration. UPDATED laparoscopic uterine power morcellation in hysterectomy and myomectomy: FDA safety communication [archived]. Silver Spring. 2014.-URL: https://www.wilsonlaw.com/wp-content/uploads/2014/12/UPDATED-Safety-Communication_Laparoscopic-Power-Morcellation.pdf.
Hartmann K.E., Fonnesbeck C., Surawicz T., et al. Management of uterine fibroids. Rockville (MD): Agency for Healthcare Research and Quality (US). Comparative Effectiveness Review, No. 195. 2017.-URL: https://www.ncbi.nlm.nih.gov/books/NBK537742/.
Surace A., Baù M.G., Privitera S., et al. Risk of unexpected uterine leiomyosarcoma during laparoscopic procedures: Experience from a single tertiary institute in Italy. Int J Gynaecol Obstet. 2022; 156(2): 236–9.-DOI: https://doi.org/10.1002/ijgo.13701.
Pedra Nobre S., Hensley M.L., So M., et al. The impact of tumor fragmentation in patients with stage I uterine leiomyosarcoma on patterns of recurrence and oncologic outcome. Gynecol Oncol. 2021; 160(1): 99–105.-DOI: https://dx.doi.org/10.1016/j.ygyno.2020.10.020.
Rey Valzacchi G.M., Rosas P., Uzal M., et al. Incidence of leiomyosarcoma at surgery for presumed uterine myomas in different age groups. J Minim Invasive Gynecol. 2020; 27(4):926–9.-DOI: https://dx.doi.org/10.1016/j.jmig.2019.06.013.
Kainsbak J., Hansen E.S., Dueholm M. Literature review of outcomes and prevalence and case report of leiomyosarcomas and non-typical uterine smooth muscle leiomyoma tumors treated with uterine artery embolization. Eur J Obstet Gynecol Reprod Biol. 2015; 191: 130–7. -DOI: https://dx.doi.org/10.1016/j.ejogrb.2015.05.018.
ООО «Российское общество акушеров-гинекологов» (РОАГ). Миома матки: клинические рекомендации (протокол лечения). Минздрав РФ. 2024; 1–46.-URL: https://drive.google.com/file/d/1W57cS9Yq1DoJB8GNLmPny1hpI-pC5bXV/view. [Russian Society of Obstetricians and Gynecologists (ROSG). Uterine fibroids: clinical guidelines (treatment protocol). Ministry of Health of the Russian Federation. 2024; 1–46.-URL: https://drive.google.com/file/d/1W57cS9Yq1DoJB8GNLmPny1hpI-pC5bXV/view (In Rus)].
Qu Y., Chen L., Guo S., et al. Genetic liability to multiple factors and uterine leiomyoma risk: a Mendelian randomization study. Front Endocrinol (Lausanne). 2023; 14: 1133260.-DOI: https://dx.doi.org/10.3389/fendo.2023.1133260.
Uterine Morcellation for Presumed Leiomyomas: ACOG Committee Opinion, Number 822. Obstet Gynecol. 2021; 137(3): e63–74.-DOI: https://dx.doi.org/10.1097/AOG.0000000000004291.
Song K.-J., Yu X.-N., Lv T., et al. Expression and prognostic value of lactate dehydrogenase-A and -D subunits in human uterine myoma and uterine sarcoma. Medicine (Baltimore). 2018; 97(14): e0268.-DOI: https://dx.doi.org/10.1097/MD.0000000000010268.
Glorie N., Baert T., VAN DEN Bosch T., Coosemans A.N. Circulating protein biomarkers to differentiate uterine sarcomas from leiomyomas. Anticancer Res. 2019; 39(8): 3981–9.-DOI: https://dx.doi.org/10.21873/anticanres.13553.
Di Cello A., Borelli M., Marra M.L., et al. A more accurate method to interpret lactate dehydrogenase (LDH) isoenzymes’ results in patients with uterine masses. Eur J Obstet Gynecol Reprod Biol. 2019; 236: 143–7.-DOI: https://dx.doi.org/10.1016/j.ejogrb.2019.03.017.
Zhang F., Liu Y., Quan Q., et al. Diagnostic value of preoperative CA125, LDH and HE4 for leiomyosarcoma of the female reproductive system. Cancer Manag Res. 2021; 13: 4657–64.-DOI: https://dx.doi.org/10.2147/CMAR.S302223.
Tabatabaei F., Babadi S., Nourigheimasi S., et al. Neutrophil to lymphocyte ratio as an assessment tool to differentiate between uterine sarcoma and myoma: a systematic review and meta-analysis. BMC Cancer. 2024; 24(1): 12.-DOI: https://dx.doi.org/10.1186/s12885-023-11775-5.
Jeong M.J., Park J.H., Hur S.Y., et al. Preoperative neutrophil-to-lymphocyte ratio as a prognostic factor in uterine sarcoma. J Clin Med. 2020; 9(9).-DOI: https://dx.doi.org/10.3390/jcm9092898.
Suh D.S., Song Y.J., Roh H.-J., et al. Preoperative blood inflammatory markers for the differentiation of uterine leiomyosarcoma from leiomyoma. Cancer Manag Res. 2021; 13: 5001–11.-DOI: https://dx.doi.org/10.2147/CMAR.S314219.
Cho H., Kim K., Kim Y.-B., No J.H. Differential diagnosis between uterine sarcoma and leiomyoma using preoperative clinical characteristics. J Obstet Gynaecol Res. 2016; 42(3): 313–8.-DOI: https://dx.doi.org/10.1111/jog.12915.
Van den Bosch T., Dueholm M., Leone F.P.G., et al. Terms, definitions and measurements to describe sonographic features of myometrium and uterine masses: a consensus opinion from the Morphological Uterus Sonographic Assessment (MUSA) group. Ultrasound Obstet Gynecol. 2015; 46(3): 284–98.-DOI: https://dx.doi.org/10.1002/uog.14806.
Cabezas N., López-Picazo A., Diaz P., et al. How frequently benign uterine myomas appear suspicious for sarcoma as assessed by transvaginal ultrasound? Diagnostics (Basel, Switzerland). 2023; 13(3).-DOI: https://dx.doi.org/10.3390/diagnostics13030501.
Wojtowicz K., Góra T., Guzik P., et al. Uterine myomas and sarcomas — clinical and ultrasound characteristics and differential diagnosis using pulsed and color doppler techniques. J Ultrason. 2022; 22(89): 100–8.-DOI: https://dx.doi.org/10.15557/JoU.2022.0017.
Russo C., Camilli S., Martire F.G., et al. Ultrasound features of highly vascularized uterine myomas (uterine smooth muscle tumors) and correlation with histopathology. Ultrasound Obstet Gynecol. 2022; 60(2): 269–76.-DOI: https://dx.doi.org/10.1002/uog.24855.
Köhler G., Vollmer M., Nath N., et al. Benign uterine mass-discrimination from leiomyosarcoma by a preoperative risk score: a multicenter cohort study. Arch Gynecol Obstet. 2019; 300(6): 1719–27.-DOI: https://dx.doi.org/10.1007/s00404-019-05344-0.
Ludovisi M., Moro F., Pasciuto T., et al. Imaging in gynecological disease (15): clinical and ultrasound characteristics of uterine sarcoma. Ultrasound Obstet Gynecol. 2019; 54(5): 676–87.-DOI: https://dx.doi.org/10.1002/uog.20270.
Li D., Yin N., Du G., et al. A real-world study on diagnosis and treatment of uterine sarcoma in Western China. Int J Biol Sci. 2020; 16(3): 388–95.-DOI: https://dx.doi.org/10.7150/ijbs.39773.
Najibi S., Gilani M.M., Zamani F., et al. Comparison of the diagnostic accuracy of contrast-enhanced/DWI MRI and ultrasonography in the differentiation between benign and malignant myometrial tumors. Ann Med Surg. 2021; 70: 102813.-DOI: https://dx.doi.org/10.1016/j.amsu.2021.102813.
Barral M., Placé V., Dautry R., et al. Magnetic resonance imaging features of uterine sarcoma and mimickers. Abdom Radiol (New York). 2017; 42(6): 1762–72.-DOI: https://dx.doi.org/10.1007/s00261-017-1076-9.
Silberzweig J.E., Powell D.K., Matsumoto A.H., Spies J.B. Management of uterine fibroids: A focus on uterine-sparing interventional techniques. Radiology. 2016; 280(3): 675–92.-DOI: https://dx.doi.org/10.1148/radiol.2016141693.
Kubik-Huch R.A., Weston M., Nougaret S., et al. European Society of Urogenital Radiology (ESUR) guidelines: MR imaging of leiomyomas. Eur Radiol. 2018; 28(8): 3125–37.-DOI: https://dx.doi.org/10.1007/s00330-017-5157-5.
Lakhman Y., Veeraraghavan H., Chaim J., et al. Differentiation of uterine leiomyosarcoma from atypical leiomyoma: Diagnostic accuracy of qualitative MR imaging features and feasibility of texture analysis. Eur Radiol. 2017; 27(7): 2903–15.-DOI: https://dx.doi.org/10.1007/s00330-016-4623-9.
Bura V., Pintican R.M., David R.E., et al. MRI findings in-between leiomyoma and leiomyosarcoma: a Rad-Path correlation of degenerated leiomyomas and variants. Br J Radiol. 2021; 94 (1125): 20210283.-DOI: https://dx.doi.org/10.1259/bjr.20210283.
Fujii S., Mukuda N., Ochiai R., et al. MR imaging findings of unusual leiomyoma and malignant uterine myometrial tumors: what the radiologist should know. Jpn J Radiol. 2021; 39(6): 527–39.-DOI: https://dx.doi.org/10.1007/s11604-021-01096-7.
Ando T., Kato H., Furui T., et al. Uterine smooth muscle tumours with hyperintense area on T 1 weighted images: differentiation between leiomyosarcomas and leiomyomas. Br J Radiol. 2018; 91(1084).-DOI: https://dx.doi.org/10.1259/bjr.20170767.
Abdel Wahab C., Jannot A.-S., Bonaffini P.A., et al. Diagnostic algorithm to differentiate benign atypical leiomyomas from malignant uterine sarcomas with diffusion-weighted MRI. Radiology. 2020; 297(2): 361–71.-DOI: https://dx.doi.org/10.1148/radiol.2020191658.
Li H.M., Liu J., Qiang J.W., Zhang H., et al. Diffusion-weighted imaging for differentiating uterine leiomyosarcoma from degenerated leiomyoma. J Comput Assist Tomogr. 2017; 41(4): 599–606.-DOI: https://dx.doi.org/10.1097/RCT.0000000000000565.
Kim H., Rha S.E., Shin Y.R., et al. Differentiating uterine sarcoma from atypical leiomyoma on preoperative magnetic resonance imaging using logistic regression classifier: Added value of diffusion-weighted imaging-based quantitative parameters. Korean J Radiol. 2024; 25(1): 43–54.-DOI: https://dx.doi.org/10.3348/kjr.2023.0760.
Bi Q., Xiao Z., Lv F., et al. Utility of clinical parameters and multiparametric MRI as predictive factors for differentiating uterine sarcoma from atypical leiomyoma. Acad Radiol. 2018; 25(8): 993–1002.-DOI: https://dx.doi.org/10.1016/j.acra.2018.01.002.
Hindman N., Kang S., Fournier L., et al. MRI evaluation of uterine masses for risk of leiomyosarcoma: A consensus statement. Radiology. 2023; 306(2): e211658.-DOI: https://dx.doi.org/10.1148/radiol.211658.
Malek M., Rahmani M., Seyyed Ebrahimi S.M., et al. Investigating the diagnostic value of quantitative parameters based on T2-weighted and contrast-enhanced MRI with psoas muscle and outer myometrium as internal references for differentiating uterine sarcomas from leiomyomas at 3T MRI. Cancer Imaging. 2019; 19(1): 20.-DOI: https://dx.doi.org/10.1186/s40644-019-0206-8.
Lin G., Yang L.-Y., Huang Y.-T., et al. Comparison of the diagnostic accuracy of contrast-enhanced MRI and diffusion-weighted MRI in the differentiation between uterine leiomyosarcoma / smooth muscle tumor with uncertain malignant potential and benign leiomyoma. J Magn Reson Imaging. 2016; 43(2): 333–42.-DOI: https://dx.doi.org/10.1002/jmri.24998.
Nakai G., Yamada T., Hamada T., et al. Pathological findings of uterine tumors preoperatively diagnosed as red degeneration of leiomyoma by MRI. Abdom Radiol (New York). 2017; 42(7): 1825–31.-DOI: https://dx.doi.org/10.1007/s00261-017-1126-3.
Li H.M., Liu J., Qiang J.W., et al. Endometrial stromal sarcoma of the uterus: Magnetic resonance imaging findings including apparent diffusion coefficient value and its correlation with Ki-67 expression. Int J Gynecol Cancer. 2017; 27(9): 1877–87.-DOI: https://dx.doi.org/10.1097/IGC.0000000000001114.
Ricci S., Stone R.L., Fader A.N. Uterine leiomyosarcoma: Epidemiology, contemporary treatment strategies and the impact of uterine morcellation. Gynecol Oncol. 2017; 145(1): 208–16.-DOI: https://dx.doi.org/10.1016/j.ygyno.2017.02.019.
Peters A., Sadecky A.M., Winger D.G., et al. Characterization and preoperative risk analysis of leiomyosarcomas at a high-volume tertiary care center. Int J Gynecol Cancer. 2017; 27(6): 1183–90.-DOI: https://dx.doi.org/10.1097/IGC.0000000000000940.
Stukan M., Rutkowski P., Smadja J., Bonvalot S. Ultrasound-guided trans-uterine cavity core needle biopsy of uterine myometrial tumors to differentiate sarcoma from a benign lesion-description of the method and review of the literature. Diagnostics (Basel, Switzerland). 2022; 12(6). -DOI: https://dx.doi.org/10.3390/diagnostics12061348.
Van Houdt W.J., Schrijver A.M., Cohen-Hallaleh R.B., et al. Needle tract seeding following core biopsies in retroperitoneal sarcoma. Eur J Surg Oncol. 2017; 43(9):1740–5.-DOI: https://dx.doi.org/10.1016/j.ejso.2017.06.009.
Gronchi A., Miah A.B., Dei Tos A.P., et al. Soft tissue and visceral sarcomas: ESMO-EURACAN-GENTURIS Clinical Practice Guidelines for diagnosis, treatment and follow-up☆. Ann Oncol Off J Eur Soc Med Oncol. 2021; 32(11): 1348–65.-DOI: https://dx.doi.org/10.1016/j.annonc.2021.07.006.
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