Endometrial Sampling for Preoperative Diagnosis of Uterine Leiomyosarcoma

J Minim Invasive Gynecol. 2022 Jan;29(1):119-127. doi: 10.1016/j.jmig.2021.07.004. Epub 2021 Jul 13.


Study objectives: To examine the effectiveness of endometrial sampling for preoperative detection of uterine leiomyosarcoma in women undergoing hysterectomy, identify factors associated with missed diagnosis, and compare the outcomes of patients who had a preoperative diagnosis with those of patients who had a missed diagnosis.

Design: Retrospective cohort study using linked data from the New York Statewide Planning and Research Cooperative System and New York State Cancer Registry from 2003 to 2015.

Setting: Inpatient and outpatient encounters at civilian hospitals and ambulatory surgery centers in New York State.

Patients: Women with uterine leiomyosarcoma who underwent a hysterectomy and a preoperative endometrial sampling within 90 days before the hysterectomy.

Interventions: Endometrial sampling.

Measurements and main results: A total of 79 patients with uterine leiomyosarcoma met the sample eligibility criteria. Of these patients, 46 (58.2%) were diagnosed preoperatively, and 33 (41.8%) were diagnosed postoperatively. Patients in the 2 groups did not differ significantly in age, race/ethnicity, bleeding symptoms, or comorbidities assessed. In multivariable regression analysis, women who had endometrial sampling performed with hysteroscopy (compared with women who had endeometrial sampling performed without hysteroscopy) had a higher likelihood of preoperative diagnosis (adjusted risk ratio [aRR] 3.03; 95% confidence interval [CI], 1.43-6.42). Patients with localized stage (vs distant stage) or tumor size >11 cm (vs <8 cm) were less likely to be diagnosed preoperatively (aRR 0.50; 95% CI, 0.28-0.89, and aRR 0.54; 95% CI, 0.30-0.99, respectively). Supracervical hysterectomy was not performed in any of the patients whose leiomyosarcoma was diagnosed preoperatively compared with 21.2% of the patients who were diagnosed postoperatively (p = .002).

Conclusion: Endometrial sampling detected leiomyosarcoma preoperatively in 58.2% of the patients. The use of hysteroscopy with endometrial sampling improved preoperative detection of leiomyosarcoma by threefold. Patients with a missed diagnosis had a higher risk of undergoing suboptimal surgical management at the time of their index surgery.

Keywords: Endometrial sampling; Hysterectomy; Hysteroscopy; Leiomyosarcoma.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Endometrial Neoplasms* / surgery
  • Endometrium
  • Female
  • Humans
  • Hysterectomy
  • Leiomyosarcoma* / diagnosis
  • Leiomyosarcoma* / surgery
  • Retrospective Studies
  • Uterine Neoplasms* / diagnosis
  • Uterine Neoplasms* / surgery