Preoperative diagnosis of occult uterine sarcomas has proven to be challenging in presumed benign hysterectomy cases. We aim to discern clinical features that could identify a potential uterine sarcoma.METHODS:
We conducted a case-control study of women diagnosed with occult (no preoperative suspicion) and presumed (known or suspected) uterine sarcoma and compared these groups to age- and race-matched controls (1:2 ratio) of women undergoing hysterectomy for leiomyoma or abnormal uterine bleeding 2006–2013 in Kaiser Permanente in California. Conditional logistic regression analyses were used to identify potential preoperative clinical factors associated with uterine sarcoma (any sarcoma, presumed sarcoma, occult sarcoma) with the threshold of significance set at P less than .05.RESULTS:
Of 273 total uterine sarcoma cases identified, 118 (43.2%) were occult. Risk factors predictive of any malignancy in comparison to the control (P less than .05) included documented uterine size increase (OR 4.1 any; 3.7 presumed; 8.7 occult), pelvic pain requiring narcotic medications (OR 5.6 any; 5.9 presumed; 22.1 occult), and history of transfusion within 3 months of hysterectomy (OR 4.7 any; 7.2 presumed; 11.6 occult). Other factors such as uterine weight, postmenopausal bleeding, pelvic pain requiring hospitalization or ER admission, prior hormonal therapy or previous uterine artery embolization were not found to be significantly different between groups.CONCLUSION:
Our large case cohort identifies potential characteristics of occult and presumed uterine sarcomas in comparison to benign hysterectomy patients. These results may be useful for developing a nomogram to predict uterine sarcoma in the preoperative setting.