Accuracy of Ultrasound in the Diagnosis of Uterine Fibroids and Malignant Uterine Lesions among Saudi Women

ORIGINAL ARTICLE
Sahar Mansour, Layan Almayouf, Nouf Alnuhair, Nuha Alabdulrahim, Reham Aldossari, Renad Alqarni, Sarah Aljubailan, Shooq Alawwad, Halima Hawesa, Mahasin G. Hassan

 
For citation: Mansour S, Almayouf L, Alnuhair N, Alabdulrahim N, Aldossari R, Alqarni R, Aljubailan S, Alawwad S, Hawesa H, Hassan MG. Accuracy of Ultrasound in the Diagnosis of Uterine Fibroids and Malignant Uterine Lesions among Saudi Women. International Journal of Biomedicine. 2024;14(3):469-473. doi:10.21103/Article14(3)_OA13
 
Originally published September 6, 2024

Abstract: 

Background: Uterine fibroids, the most frequent benign uterus tumors, often cannot be distinguished from malignant uterine tumors using clinical criteria. Due to their potential overlapping characteristics, imaging differentiation between both entities is commonly challenging. This study aims to evaluate the diagnostic accuracy of ultrasound (US) in the diagnosis of uterine fibroids and malignant uterine lesions among Saudi women.
Methods and Results: Eighty Saudi women aged between 20 and 70 years were retrospectively collected from two different centers in Riyadh, Saudi Arabia. All patients were subjected to a presurgical US scan, and the diagnosis was histopathologically proven. The US accurately detected uterine fibroids in 43(53.75%) of cases with different locations. Intramural fibroids [62.8% (27/43)] were the most common, followed by subserosal fibroids [25.6% (11/43)], submucosal fibroids [7.0% (3/43)], and pedunculated fibroids [4.6% (2/43)]. Signs of endometrial cancer were US found in 7(8.75%) cases that were histologically proven. Ultrasound features suspicious of uterine cancer were found in 30(37.5%) cases that were not confirmed by histopathological examination.
The sensitivity and specificity of ultrasound for uterine cancer diagnosis were 100% (95% CI: 59.04% to 100.00%) and 58.9% (CI: 46.77% to 70.29%), respectively. Cancer incidence was more frequent among postmenopausal patients (n=5) compared to premenopausal patients (n=2).
Conclusion: The US is a good and accurate diagnostic method in differentiating types of uterine fibroids in Saudi women. The sensitivity and specificity of ultrasound in diagnosing uterine cancer are 100% and 58.9%, respectively. The incidence of cancer is higher among postmenopausal patients compared to premenopausal patients.

Keywords: 
uterine fibroids • ultrasound imaging • malignant tumors • diagnosis
References: 
  1. Lou Z, Huang Y, Li S, Luo Z, Li C, Chu K, Zhang T, Song P, Zhou J. Global, regional, and national time trends in incidence, prevalence, years lived with disability for uterine fibroids, 1990-2019: an age-period-cohort analysis for the global burden of disease 2019 study. BMC Public Health. 2023 May 19;23(1):916. doi: 10.1186/s12889-023-15765-x. PMID: 37208621; PMCID: PMC10199532.
  2.  Giuliani E, As-Sanie S, Marsh EE. Epidemiology and management of uterine fibroids. Int J Gynaecol Obstet. 2020 Apr;149(1):3-9. doi: 10.1002/ijgo.13102. Epub 2020 Feb 17. PMID: 31960950.
  3. Keizer AL, van Kesteren PJM, Terwee C, de Lange ME, Hehenkamp WJK, Kok HS. Uterine Fibroid Symptom and Quality of Life questionnaire (UFS-QOL NL) in the Dutch population: a validation study. BMJ Open. 2021 Nov 23;11(11):e052664. doi: 10.1136/bmjopen-2021-052664. PMID: 34815284; PMCID: PMC8611425.
  4. Stewart EA, Laughlin-Tommaso SK, Catherino WH, Lalitkumar S, Gupta D, Vollenhoven B. Uterine fibroids. Nat Rev Dis Primers. 2016 Jun 23;2:16043. doi: 10.1038/nrdp.2016.43. PMID: 27335259.
  5. Management of Symptomatic Uterine Leiomyomas: ACOG Practice Bulletin, Number 228. Obstet Gynecol. 2021 Jun 1;137(6):e100-e115. doi: 10.1097/AOG.0000000000004401. PMID: 34011888.
  6. Palheta MS, Medeiros FDC, Severiano ARG. Reporting of uterine fibroids on ultrasound examinations: an illustrated report template focused on surgical planning. Radiol Bras. 2023 Mar-Apr;56(2):86-94. doi: 10.1590/0100-3984.2022.0048. PMID: 37168038; PMCID: PMC10165971.
  7. Pereira AEMM, Franco J, Machado FS, Geber S. Accuracy of Transvaginal Ultrasound in the Diagnosis of Intrauterine Lesions. Rev Bras Ginecol Obstet. 2021 Jul;43(7):530-534. doi: 10.1055/s-0041-1732462. Epub 2021 Aug 30. PMID: 34461663; PMCID: PMC10305154.
  8. Liu YH, Qiu YH, Ru Y, Liu YQ, Wang D, Zhang PA. Selection of different surgical methods for uterine fibroids: Protocol for a retrospective clinical study. Medicine (Baltimore). 2021 Dec 23;100(51):e28378. doi: 10.1097/MD.0000000000028378. PMID: 34941163; PMCID: PMC8702229.
  9. Metwally M, Raybould G, Cheong YC, Horne AW. Surgical treatment of fibroids for subfertility. Cochrane Database Syst Rev. 2020 Jan 29;1(1):CD003857. doi: 10.1002/14651858.CD003857.pub4. PMID: 31995657; PMCID: PMC6989141.
  10. Wojtowicz K, Góra T, Guzik P, Harpula M, Chechliński P, Wolak E, Stryjkowska-Góra A. Uterine Myomas and Sarcomas - Clinical and Ultrasound Characteristics and Differential Diagnosis Using Pulsed and Color Doppler Techniques. J Ultrason. 2022 Apr 27;22(89):100-108. doi: 10.15557/JoU.2022.0017. PMID: 35811590; PMCID: PMC9231509.
  11. Chelmow D, Brooks R, Cavens A, Huber-Keener K, Scott DM, Sheth SS, Whetstone S, Worly B, Burke W. Executive Summary of the Uterine Cancer Evidence Review Conference. Obstet Gynecol. 2022 Apr 1;139(4):626-643. doi: 10.1097/AOG.0000000000004711. Epub 2022 Mar 10. PMID: 35272316; PMCID: PMC8936160.
  12. Giunchi S, Perrone AM, Tesei M, Bovicelli A, De Crescenzo E, Dondi G, et al. Sonographic imaging in uterine sarcoma: a narrative review of literature, Gynecol Pelvic Med. 2021; 5: 14.
  13. Sun S, Bonaffini PA, Nougaret S, Fournier L, Dohan A, Chong J, Smith J, Addley H, Reinhold C. How to differentiate uterine leiomyosarcoma from leiomyoma with imaging. Diagn Interv Imaging. 2019 Oct;100(10):619-634. doi: 10.1016/j.diii.2019.07.007. Epub 2019 Aug 16. PMID: 31427216.
  14. Pourhoseingholi MA, Vahedi M, Rahimzadeh M. Sample size calculation in medical studies. Gastroenterol Hepatol Bed Bench. 2013 Winter;6(1):14-7. PMID: 24834239; PMCID: PMC4017493.
  15. Qi H, Zhou C, Huang Z, Yang N, Wu Q. Value of Transabdominal Combined Transvaginal Color Doppler Ultrasonography in the Distinguish between Uterine Adenomyoma and Uterine Fibroids. Biomed Res Int. 2022 Jul 7;2022:9599571. doi: 10.1155/2022/9599571. Retraction in: Biomed Res Int. 2023 Nov 29;2023:9876769. doi: 10.1155/2023/9876769. PMID: 35845931; PMCID: PMC9283036.
  16. Woźniak A, Woźniak S. Ultrasonography of uterine leiomyomas. Prz Menopauzalny. 2017 Dec;16(4):113-117. doi: 10.5114/pm.2017.72754. Epub 2017 Dec 30. PMID: 29483851; PMCID: PMC5824679.
  17. De La Cruz MS, Buchanan EM. Uterine Fibroids: Diagnosis and Treatment. Am Fam Physician. 2017 Jan 15;95(2):100-107. PMID: 28084714.
  18. Khan AT, Shehmar M, Gupta JK. Uterine fibroids: current perspectives. Int J Womens Health. 2014 Jan 29;6:95-114. doi: 10.2147/IJWH.S51083. PMID: 24511243; PMCID: PMC3914832.
  19. George JW. The burden of uterine fibroids: an overview. J Histotechnol. 2023 Dec;46(4):153-155. doi: 10.1080/01478885.2023.2265185. Epub 2023 Nov 27. PMID: 37791571.
  20. Mori KM, Abaid LN, Mendivil AA, Brown JV 3rd, Beck TL, Micha JP, Epstein HD, Goldstein BH. The incidence of occult malignancy following uterine morcellation: A ten-year single institution experience retrospective cohort study. Int J Surg. 2018 May;53:239-242. doi: 10.1016/j.ijsu.2018.03.075. Epub 2018 Apr 3. PMID: 29621658.
  21. Cheng G, Hu Y, Gong Y. Clinical manifestations and prognosis of unexpected uterine sarcoma of uterine fibroids in Tianjin China. BMC Womens Health. 2022 Dec 6;22(1):495. doi: 10.1186/s12905-022-02077-2. PMID: 36474216; PMCID: PMC9724254.
  22. Zhu M, Chen S. Clinical features of uterine sarcomas presenting mainly with uterine masses: a retrospective study. BMC Womens Health. 2023 Jul 26;23(1):394. doi: 10.1186/s12905-023-02517-7. PMID: 37496042; PMCID: PMC10373283.
  23. Liu S, Wang Y, Yang X, Lei B, Liu L, Li S X., et al. Deep Learning in Medical Ultrasound Analysis: A Review. Engineering. 2019; 5: 261-275.
  24. Bulun SE. Uterine fibroids. N Engl J Med. 2013 Oct 3;369(14):1344-55. doi: 10.1056/NEJMra1209993. PMID: 24088094.
  25. Muawad R, Dabbagh R, Sabr Y. Association of health and lifestyle factors with uterine fibroids among Saudi women: A case-control study. J Taibah Univ Med Sci. 2022 Jul 11;17(6):1039-1046. doi: 10.1016/j.jtumed.2022.06.005. PMID: 36212583; PMCID: PMC9519786.
  26. Ludovisi M, Moro F, Pasciuto T, Di Noi S, Giunchi S, Savelli L, Pascual MA, Sladkevicius P, Alcazar JL, Franchi D, Mancari R, Moruzzi MC, Jurkovic D, Chiappa V, Guerriero S, Exacoustos C, Epstein E, Frühauf F, Fischerova D, Fruscio R, Ciccarone F, Zannoni GF, Scambia G, Valentin L, Testa AC. Imaging in gynecological disease (15): clinical and ultrasound characteristics of uterine sarcoma. Ultrasound Obstet Gynecol. 2019 Nov;54(5):676-687. doi: 10.1002/uog.20270. Epub 2019 Oct 7. PMID: 30908820.
  27. Kim JH, Kim HJ, Kim SH, Shin SA, Park SY, Kim DY, Lee SR, Chae HD, Kang BM. Sonographic and Clinical Characteristics of Uterine Sarcoma Initially Misdiagnosed as Uterine Fibroid in Women in the Late Reproductive Age. J Menopausal Med. 2019 Dec;25(3):164-171. doi: 10.6118/jmm.19007. PMID: 32307942; PMCID: PMC6952706.
  28. Szabó I, Szánthó A, Csabay L, Csapó Z, Szirmai K, Papp Z. Color Doppler ultrasonography in the differentiation of uterine sarcomas from uterine leiomyomas. Eur J Gynaecol Oncol. 2002;23(1):29-34. PMID: 11876388.
  29. Exacoustos C, Romanini ME, Amadio A, Amoroso C, Szabolcs B, Zupi E, Arduini D. Can gray-scale and color Doppler sonography differentiate between uterine leiomyosarcoma and leiomyoma? J Clin Ultrasound. 2007 Oct;35(8):449-57. doi: 10.1002/jcu.20386. PMID: 17636502.
  30. Aviram R, Ochshorn Y, Markovitch O, Fishman A, Cohen I, Altaras MM, Tepper R. Uterine sarcomas versus leiomyomas: gray-scale and Doppler sonographic findings. J Clin Ultrasound. 2005 Jan;33(1):10-3. doi: 10.1002/jcu.20075. PMID: 15690441.
  31. Donnez J, Dolmans MM. Uterine fibroid management: from the present to the future. Hum Reprod Update. 2016 Nov;22(6):665-686. doi: 10.1093/humupd/dmw023. Epub 2016 Jul 27. PMID: 27466209; PMCID: PMC5853598.
  32. Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003 Jan;188(1):100-7. doi: 10.1067/mob.2003.99. PMID: 12548202.
  33. Wise LA, Laughlin-Tommaso SK. Epidemiology of Uterine Fibroids: From Menarche to Menopause. Clin Obstet Gynecol. 2016 Mar;59(1):2-24. doi: 10.1097/GRF.0000000000000164. PMID: 26744813; PMCID: PMC4733579.
  34. Cermik D, Arici A, Taylor HS. Coordinated regulation of HOX gene expression in myometrium and uterine leiomyoma. Fertil Steril. 2002 Nov;78(5):979-84. doi: 10.1016/s0015-0282(02)03366-6. PMID: 12413981.
  35. World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013 Nov 27;310(20):2191-4. doi: 10.1001/jama.2013.281053. PMID: 24141714.

Download Article
Received June 18, 2024.
Accepted August 29, 2024.
©2024 International Medical Research and Development Corporation.