A Radiology 'How I Do It' article sets out how to apply the 2023 consensus algorithm for assessing uterine masses for leiomyosarcoma risk. The risk of unsuspected sarcoma may be as high as 1 in 770 women having surgery for presumed fibroids, and morcellation or other minimally invasive treatment of an unrecognised sarcoma can spread disease.
Contrast-enhanced MRI with diffusion-weighted imaging and ADC measurement reaches 88–94.6% accuracy for leiomyosarcoma. The algorithm has been preliminarily validated, and the article adds practical nuances for applying it.
This is an expert review, not new data. Its value is in making a structured MRI assessment routine before uterus-sparing or morcellating procedures.
- Offer contrast-enhanced MRI with DWI before myomectomy, morcellation or embolisation for an atypical or enlarging mass.
- Report T2 signal, diffusion restriction, ADC value, enhancement and margins.
- Use the consensus algorithm's risk category in the conclusion.
- Discuss high-risk masses with gynaecological oncology before any minimally invasive procedure.
Why it matters
A missed sarcoma treated as a fibroid can be spread by the operation meant to cure it.
Don't overread it
An expert review; the accuracy figures come from earlier studies and the algorithm's validation is described as preliminary.
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