Evaluation of uterine myomas using the leuven score (LS) as a predictor of sarcoma: a retrospective analysis

Introduction: Uterine fibroid is very common. Despite new conservative options, hysterectomy remains the main therapy worldwide. Morcellation has enabled the removal of large uteri via laparoscopy. However, the dramatic outcome in case of sarcoma morcellation has led the FDA to no longer recommend it, leading to more invasive procedures with higher morbidity and costs. Today, there are no reliable criteria to distiguish between benign fibroid and sarcoma. This study aims to analyze whether the Leuven score (LS) permits a classification in high- and low risk clusters for best surgical procedure selection.

Material and methods: The LS involves 6 sonographic criteria: past 3 months growth, high blood flow, atypical growth, irregular lining, central necrosis and oval solitary lesion. We retrospectively applied the LS for all uterine sarcoma from 2002 – 2015 (control group: all benign uterus myomatosus operated between 01/2013 – 06/2015).

Results: We included 7 uterine sarcoma and 27 benign myomas. 81% of the leiomyomas showed a negative LS, and only one sarcoma showed a negative score, which represents a NPV of 95.6% (PPV 54.5%). The size of the myoma and uterus was similar in both groups. 85% of the women with sarcomas were postmenopausal (18.5% in controls) and only 50% showed bleeding versus 74% in the control group.

Conclusion: The LS could help to distinguish between benign fibroid and sarcoma, with a high probability of a benign histology if the score is negative. Caution is required when ≥1 criteria is present (morcellation not recommended). We continue the analysis prospectively with additional criteria.