Population-Based Estimates of the Prevalence of Uterine Sarcoma Among Patients With Leiomyomata Undergoing Surgical Treatment

摘要

Uterine leiomyoma (ULM) is common among women in the United States and is associated with abnormal uterine bleeding as well as pelvic pressure and pain. The annual diagnosis rate for ULM ranges from 2.0 to 12.8 per 1000 reproductive-age women. Standard surgical management for symptomatic patients includes open and laparoscopic hysterectomy, uterine artery embolization, myolysis, and magnetic resonance-guided focused ultrasound. Electric morcellation has been used by surgeons during laparoscopic and robotic-assisted hysterectomies and myomectomies as a less invasive alternative to open surgery. Concern that morcellation may spread occult sarcoma tissue led the US Food and Drug Administration (FDA) in April 2014 to issue a statement discouraging the use of this technique. Based on a literature search, the FDA reported that 1 in 352 women undergoing surgery for presumed benign ULM have occult uterine sarcoma. A study published in July 2014 reported similar results: 1 in 368 women undergoing morcellation had uterine cancer. The estimates in this study, however, were limited by the lack of pathologic confirmation and by the selective participation of hospitals. Moreover, the literature estimates used by the FDA may overestimate risk because of referral and reporting bias.