Naar een nauwkeuriger diagnose van uterine myomen en sarcomen op basis van echografie en biomarker onderzoek.

Malignant mesenchymal tumors of the uterus (also called uterine sarcomas) are rare and are associated with a poor five-year survival (38,5% (95%CI 31,9-45,2%)). The Belgian cancer registry reported 421 new cases of mixed epithelial and mesenchymal tumors of the uterus over a period of 10 years (2001-2010). In contrast, the incidence of benign mesenchymal tumors (also called leiomyomas) at age 50 is estimated to be 50% .Distinguishing between uterine myoma and uterine sarcoma is of utmost importance to adjust patient management. A myoma can be treated conservatively or by minimally invasive surgery (e.g. laparoscopic myomectomy with power morcellation). On the other hand, uterine sarcoma is mandatorily treated by radical en-bloc surgery in an oncological centre. In 2014 the FDA (U.S. Food & Drug administration) published a safety communication against the use of laparoscopic power morcellation after an unfortunate event of uterine sarcoma morcellation, which led to widespread metastatic disease in one specific patient. This warning resulted in an increase in open surgery (e.g. abdominal hysterectomy) mirrored by an increase in operative complications. The estimated risk of an unexpected leiomyosarcoma ranges from 1/498 to less than 1/10.000 surgical procedures for presumed leiomyomas. Unfortunately, there are no diagnostic tools that can correctly distinguish between a uterine myoma and uterine sarcoma: nor ultrasound, nor MRI, nor any single liquid biomarker. All ultrasound studies are retrospective with small inclusion numbers. Based on those retrospective studies, uterine sarcomas are large, solitary and inhomogeneous with moderate to high vascularity and cystic areas. In 2015, a consensus opinion among international experts in gynaecological ultrasound has been published on how to describe sonographic features of the myometrium and uterine lesions (the Morphological Uterus Sonographic Assessment or MUSA-consensus): size, location, echogenicity, rim and shape of the lesion; presence and type of shadow; presence, size, echogenicity of cysts, and vascularity of the lesion. This was a first step towards the possibility of conducting multicentre international studies on ultrasound features of different myometrial lesions and their correlation with clinical outcome. Liquid biopsy has shown to give additional information in the diagnostic workup of different cancers. A liquid biopsy is a non-invasive method (blood sampling) for the detection of circulating biomarkers. The response to a treatment could also be monitored by these biomarkers. The knowledge about liquid biopsies in uterine sarcoma is limited, due to the low prevalence of the disease. It has been demonstrated that neutrophil-to-lymphocyte ratio (NLR) is increased at diagnosis and that CA-125 (cancer antigen 125), LDH (Lactate dehydrogenase) and GDF-15 (growth differentiation factor 15) are increased in leiomyosarcoma compared to leiomyoma.