Table 3 Statements on diagnostic tests for uterine sarcoma

There are no features predicting a leiomyosarcoma (LMS) on any imaging technique with certainty

C

A large (≥8 cm), solitary, oval-shaped, highly vascularised (peripheral and central) and irregular, heterogeneous myometrial tumour with central necrosis/degenerative cystic changes and absence of calcifications must raise the suspicion of a LMS

D

Rapid increase in size (within 3 months) has been reported in LMS but is generally not distinctive as it may occur in fibroids as well. No growth—in 3 months—may be reassuring unless in combination with GnRH

C

MRI with contrast enhancement may prove helpful in differentiating between LMS and fibroid

C

Total LDH and LDH isozyme 3 may help in differentiating between LMS and fibroid

C

CA125 may be elevated in advanced staged LMS but seems not useful in early stage LMS

C

Endometrial sampling in the detection of uterine sarcoma is indicated in abnormal uterine bleeding. Without abnormal uterine bleeding its role is unclear

D

Transcervical or transabdominal needle biopsy may prove of help in differentiating between LMS and a fibroid, although no data are available on spread of tumour cells caused by the biopsy needle

D