Sonographic features of uterine sarcomas: a multicentre retrospective study

Objectives: To describe the sonographic features in a series of uterine sarcomas. Methods: Retrospective cohort study. Clinical (age, menopausal status); sonographic (lesion size, contour, echogenicity, presence of acoustic shadowing, vascularisation as assessed by colour Doppler) and histological (histological type) data from 60 women with histological diagnosis of uterine sarcoma evaluated and treated at three university hospitals were reviewed. Results: Mean patients’ age was 53.7 years (range: 26 to 81 years). 40% of women were premenopausal. 22% of patients were asymptomatic. 59% had vaginal bleeding. Histologically, there were 25 leiomyosarcomas, 25 endometrial stromal sarcomas and 10 carcinosarcomas. In 11 cases (18.3%) no distinct mass was identifiable. Mean uterine volume was 511.5 mL (range: 23.0 to 4804.2 mL). In those 49 cases were a mass was identifiable, t he sonographic features were as follows: Mean tumour volume: 7.9 cm (SD: 45.9, range: 1.5 to 21.8 cm). Mass contour: well-defined (n = 34, 69%); ill-defined (n = 15, 31%). Echogenicity: homogeneous (n = 12, 25%); heterogeneous (n = 29, 59%); cystic areas (n = 8, 16%). Acoustic shadowing: yes (n = 3, 8%); no (n = 32, 65%), not described (n = 13, 37%). Shape: rounded (n = 35, 72%), lobulated (n = 10, 20%), Ovoid (n = 4, 8%). Colour score: No flow (n = 3, 7%); scanty (n = 19, 44%); moderate (n = 9, 21%); abundant (n = 12, 28%). Most lesions had intramural (n = 22, 44.8%) or submucosal/intracavitary (n = 17, 34.6%) location. Only in 45% of cases there was sonographic suspicion of sarcoma prior to surgery. Conclusions: The sonographic spectrum of sarcomas is wide. Many cases do not present suspicious findings. These data show the limitations of ultrasonography for the diagnosis of these lesions.