title: The value of perioperative imaging in patients with uterine sarcomas.
abstract: OBJECTIVE
  To explore the yield and impact of perioperative imaging on management among patients undergoing surgical resection and treatment of uterine sarcomas.
  
  
  METHODS
  A retrospective chart review was done for women with histologically confirmed uterine sarcomas treated at Barnes Jewish Hospital/Washington University from 2001 to 2007. Descriptive statistics, Cox multivariate models, and Kaplan-Meier plots were used to evaluate associations and survival.
  
  
  RESULTS
  A total of 92 patients were identified and 55 (60%) were diagnosed with stage III-IV disease. Perioperative imaging was obtained in 84 (91%) cases, including chest X-ray in 66 (72%), computerized tomography (CT) of the abdomen and pelvis in 59 (64%), chest CT in 33 (36%), positron emission tomography (PET) in 8 (9%), and CT of the head, pelvic magnetic resonance imaging (MRI), or bone scan in a total of 2 (2.2%). Imaging identified abnormalities concerning for metastases in 30 (32%) studies. Thirty-four recurrences have been documented, and 21 (62%) of these treatment failures were extrapelvic. Multivariate analysis of this series noted that tomographic evidence of extrauterine disease predicted recurrence (p=0.028) and incomplete surgical resection (p=0.003, HR 6.0 95% CI 1.9-19.9) predicted disease-free survival. Imaging contributed to change in surgical and post-surgical treatment decisions in 8 (9%) patients.
  
  
  CONCLUSIONS
  Pretreatment imaging studies change management in a minority of patients with newly diagnosed uterine sarcomas.
authors: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine and Siteman Cancer Center, USA.
authors: Elizabeth K
authors: EK
authors: Nugent
authors: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine and Siteman Cancer Center, USA.
authors: Israel
authors: I
authors: Zighelboim
authors: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine and Siteman Cancer Center, USA.
authors: Ashley S
authors: AS
authors: Case
authors: Division of Biostatistics, Washington University School of Medicine and Siteman Cancer Center, USA.
authors: Feng
authors: F
authors: Gao
authors: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine and Siteman Cancer Center, USA.
authors: Premal H
authors: PH
authors: Thaker
authors: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine and Siteman Cancer Center, USA.
authors: Janet S
authors: JS
authors: Rader
authors: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine and Siteman Cancer Center, USA.
authors: David G
authors: DG
authors: Mutch
authors: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine and Siteman Cancer Center, USA. Electronic address: massadl@wudosis.wustl.edu.
authors: L Stewart
authors: LS
authors: Massad
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003952:Diagnostic Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009367:Neoplasm Staging; D019990:Perioperative Care; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D012509:Sarcoma / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D014594:Uterine Neoplasms / Q000473:pathology*; D055815:Young Adult