The value of perioperative imaging in patients with uterine sarcomas.
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.
Nugent
Elizabeth K
EK
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine and Siteman Cancer Center, USA.
Zighelboim
Israel
I
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine and Siteman Cancer Center, USA.
Case
Ashley S
AS
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine and Siteman Cancer Center, USA.
Gao
Feng
F
Division of Biostatistics, Washington University School of Medicine and Siteman Cancer Center, USA.
Thaker
Premal H
PH
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine and Siteman Cancer Center, USA.
Rader
Janet S
JS
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine and Siteman Cancer Center, USA.
Mutch
David G
DG
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine and Siteman Cancer Center, USA.
Massad
L Stewart
LS
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.
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