title: A scoring system for histopathologic and immunohistochemical evaluations of uterine leiomyosarcomas.
abstract: Uterine leiomyosarcomas (LMS) are difficult to distinguish from benign leiomyomas without surgery. In this study we performed transcervical needle biopsy on 475 patients, 8 LMS patients and 467 patients with non-sarcomas (non-LMS) in a high-risk group for LMS, and evaluated whether examinations performed with Ki-67 and CD34 immunohistochemical analyses in addition to the standard hematoxylin-eosin (H&E)-stained sections would improve preoperative diagnostic precision of the uterine smooth muscle tumors. Histopathologic analysis included three factors: degree of cytologic atypia, mitotic index and coagulative tumor cell necrosis (CTCN). We also evaluated cell proliferation with Ki-67 expression. In cases of suspected CTCN, we examined CD34 expression and counted positive blood vessels in the necrotic area. Three of the 8 LMS cases satisfied the diagnostic criteria of LMS by histopathologic evaluation with H&E-stained sections. We made a score list based on these analyses; scores for LMS specimens ranged from 6-14 points; non-LMS specimens scored 0-2 points. At the cut-off score of 6 points, the positive predictive value to distinguish LMS from non-LMS was 100%, showing that this scoring system, is a useful method for preoperative differentiation between LMS and non-LMS tumors.
authors.affiliation: Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan. c-yoshida@med.osaka-cu.ac.jp
authors.forename: Chika
authors.initials: C
authors.lastname: Yoshida
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Ichimura
authors.forename: Naoki
authors.initials: N
authors.lastname: Kawamura
authors.forename: Akemi
authors.initials: A
authors.lastname: Nakano
authors.forename: Mari
authors.initials: M
authors.lastname: Kasai
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Sumi
authors.forename: Osamu
authors.initials: O
authors.lastname: Ishiko
mesh_terms: D018952:Antigens, CD34 / Q000378:metabolism*; D001707:Biopsy, Needle; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D019394:Ki-67 Antigen / Q000378:metabolism*; D007889:Leiomyoma / Q000473:pathology; D007890:Leiomyosarcoma / Q000175:diagnosis* / Q000378:metabolism; D008875:Middle Aged; D008940:Mitotic Index; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014594:Uterine Neoplasms / Q000175:diagnosis* / Q000378:metabolism
chemical_list: D018952:Antigens, CD34; D019394:Ki-67 Antigen