title: Risk Factors for Occult Uterine Sarcoma Among Women Undergoing Minimally Invasive Gynecologic Surgery.
abstract: OBJECTIVE
  To determine factors that can identify a population at increased risk for uterine leiomyosarcoma.
  
  
  METHODS
  Retrospective case-control study (Canadian Task Force classification II-2).
  
  
  METHODS
  University teaching hospitals.
  
  
  METHODS
  Seventy-two women who underwent minimally invasive gynecologic surgery for presumed leiomyoma. Patients diagnosed with leiomyosarcoma (cases) were matched with up to 4 controls on age, year of surgery, and surgeon specialty.
  
  
  METHODS
  Cases were identified through the pathology database, and the diagnosis of leiomyosarcoma or leiomyoma was confirmed by gynecologic pathologists. The cumulative risk of leiomyosarcoma was calculated, and factors predictive of elevated risk for leiomyosarcoma were investigated using conditional logistic regression.
  
  
  RESULTS
  Fifteen patients with the diagnosis of inadvertently morcellated leiomyosarcoma were identified and matched with 57 controls. The cumulative risk of diagnosing uterine leiomyosarcoma on pathology after performing minimally invasive gynecologic surgery with morcellation was 0.19% (95% confidence interval [CI], 0.06%-0.56%). The presence of a hematocrit value < 30% (adjusted odds ratio [aOR], 20; 95% CI, 1.08-100; p = .05) was independently associated with the diagnosis of uterine leiomyosarcoma on multivariate analysis. Increased myoma size (aOR, 9.73; 95% CI, 0.75-1.26; p = .08) and presence of a solitary myoma (aOR, 3.85; 95% CI, 0.65-25; p = .14) were associated with a greater risk of uterine leiomyosarcoma; however, the difference was not statistically significant.
  
  
  CONCLUSIONS
  Anemia and myoma size >7 cm may be associated with occult leiomyosarcoma; however, these criteria are not sufficiently discriminatory to allow for preoperative identification of patients with uterine sarcoma. Future large multicenter studies are needed to further investigate these findings and the discovery of innovative ways to detect uterine leiomyosarcoma are urgently needed.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA; Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA; Harvard School of Medicine, Boston, MA.
authors.forename: Titilope
authors.initials: T
authors.lastname: Oduyebo
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA; Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA; Harvard School of Medicine, Boston, MA.
authors.forename: Emily
authors.initials: E
authors.lastname: Hinchcliff
authors.affiliation: Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital, Boston, MA; Harvard School of Medicine, Boston, MA.
authors.forename: Emily E
authors.initials: EE
authors.lastname: Meserve
authors.affiliation: Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital, Boston, MA; Harvard School of Medicine, Boston, MA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Seidman
authors.affiliation: Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital, Boston, MA; Harvard School of Medicine, Boston, MA.
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Quade
authors.affiliation: Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA; Harvard School of Medicine, Boston, MA.
authors.forename: J Alejandro
authors.initials: JA
authors.lastname: Rauh-Hain
authors.affiliation: Harvard School of Medicine, Boston, MA; Dana-Farber Cancer Institute, Boston, MA.
authors.forename: Suzanne
authors.initials: S
authors.lastname: George
authors.affiliation: Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital, Boston, MA; Harvard School of Medicine, Boston, MA.
authors.forename: Marisa R
authors.initials: MR
authors.lastname: Nucci
authors.affiliation: Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA; Harvard School of Medicine, Boston, MA.
authors.forename: Marcela G
authors.initials: MG
authors.lastname: del Carmen
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA; Harvard School of Medicine, Boston, MA. Electronic address: mmuto@partners.org.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Muto
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D007890:Leiomyosarcoma / Q000473:pathology*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D014594:Uterine Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Laparoscopy; Morcellation; Myoma; Sarcoma; Uterine leiomyosarcoma