title: The Role of Endometrial Biopsy in the Preoperative Detection of Uterine Leiomyosarcoma.
abstract: To assess the sensitivity of preoperative endometrial biopsy in detection of uterine leiomyosarcoma (ULMS).
  
  
  
  Retrospective analysis of a prospectively collected database (Canadian Task Force III).
  
  
  
  Two academic tertiary referral centers.
  
  
  
  All cases of ULMS treated at participating institutions between January 2005 and August 2012 were identified following IRB approval.
  
  
  
  Abstracted data included demographics, preoperative evaluation, presenting symptom, surgical management, pathology and clinical outcomes. Chi-square tests were used for statistical analysis.
  
  
  
  329 cases were identified, of which 152 cases had complete pathologic data available for review. Sixty-eight (45%) of 152 patients had endometrial sampling prior to surgery. Patients with postmenopausal bleeding were significantly more likely to be biopsied preoperatively (51.6% vs 9.5%, p = <.0001). Of those sampled, 43 (63%) underwent endometrial pipelle biopsies and 25 (37%) had dilation and curettage. Endometrial sampling was significantly more likely to detect a concern for malignancy in patients who presented with postmenopausal bleeding (72.7% vs 32.3%, p = 0.002), however it was less likely to detect malignancy in patients with abnormal premenopausal bleeding (31.8% vs 64.3%, p = .02), compared to other presenting symptoms. Overall, 51.5% of patients with ULMS on final pathology had preoperative endometrial biopsies in which leiomyosarcoma or atypical spindle cell proliferation were diagnosed, whereas 35.5% of the pre-operative biopsies identified ULMS specifically.
  
  
  
  The sensitivity of an endometrial biopsy to detect ULMS is low, illustrating the difficulty of diagnosing ULMS preoperatively. As expected, the probability that an endometrial biopsy will detect ULMS or a related worrisome pathological finding is higher for patients with post-menopausal bleeding. Thus, benign endometrial biopsy results, particularly in pre-menopausal patients, should be interpreted with caution if there is suspicion for leiomyosarcoma. However, a positive or suspicious result can play an important role in the subsequent management of patients with ULMS, even if the absolute numbers of affected patients are small.
authors: Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts; Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts. Electronic address: ehinchcliff@partners.org.
authors: Emily M
authors: EM
authors: Hinchcliff
authors: Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors: Katharine M
authors: KM
authors: Esselen
authors: Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts.
authors: Jaclyn C
authors: JC
authors: Watkins
authors: Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts; Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors: Titilope
authors: T
authors: Oduyebo
authors: Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors: J Alejandro
authors: JA
authors: Rauh-Hain
authors: Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors: Marcela G
authors: MG
authors: Del Carmen
authors: Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts.
authors: Bradley J
authors: BJ
authors: Quade
authors: Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors: Michael G
authors: MG
authors: Muto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D004717:Endometrium / Q000473:pathology*; D005260:Female; D006801:Humans; D007890:Leiomyosarcoma / Q000175:diagnosis* / Q000601:surgery; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014592:Uterine Hemorrhage / Q000473:pathology; D014594:Uterine Neoplasms / Q000175:diagnosis* / Q000601:surgery; D055815:Young Adult
keywords: Endometrial biopsy; Uterine leiomyoma; Uterine leiomyosarcoma