{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T05:54:31Z","timestamp":1790747671503,"version":"4.1.0"},"reference-count":18,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100004775","name":"Natural Science Foundation of Gansu Province","doi-asserted-by":"publisher","award":["24JRRA407"],"award-info":[{"award-number":["24JRRA407"]}],"id":[{"id":"10.13039\/501100004775","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Clinical Ultrasound"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To investigate the clinical features, ultrasound manifestations and diagnostic value of high\u2010grade endometrial stromal sarcoma (HGESS), analyze their correlation with pathological findings, and provide evidence for preoperative diagnosis, differential diagnosis and prognostic evaluation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 36 patients with surgico\u2010pathologically confirmed HGESS (2023\u20132026) were retrospectively enrolled. Control groups included 28 low\u2010grade endometrial stromal sarcoma (LGESS) and 30 uterine leiomyosarcoma (ULMS). This retrospective singlecenter study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting checklist. Clinical, ultrasound, and pathological data were collected. Multivariate logistic regression with bootstrap internal validation, Receiver\u2010operating characteristic (ROC) curves, Kappa test, Spearman's correlation, Kaplan\u2013Meier survival analysis, and Log\u2010rank test were performed. We acknowledged the potential overfitting risk for regression analysis given the limited sample size.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The predominant symptoms of HGESS were irregular vaginal bleeding and lower abdominal distension and pain, with markedly shorter disease course than LGESS (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Serum LDH, CA125, and HE4 were significantly elevated in HGESS versus control groups (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Typical ultrasound findings included ill\u2010defined borders, heterogeneous hypoechogenicity, frequent internal necrosis and cystic degeneration, predominant Grade III blood flow and decreased resistance index (RI) (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Multivariate logistic regression identified ill\u2010defined borders, heterogeneous internal echo, Grade III blood flow and elevated LDH as independent risk factors for HGESS. Bootstrap internal validation supported model stability. The combined ultrasound\u2010tumor\u2010marker model yielded the area under the curve (AUC)\u2009=\u20090.918, sensitivity\u2009=\u2009100%, specificity\u2009=\u200974.1%. Caution should be exercised interpreting this high diagnostic performance given singlecenter retrospective design and sample\u2010size limitation. Lesion maximum diameter (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.621,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and blood\u2010flow abundance (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.584,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) positively correlated with the degree of histological malignancy. Shorter progression\u2010free survival (PFS) was observed for patients with lesion\u2009&gt;\u20095\u2009cm (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), RI\u2009&lt;\u20090.40 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003), and lymph\u2010node metastasis (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) in Log\u2010rank tests.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>HGESS is highly malignant with rapid progression and characteristic ultrasound signs. Combined ultrasound and tumor\u2010markers improve preoperative differential diagnosis. Ultrasound parameters provide prognostic clues for HGESS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jcu.70414","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T04:54:37Z","timestamp":1790744077000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical and Ultrasound Characteristics of High\u2010Grade Endometrial Stromal Sarcoma"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-3850-5896","authenticated-orcid":false,"given":"Fei","family":"Chen","sequence":"first","affiliation":[{"name":"Ultrasound Medical Center The Second Hospital of Lanzhou University  Lanzhou China"},{"name":"Gansu Province Clinical Research Center for Ultrasonography  Lanzhou China"},{"name":"Gansu Province Medical Engineering Research Center for Intelligence Ultrasound  Lanzhou China"},{"name":"Gansu Province Interventional Ultrasound Equipment Application Industry Technology Center  Lanzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4358-6174","authenticated-orcid":false,"given":"Lan","family":"Bu","sequence":"additional","affiliation":[{"name":"Ultrasound Medical Center The Second Hospital of Lanzhou University  Lanzhou China"},{"name":"Gansu Province Clinical Research Center for Ultrasonography  Lanzhou China"},{"name":"Gansu Province Medical Engineering Research Center for Intelligence Ultrasound  Lanzhou China"},{"name":"Gansu Province Interventional Ultrasound Equipment Application Industry Technology Center  Lanzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9725-1743","authenticated-orcid":false,"given":"Fang","family":"Nie","sequence":"additional","affiliation":[{"name":"Ultrasound Medical Center The Second Hospital of Lanzhou University  Lanzhou China"},{"name":"Gansu Province Clinical Research Center for Ultrasonography  Lanzhou China"},{"name":"Gansu Province Medical Engineering Research Center for Intelligence Ultrasound  Lanzhou China"},{"name":"Gansu Province Interventional Ultrasound Equipment Application Industry Technology Center  Lanzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"issue":"6","key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1016\/0301-5629(90)90020-D","article-title":"Doppler Ultrasound Color Flow Imaging in the Study of Breast Cancer: Preliminary Findings","volume":"16","author":"Adler D. 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S.","year":"2010","journal-title":"European Journal of Surgical Oncology"},{"issue":"4","key":"e_1_2_11_10_1","doi-asserted-by":"crossref","first-page":"281","DOI":"10.3348\/kjr.2006.7.4.281","article-title":"Sonographic Findings of Uterine Endometrial Stromal Sarcoma","volume":"7","author":"Kim J. A.","year":"2006","journal-title":"Korean Journal of Radiology"},{"issue":"2","key":"e_1_2_11_11_1","doi-asserted-by":"crossref","first-page":"170","DOI":"10.6004\/jnccn.2018.0006","article-title":"Uterine Neoplasms, Version 1.2018: NCCN Clinical Practice Guidelines in Oncology","volume":"16","author":"Koh W. J.","year":"2018","journal-title":"Journal of the National Comprehensive Cancer Network"},{"issue":"5","key":"e_1_2_11_12_1","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1038\/s41379-020-00705-6","article-title":"Targeted RNA Expression Profiling Identifies High\u2010Grade Endometrial Stromal Sarcoma as a Clinically Relevant Molecular Subtype of Uterine Sarcoma","volume":"34","author":"Momeni\u2010Boroujeni A.","year":"2020","journal-title":"Modern Pathology"},{"issue":"3","key":"e_1_2_11_13_1","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1053\/j.semdp.2022.01.004","article-title":"Endometrial Stromal Tumors: Diagnostic Updates and Challenges","volume":"39","author":"Niu S.","year":"2022","journal-title":"Seminars in Diagnostic Pathology"},{"issue":"2","key":"e_1_2_11_14_1","doi-asserted-by":"crossref","first-page":"124","DOI":"10.14366\/usg.15045","article-title":"Ultrasonographic Findings of Low\u2010Grade Endometrial Stromal Sarcoma of the Uterus With a Focus on Cystic Degeneration","volume":"35","author":"Park G. E.","year":"2016","journal-title":"Ultrasonography"},{"issue":"2","key":"e_1_2_11_15_1","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1016\/j.ygyno.2017.05.036","article-title":"Low\u2010Grade and High\u2010Grade Endometrial Stromal Sarcoma: A National Cancer Database Study","volume":"146","author":"Seagle B. 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