{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T22:18:25Z","timestamp":1792189105169,"version":"4.4.0"},"reference-count":119,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2022,4,13]],"date-time":"2022-04-13T00:00:00Z","timestamp":1649808000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100010621","name":"Medical University of Lublin","doi-asserted-by":"publisher","award":["DS 121"],"award-info":[{"award-number":["DS 121"]}],"id":[{"id":"10.13039\/501100010621","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010621","name":"Medical University of Lublin","doi-asserted-by":"publisher","award":["DS 120"],"award-info":[{"award-number":["DS 120"]}],"id":[{"id":"10.13039\/501100010621","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>The distinguishing of uterine leiomyosarcomas (ULMS) and uterine leiomyomas (ULM) before the operation and histopathological evaluation of tissue is one of the current challenges for clinicians and researchers. Recently, a few new and innovative methods have been developed. However, researchers are trying to create different scales analyzing available parameters and to combine them with imaging methods with the aim of ULMs and ULM preoperative differentiation ULMs and ULM. Moreover, it has been observed that the technology, meaning machine learning models and artificial intelligence (AI), is entering the world of medicine, including gynecology. Therefore, we can predict the diagnosis not only through symptoms, laboratory tests or imaging methods, but also, we can base it on AI. What is the best option to differentiate ULM and ULMS preoperatively? In our review, we focus on the possible methods to diagnose uterine lesions effectively, including clinical signs and symptoms, laboratory tests, imaging methods, molecular aspects, available scales, and AI. In addition, considering costs and availability, we list the most promising methods to be implemented and investigated on a larger scale.<\/jats:p>","DOI":"10.3390\/cancers14081966","type":"journal-article","created":{"date-parts":[[2022,4,13]],"date-time":"2022-04-13T21:33:42Z","timestamp":1649885622000},"page":"1966","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":37,"title":["Preoperative Differentiation of Uterine Leiomyomas and Leiomyosarcomas: Current Possibilities and Future Directions"],"prefix":"10.3390","volume":"14","author":[{"given":"Klaudia","family":"\u017bak","sequence":"first","affiliation":[{"name":"I Chair and Department of Oncological Gynaecology and Gynaecology, Student Scientific Association, Medical University of Lublin, 20-059 Lublin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bart\u0142omiej","family":"Zaremba","sequence":"additional","affiliation":[{"name":"I Chair and Department of Oncological Gynaecology and Gynaecology, Student Scientific Association, Medical University of Lublin, 20-059 Lublin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicja","family":"Rajtak","sequence":"additional","affiliation":[{"name":"I Chair and Department of Oncological Gynaecology and Gynaecology, Medical University of Lublin, 20-059 Lublin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2300-3266","authenticated-orcid":false,"given":"Jan","family":"Kotarski","sequence":"additional","affiliation":[{"name":"I Chair and Department of Oncological Gynaecology and Gynaecology, Medical University of Lublin, 20-059 Lublin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fr\u00e9d\u00e9ric","family":"Amant","sequence":"additional","affiliation":[{"name":"Department of Oncology, Gynecological Oncology, KU Leuven, 3000 Leuven, Belgium"},{"name":"Centre for Gynecologic Oncology Amsterdam (CGOA), Antoni Van Leeuwenhoek-Netherlands Cancer Institute (Avl-NKI) and University Medical Centra (UMC), 1066 CX Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9414-108X","authenticated-orcid":false,"given":"Marcin","family":"Bobi\u0144ski","sequence":"additional","affiliation":[{"name":"I Chair and Department of Oncological Gynaecology and Gynaecology, Medical University of Lublin, 20-059 Lublin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1016\/j.pop.2021.07.003","article-title":"Endometrial Biopsy: Indications and Technique","volume":"48","author":"Long","year":"2021","journal-title":"Prim. Care"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1713","DOI":"10.1002\/cncr.10382","article-title":"Transcervical needle biopsy for the differential diagnosis between uterine sarcoma and leiomyoma","volume":"94","author":"Kawamura","year":"2002","journal-title":"Cancer"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1080\/01443615.2020.1833849","article-title":"The incidence of unexpected gynaecological malignancies in hysterectomies carried out for benign indications","volume":"41","author":"Yildiz","year":"2021","journal-title":"J. Obstet. Gynaecol. J. Inst. Obstet. Gynaecol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"179.e1","DOI":"10.1016\/j.ajog.2018.11.1086","article-title":"Incidence of sarcoma in patients undergoing hysterectomy for benign indications: A population-based study","volume":"220","author":"Multinu","year":"2019","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/j.ygyno.2014.11.011","article-title":"Impact of morcellation on survival outcomes of patients with unexpected uterine leiomyosarcoma: A systematic review and meta-analysis","volume":"137","author":"Bogani","year":"2015","journal-title":"Gynecol. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"928","DOI":"10.1016\/j.jmig.2014.04.012","article-title":"Electric motorized morcellator versus transvaginal extraction for myoma retrieval after laparoscopic myomectomy: A propensity-matched analysis","volume":"21","author":"Bogani","year":"2014","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"3981","DOI":"10.21873\/anticanres.13553","article-title":"Circulating Protein Biomarkers to Differentiate Uterine Sarcomas from Leiomyomas","volume":"39","author":"Glorie","year":"2019","journal-title":"Anticancer Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1454","DOI":"10.1016\/S1470-2045(15)00375-7","article-title":"Morcellation of uterine leiomyomas: A plea for patient triage","volume":"16","author":"Amant","year":"2015","journal-title":"Lancet Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"3154","DOI":"10.1002\/cncr.28844","article-title":"Retrospective cohort study evaluating the impact of intraperitoneal morcellation on outcomes of localized uterine leiomyosarcoma","volume":"120","author":"George","year":"2014","journal-title":"Cancer"},{"key":"ref_10","unstructured":"(2021, December 30). Health C for D and R. UPDATE: Perform Only Contained Morcellation When Laparoscopic Power Morcellation Is Appropriate: FDA Safety Communication. FDA, Available online: https:\/\/www.fda.gov\/medical-devices\/safety-communications\/update-perform-only-contained-morcellation-when-laparoscopic-power-morcellation-appropriate-fda."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1097\/IGC.0000000000000911","article-title":"European Society of Gynecological Oncology Statement on Fibroid and Uterine Morcellation","volume":"27","author":"Halaska","year":"2017","journal-title":"Int. J. Gynecol. Cancer Off J. Int. Gynecol. Cancer Soc."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1719","DOI":"10.1007\/s00404-019-05344-0","article-title":"Benign uterine mass-discrimination from leiomyosarcoma by a preoperative risk score: A multicenter cohort study","volume":"300","author":"Vollmer","year":"2019","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_13","first-page":"414","article-title":"Uterine sarcoma in patients operated on for presumed leiomyoma and rapidly growing leiomyoma","volume":"83","author":"Parker","year":"1994","journal-title":"Obstet. Gynecol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1186\/2193-1801-3-678","article-title":"Novel uterine sarcoma preoperative diagnosis score predicts the need for surgery in patients presenting with a uterine mass","volume":"3","author":"Nagai","year":"2014","journal-title":"SpringerPlus"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1016\/S0015-0282(16)45789-4","article-title":"Uterine leiomyomata: Etiology, symptomatology, and management","volume":"36","author":"Buttram","year":"1981","journal-title":"Fertil. Steril."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1007\/s13669-018-0243-5","article-title":"Natural History of Uterine Fibroids: A Radiological Perspective","volume":"7","author":"Ghosh","year":"2018","journal-title":"Curr. Obstet. Gynecol. Rep."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1002\/uog.7482","article-title":"The natural history of fibroids","volume":"35","author":"Mavrelos","year":"2010","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"370","DOI":"10.21037\/atm-20-4559","article-title":"Assessing the risk of rapid fibroid growth in patients with asymptomatic solitary uterine myoma using a multivariate prediction model","volume":"9","author":"Li","year":"2021","journal-title":"Ann. Transl. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1483","DOI":"10.1016\/j.jogc.2020.05.016","article-title":"Factors Affecting Overall Survival in Premenopausal Women with Uterine Leiomyosarcoma: A Retrospective Analysis with Long-Term Follow-Up","volume":"42","author":"Singh","year":"2020","journal-title":"J. Obstet. Gynaecol. Can."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1111\/aogs.12930","article-title":"Uterine leiomyosarcoma\u2014Incidence, treatment, and the impact of morcellation. A nationwide cohort study","volume":"95","author":"Skorstad","year":"2016","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1016\/j.ejogrb.2016.05.025","article-title":"Parasitic leiomyomas: A systematic review","volume":"203","author":"Lete","year":"2016","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"101654","DOI":"10.1016\/j.jogoh.2019.101654","article-title":"Leiomyomas in an African Caribbean hysterectomy population considered to be ethnically related to African Americans","volume":"49","author":"Kadhel","year":"2020","journal-title":"J. Gynecol. Obstet. Hum. Reprod."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Moroni, R.M., Vieira, C.S., Ferriani, R.A., dos Reis, R.M., Nogueira, A.A., and Brito, L.G.O. (2015). Presentation and treatment of uterine leiomyoma in adolescence: A systematic review. BMC Womens Health, 15.","DOI":"10.1186\/s12905-015-0162-9"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1006\/gyno.1999.5436","article-title":"Leiomyosarcoma of the uterus: A clinicopathologic multicenter study of 71 cases","volume":"74","author":"Mayerhofer","year":"1999","journal-title":"Gynecol. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1634\/theoncologist.2014-0361","article-title":"Age-stratified risk of unexpected uterine sarcoma following surgery for presumed benign leiomyoma","volume":"20","author":"Brohl","year":"2015","journal-title":"Oncologist"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.ejogrb.2015.11.009","article-title":"Incidence of occult leiomyosarcoma in presumed morcellation cases: A database study","volume":"197","author":"Rodriguez","year":"2016","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1016\/j.acra.2018.01.002","article-title":"Utility of Clinical Parameters and Multiparametric MRI as Predictive Factors for Differentiating Uterine Sarcoma from Atypical Leiomyoma","volume":"25","author":"Bi","year":"2018","journal-title":"Acad. Radiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1177\/0300891620919161","article-title":"Primary leiomyosarcoma of the uterine cervix: Report of 4 cases, systematic review, and meta-analysis","volume":"106","author":"Yuksel","year":"2020","journal-title":"Tumori"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1007\/s11912-020-00927-6","article-title":"Morcellation of the Uterus: Is There Any Place?","volume":"22","author":"Halaska","year":"2020","journal-title":"Curr. Oncol. Rep."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"55","DOI":"10.7812\/TPP\/13-072","article-title":"Investigation of Women with Postmenopausal Uterine Bleeding: Clinical Practice Recommendations","volume":"18","author":"Munro","year":"2014","journal-title":"Perm. J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1056\/NEJM198310133091503","article-title":"A radioimmunoassay using a monoclonal antibody to monitor the course of epithelial ovarian cancer","volume":"309","author":"Bast","year":"1983","journal-title":"N. Engl. J. Med."},{"key":"ref_32","first-page":"328","article-title":"Serum CA 125 levels in patients with endometriosis: Changes in CA 125 levels during menstruation","volume":"72","author":"Masahashi","year":"1988","journal-title":"Obstet. Gynecol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1097\/00000441-198607000-00005","article-title":"Evaluation of serum CA125 values in healthy individuals and pregnant women","volume":"292","author":"Haga","year":"1986","journal-title":"Am. J. Med. Sci."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"876","DOI":"10.1016\/S0015-0282(16)49409-4","article-title":"Serum levels of CA-125 in patients with endometriosis: A preliminary report","volume":"45","author":"Giudice","year":"1986","journal-title":"Fertil. Steril."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1046\/j.1525-1438.1994.04030156.x","article-title":"CA 125 in serum and tumor from patients with uterine sarcoma","volume":"4","author":"Duk","year":"1994","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_36","first-page":"370","article-title":"Potential role of preoperative serum CA125 for the differential diagnosis between uterine leiomyoma and uterine leiomyosarcoma","volume":"27","author":"Juang","year":"2006","journal-title":"Eur. J. Gynaecol. Oncol."},{"key":"ref_37","first-page":"412","article-title":"Assessment of the predictivity of preoperative serum CA 125 in the differential diagnosis of uterine leiomyoma and uterine sarcoma in the Turkish female population","volume":"30","author":"Yilmaz","year":"2009","journal-title":"Eur. J. Gynaecol. Oncol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1228","DOI":"10.1111\/aogs.13008","article-title":"Preoperative evaluation in women with uterine leiomyosarcoma. A nationwide cohort study","volume":"95","author":"Skorstad","year":"2016","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"4657","DOI":"10.2147\/CMAR.S302223","article-title":"Diagnostic Value of Preoperative CA125, LDH and HE4 for Leiomyosarcoma of the Female Reproductive System","volume":"13","author":"Zhang","year":"2021","journal-title":"Cancer Manag. Res."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.1126\/science.140.3573.1329","article-title":"Lactate Dehydrogenase Isozymes: Dissociation and Recombination of Subunits","volume":"140","author":"Markert","year":"1963","journal-title":"Science"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"904","DOI":"10.1002\/iub.1216","article-title":"Lactate dehydrogenase A in cancer: A promising target for diagnosis and therapy","volume":"65","author":"Miao","year":"2013","journal-title":"IUBMB Life"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"3898","DOI":"10.1111\/j.1742-4658.2012.08748.x","article-title":"Knockdown of lactate dehydrogenase A suppresses tumor growth and metastasis of human hepatocellular carcinoma","volume":"279","author":"Sheng","year":"2012","journal-title":"FEBS J."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1007\/s10549-011-1466-6","article-title":"LDH-A silencing suppresses breast cancer tumorigenicity through induction of oxidative stress mediated mitochondrial pathway apoptosis","volume":"131","author":"Wang","year":"2012","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1159\/000294861","article-title":"Leiomyosarcoma of the uterus: Ultrasonography and serum lactate dehydrogenase level","volume":"33","author":"Seki","year":"1992","journal-title":"Gynecol. Obstet. Investig."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1136\/ijgc-00009577-200207000-00005","article-title":"Usefulness of Gd-DTPA contrast-enhanced dynamic MRI and serum determination of LDH and its isozymes in the differential diagnosis of leiomyosarcoma from degenerated leiomyoma of the uterus","volume":"12","author":"Goto","year":"2002","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1016\/j.tjog.2017.05.003","article-title":"Efficacy of PET\/CT to exclude leiomyoma in patients with lesions suspicious for uterine sarcoma on MRI","volume":"56","author":"Kusunoki","year":"2017","journal-title":"Taiwan J. Obstet. Gynecol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1186\/s40064-015-1318-7","article-title":"Highly improved accuracy of the revised PREoperative sarcoma score (rPRESS) in the decision of performing surgery for patients presenting with a uterine mass","volume":"4","author":"Nagai","year":"2015","journal-title":"SpringerPlus"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1111\/jog.13792","article-title":"Diagnostic value of combination serum assay of lactate dehydrogenase, D-dimer, and C-reactive protein for uterine leiomyosarcoma","volume":"45","author":"Nishigaya","year":"2019","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Zhang, G., Yu, X., Zhu, L., Fan, Q., Shi, H., and Lang, J. (2020). Preoperative clinical characteristics scoring system for differentiating uterine leiomyosarcoma from fibroid. BMC Cancer, 20.","DOI":"10.1186\/s12885-020-07003-z"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.ijgo.2008.12.008","article-title":"FIGO staging for uterine sarcomas","volume":"104","author":"Prat","year":"2009","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/0002-9378(75)90631-6","article-title":"Carcinoembryonic antigen in patients with gynecologic malignancies","volume":"121","author":"DiSaia","year":"1975","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.1111\/j.1525-1438.2007.01187.x","article-title":"Preoperative tumor markers at diagnosis in women with malignant mixed m\u00fcllerian tumors\/carcinosarcoma of the uterus","volume":"18","author":"Hoskins","year":"2008","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1007\/s00404-012-2529-6","article-title":"Serum CA 125, CA 15-3, CEA, and CA 19-9: A prognostic factor for uterine carcinosarcomas?","volume":"287","author":"Thomakos","year":"2013","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"5001","DOI":"10.2147\/CMAR.S314219","article-title":"Preoperative Blood Inflammatory Markers for the Differentiation of Uterine Leiomyosarcoma from Leiomyoma","volume":"13","author":"Suh","year":"2021","journal-title":"Cancer Manag. Res."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1016\/j.ejso.2010.05.004","article-title":"Neutrophil to lymphocyte ratio for preoperative diagnosis of uterine sarcomas: A case-matched comparison","volume":"36","author":"Kim","year":"2010","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"8839512","DOI":"10.1155\/2021\/8839512","article-title":"Prognostic Value of Pretreated Blood Inflammatory Markers in Patients with Bone Sarcoma: A Meta-Analysis","volume":"2021","author":"Jiang","year":"2021","journal-title":"Dis Markers"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"e12176","DOI":"10.1097\/MD.0000000000012176","article-title":"Prognostic value of pretreatment neutrophil-to-lymphocyte ratio in patients with soft tissue sarcoma: A meta-analysis","volume":"97","author":"Liu","year":"2018","journal-title":"Medicine"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"113","DOI":"10.5114\/pm.2017.72754","article-title":"Ultrasonography of uterine leiomyomas","volume":"16","year":"2017","journal-title":"Menopause Rev."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1097\/IGC.0000000000000037","article-title":"Growth differentiation factor-15 as biomarker in uterine sarcomas","volume":"24","author":"Trovik","year":"2014","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1097\/RUQ.0000000000000454","article-title":"Ultrasound Features of Uterine Sarcomas","volume":"35","author":"Oh","year":"2019","journal-title":"Ultrasound Q."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1046\/j.1469-0705.1997.09020101.x","article-title":"Uterine sarcoma: Can it be differentiated from uterine leiomyoma with Doppler ultrasonography? A preliminary report","volume":"9","author":"Hata","year":"1997","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_62","first-page":"29","article-title":"Color Doppler ultrasonography in the differentiation of uterine sarcomas from uterine leiomyomas","volume":"23","author":"Csabay","year":"2002","journal-title":"Eur. J. Gynaecol. Oncol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1002\/jcu.20075","article-title":"Uterine sarcomas versus leiomyomas: Gray-scale and Doppler sonographic findings","volume":"33","author":"Aviram","year":"2005","journal-title":"J. Clin. Ultrasound"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1002\/jcu.20386","article-title":"Can gray-scale and color Doppler sonography differentiate between uterine leiomyosarcoma and leiomyoma?","volume":"35","author":"Exacoustos","year":"2007","journal-title":"J. Clin. Ultrasound"},{"key":"ref_65","first-page":"297","article-title":"Ultrasound diagnosis of uterine myomas","volume":"68","author":"Fascilla","year":"2016","journal-title":"Minerva Ginecol."},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Russo, C., Camilli, S., Martire, F.G., Di Giovanni, A., Lazzeri, L., Malzoni, M., Zupi, E., and Exacoustos, C. (2022). Highly vascularized uterine myomas (uterine smooth muscle tumors) on ultrasound and correlation to histopathology. Ultrasound Obstet. Gynecol.","DOI":"10.1002\/uog.24855"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1002\/uog.20270","article-title":"Imaging in gynecological disease (15): Clinical\u2009and\u2009ultrasound characteristics of uterine sarcoma","volume":"54","author":"Ludovisi","year":"2019","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1053\/j.sult.2011.04.003","article-title":"Sarcomas of Abdominal Organs: Computed Tomography and Magnetic Resonance Imaging Findings","volume":"32","author":"Qiu","year":"2011","journal-title":"Semin. Ultrasound CT MRI"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1369","DOI":"10.2214\/ajr.181.5.1811369","article-title":"CT and MRI of uterine sarcomas and their mimickers","volume":"181","author":"Rha","year":"2003","journal-title":"Am. J. Roentgenol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1016\/j.diii.2019.07.007","article-title":"How to differentiate uterine leiomyosarcoma from leiomyoma with imaging","volume":"100","author":"Sun","year":"2019","journal-title":"Diagn. Interv. Imaging"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1097\/00004728-200005000-00009","article-title":"Radiological features of leiomyomatous tumors of the colon and rectum","volume":"24","author":"Lee","year":"2000","journal-title":"J. Comput. Assist. Tomogr."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1007\/s11604-017-0712-1","article-title":"CT features for diagnosing acute torsion of uterine subserosal leiomyoma","volume":"36","author":"Ohgiya","year":"2018","journal-title":"JPN J. Radiol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1007\/s13244-018-0610-9","article-title":"Multidetector CT of expected findings and complications after hysterectomy","volume":"9","author":"Tonolini","year":"2018","journal-title":"Insights Imaging"},{"key":"ref_74","first-page":"8880080","article-title":"Uterine Sarcomas: Are There MRI Signs Predictive of Histopathological Diagnosis? A 50-Patient Case Series with Pathological Correlation","volume":"2021","author":"Vandeventer","year":"2021","journal-title":"Sarcoma"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1016\/S1470-2045(09)70226-8","article-title":"Clinical management of uterine sarcomas","volume":"10","author":"Amant","year":"2009","journal-title":"Lancet Oncol."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"20170767","DOI":"10.1259\/bjr.20170767","article-title":"Uterine smooth muscle tumours with hyperintense area on T1 weighted images: Differentiation between leiomyosarcomas and leiomyomas","volume":"91","author":"Ando","year":"2018","journal-title":"Br. J. Radiol."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1007\/s11604-021-01096-7","article-title":"MR imaging findings of unusual leiomyoma and malignant uterine myometrial tumors: What the radiologist should know","volume":"39","author":"Fujii","year":"2021","journal-title":"Jpn. J. Radiol."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/j.bpobgyn.2011.07.002","article-title":"Clinical presentation and diagnosis of uterine sarcoma, including imaging","volume":"25","author":"Wu","year":"2011","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1002\/jmri.20207","article-title":"Smooth muscle tumors of uncertain malignant potential and leiomyosarcomas of the uterus: MR findings","volume":"20","author":"Tanaka","year":"2004","journal-title":"J. Magn. Reson. Imaging"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"1423","DOI":"10.1148\/rg.236035033","article-title":"Diffusely Enlarged Uterus: Evaluation with MR Imaging","volume":"23","author":"Kido","year":"2003","journal-title":"RadioGraphics"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"2903","DOI":"10.1007\/s00330-016-4623-9","article-title":"Differentiation of Uterine Leiomyosarcoma from Atypical Leiomyoma: Diagnostic Accuracy of Qualitative MR Imaging Features and Feasibility of Texture Analysis","volume":"27","author":"Lakhman","year":"2017","journal-title":"Eur. Radiol."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1016\/j.ygyno.2011.01.022","article-title":"Uterine leiomyosarcomas: Tumor size, mitotic index, and biomarkers Ki67, and Bcl-2 identify two groups with different prognosis","volume":"121","author":"Espinosa","year":"2011","journal-title":"Gynecol. Oncol."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1097\/RCT.0b013e318197ec6f","article-title":"Hyperintense Uterine Myometrial Masses on T2-Weighted Magnetic Resonance Imaging: Differentiation with Diffusion-Weighted Magnetic Resonance Imaging","volume":"33","author":"Takeuchi","year":"2009","journal-title":"J. Comput. Assist. Tomogr."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"1742","DOI":"10.1007\/s00261-014-0324-5","article-title":"Differential diagnosis of uterine smooth muscle tumors using diffusion-weighted imaging: Correlations with the apparent diffusion coefficient and cell density","volume":"40","author":"Tasaki","year":"2015","journal-title":"Abdom. Imaging"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1097\/RCT.0000000000000565","article-title":"Diffusion-Weighted Imaging for Differentiating Uterine Leiomyosarcoma from Degenerated Leiomyoma","volume":"41","author":"Li","year":"2017","journal-title":"J. Comput. Assist. Tomogr."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"2756","DOI":"10.1007\/s00330-009-1471-x","article-title":"Combined use of T2-weighted and diffusion-weighted 3-T MR imaging for differentiating uterine sarcomas from benign leiomyomas","volume":"19","author":"Namimoto","year":"2009","journal-title":"Eur. Radiol."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"2306","DOI":"10.1007\/s00330-013-2819-9","article-title":"How to differentiate benign from malignant myometrial tumours using MR imaging","volume":"23","author":"Dechoux","year":"2013","journal-title":"Eur. Radiol."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"4927","DOI":"10.1007\/s00261-021-03132-6","article-title":"Differentiating leiomyosarcoma from leiomyoma: In support of an MR imaging predictive scoring system","volume":"46","author":"Jagannathan","year":"2021","journal-title":"Abdom. Radiol."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1148\/radiol.2020191658","article-title":"Diagnostic Algorithm to Differentiate Benign Atypical Leiomyomas from Malignant Uterine Sarcomas with Diffusion-Weighted MRI","volume":"297","author":"Jannot","year":"2020","journal-title":"Radiology"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1017\/S0266462318000168","article-title":"Preoperative Magnetic Resonance Imaging Diagnostic Features of uterine leiomyosarcomas: A systematic review","volume":"34","author":"Kaganov","year":"2018","journal-title":"Int. J. Technol. Assess. Health Care"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"1492","DOI":"10.1126\/science.3103217","article-title":"Elevated levels of glucose transport and transporter messenger RNA are induced by ras or src oncogenes","volume":"235","author":"Flier","year":"1987","journal-title":"Science"},{"key":"ref_92","first-page":"1069","article-title":"Use of 18F-fluorodeoxyglucose positron emission tomography for diagnosis of uterine sarcomas","volume":"23","author":"Nagamatsu","year":"2010","journal-title":"Oncol. Rep."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1006\/gyno.2000.6081","article-title":"Positron emission tomography with (18)F-fluorodeoxyglucose of uterine sarcoma: A comparison with magnetic resonance imaging and power Doppler imaging","volume":"80","author":"Umesaki","year":"2001","journal-title":"Gynecol. Oncol."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1016\/j.ygyno.2007.11.044","article-title":"Comparison of the validity of magnetic resonance imaging and positron emission tomography\/computed tomography in the preoperative evaluation of patients with uterine corpus cancer","volume":"108","author":"Park","year":"2008","journal-title":"Gynecol. Oncol."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1007\/s00259-018-3975-6","article-title":"Preoperative [18F]FDG PET\/CT tumour heterogeneity index in patients with uterine leiomyosarcoma: A multicentre retrospective study","volume":"45","author":"Lee","year":"2018","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_96","first-page":"463","article-title":"Fluorine-18-fluorodeoxyglucose PET\/CT for the evaluation of suspected recurrent uterine leiomyosarcomas","volume":"52","author":"Kao","year":"2011","journal-title":"Acta Radiol. Stockh. Swed."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"5100","DOI":"10.1200\/jco.2004.22.90140.5100","article-title":"Availability of whole-body positron emission tomography (PET) for the detection of metastatic sites in recurrent uterine sarcoma","volume":"22","author":"Murakami","year":"2004","journal-title":"J. Clin. Oncol."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1157\/13107970","article-title":"Positron emission tomography with 18F-fluorodeoxyglucose in patients with uterine sarcoma","volume":"26","year":"2007","journal-title":"Rev. Esp. Med. Nucl."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"1349","DOI":"10.1097\/IGC.0b013e3182a20e18","article-title":"Diagnostic performance of fluorine-18-fluorodeoxyglucose positron emission tomography imaging in uterine sarcomas: Systematic review and meta-analysis of the literature","volume":"23","author":"Sadeghi","year":"2013","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.ejrad.2018.11.009","article-title":"A machine learning approach for distinguishing uterine sarcoma from leiomyomas based on perfusion weighted MRI parameters","volume":"110","author":"Malek","year":"2019","journal-title":"Eur. J. Radiol."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.1007\/s11307-019-01332-7","article-title":"Preoperative Differentiation of Uterine Sarcoma from Leiomyoma: Comparison of Three Models Based on Different Segmentation Volumes Using Radiomics","volume":"21","author":"Xie","year":"2019","journal-title":"Mol. Imaging Biol."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.ejrad.2019.04.004","article-title":"Preliminary utilization of radiomics in differentiating uterine sarcoma from atypical leiomyoma: Comparison on diagnostic efficacy of MRI features and radiomic features","volume":"115","author":"Xie","year":"2019","journal-title":"Eur. J. Radiol."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"1390","DOI":"10.1016\/j.acra.2018.11.014","article-title":"Machine Learning to Differentiate T2-Weighted Hyperintense Uterine Leiomyomas from Uterine Sarcomas by Utilizing Multiparametric Magnetic Resonance Quantitative Imaging Features","volume":"26","author":"Nakagawa","year":"2019","journal-title":"Acad. Radiol."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"6125","DOI":"10.1007\/s00330-020-07678-9","article-title":"A combined radiomics and clinical variables model for prediction of malignancy in T2 hyperintense uterine mesenchymal tumors on MRI","volume":"31","author":"Wang","year":"2021","journal-title":"Eur. Radiol."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1016\/j.ygyno.2021.04.004","article-title":"Using rADioMIcs and machine learning with ultrasonography for the differential diagnosis of myometRiAL tumors (the ADMIRAL pilot study). Radiomics and differential diagnosis of myometrial tumors","volume":"161","author":"Chiappa","year":"2021","journal-title":"Gynecol. Oncol."},{"key":"ref_106","doi-asserted-by":"crossref","unstructured":"Ravegnini, G., Ferioli, M., Morganti, A.G., Strigari, L., Pantaleo, M.A., Nannini, M., De Leo, A., De Crescenzo, E., Coe, M., and De Palma, A. (2021). Radiomics and Artificial Intelligence in Uterine Sarcomas: A Systematic Review. J. Pers. Med., 11.","DOI":"10.3390\/jpm11111179"},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.ygyno.2008.02.026","article-title":"The utility of preoperative endometrial sampling for the detection of uterine sarcomas","volume":"110","author":"Bansal","year":"2008","journal-title":"Gynecol. Oncol."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1016\/j.jmig.2016.01.022","article-title":"The Role of Endometrial Biopsy in the Preoperative Detection of Uterine Leiomyosarcoma","volume":"23","author":"Hinchcliff","year":"2016","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1159\/000326313","article-title":"Cytodiagnostic problems in uterine sarcoma. Analysis according to a novel classification of tumor growth types","volume":"48","author":"Oda","year":"2004","journal-title":"Acta Cytol."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1097\/00000478-199406000-00001","article-title":"Problematic uterine smooth muscle neoplasms. A clinicopathologic study of 213 cases","volume":"18","author":"Bell","year":"1994","journal-title":"Am. J. Surg. Pathol."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1097\/IGC.0000000000000189","article-title":"Preoperative ultrasound-guided needle biopsy of 63 uterine tumors having high signal intensity upon T2-weighted magnetic resonance imaging","volume":"24","author":"Tamura","year":"2014","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.jmig.2021.07.004","article-title":"Endometrial Sampling for Preoperative Diagnosis of Uterine Leiomyosarcoma","volume":"29","author":"Kho","year":"2022","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_113","doi-asserted-by":"crossref","unstructured":"Lawlor, H., Ward, A., Maclean, A., Lane, S., Adishesh, M., Taylor, S., DeCruze, S.B., and Hapangama, D.K. (2020). Developing a Preoperative Algorithm for the Diagnosis of Uterine Leiomyosarcoma. Diagnostics, 10.","DOI":"10.3390\/diagnostics10100735"},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"725","DOI":"10.3892\/or_00000493","article-title":"A scoring system for histopathologic and immunohistochemical evaluations of uterine leiomyosarcomas","volume":"22","author":"Yoshida","year":"2009","journal-title":"Oncol. Rep."},{"key":"ref_115","first-page":"361","article-title":"Telomerase activity in needle biopsied uterine myoma-like tumors: Differential diagnosis between uterine sarcomas and leiomyomas","volume":"20","author":"Tsujimura","year":"2002","journal-title":"Int. J. Oncol."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"54","DOI":"10.2174\/1381612825666190402101143","article-title":"GDF-15: A Multifunctional Modulator and Potential Therapeutic Target in Cancer","volume":"25","author":"Fang","year":"2019","journal-title":"Curr. Pharm. Des."},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"3718","DOI":"10.1111\/cas.14215","article-title":"Serum microRNA profile enables preoperative diagnosis of uterine leiomyosarcoma","volume":"110","author":"Yokoi","year":"2019","journal-title":"Cancer Sci."},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"13729","DOI":"10.1038\/s41598-021-93069-z","article-title":"Radiomics models based on enhanced computed tomography to distinguish clear cell from non-clear cell renal cell carcinomas","volume":"11","author":"Wang","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"5506","DOI":"10.1038\/s41598-021-85168-8","article-title":"Amide proton transfer weighted (APTw) imaging based radiomics allows for the differentiation of gliomas from metastases","volume":"11","author":"Sartoretti","year":"2021","journal-title":"Sci. Rep."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/14\/8\/1966\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:53:28Z","timestamp":1760136808000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/14\/8\/1966"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,13]]},"references-count":119,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2022,4]]}},"alternative-id":["cancers14081966"],"URL":"https:\/\/doi.org\/10.3390\/cancers14081966","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,13]]}}}