{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:38:45Z","timestamp":1787027925438,"version":"build-2736575974"},"reference-count":33,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,1,30]],"date-time":"2023-01-30T00:00:00Z","timestamp":1675036800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Uterine myomas may resemble uterine sarcomas in some cases. However, the rate of benign myomas appearing as sarcomas at an ultrasound examination is not known. The objective of this study is to determine the percentage of benign myomas that appear suspicious for uterine sarcoma on ultrasound examination. This is a prospective observational multicenter study (June 2019\u2013December 2021) comprising a consecutive series of patients with histologically proven uterine myoma after hysterectomy or myomectomy who underwent transvaginal and\/or transabdominal ultrasound prior to surgery. All ultrasound examinations were performed by expert examiners. MUSA criteria were used to describe the lesions (1). Suspicion of sarcoma was established when three or more sonographic features, described by Ludovisi et al. as \u201cfrequently seen in uterine sarcoma\u201d, were present (2). These features are no visible myometrium, irregular cystic areas, non-uniform echogenicity, irregular contour, \u201ccooked\u201d appearance, and a Doppler color score of 3\u20134. In addition, the examiners had to classify the lesion as suspicious based on her\/his impression, independent of the number of features present. Eight hundred and ten women were included. The median maximum diameter of the myomas was 58.7 mm (range: 10.0\u2013263.0 mm). Three hundred and forty-nine (43.1%) of the patients had more than one myoma. Using the criterion of &gt;3 suspicious features, 40 (4.9%) of the myomas had suspicious appearance. By subjective impression, the examiners considered 40 (4.9%) cases suspicious. The cases were not exactly the same. We conclude that approximately 5% of benign uterine myomas may exhibit sonographic suspicion of sarcoma. Although it is a small percentage, it is not negligible.<\/jats:p>","DOI":"10.3390\/diagnostics13030501","type":"journal-article","created":{"date-parts":[[2023,1,30]],"date-time":"2023-01-30T08:28:23Z","timestamp":1675067303000},"page":"501","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["How Frequently Benign Uterine Myomas Appear Suspicious for Sarcoma as Assessed by Transvaginal Ultrasound?"],"prefix":"10.3390","volume":"13","author":[{"given":"Nieves","family":"Cabezas","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, University Hospital Virgen Macarena, 41009 Seville, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"L\u00f3pez-Picazo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, 31008 Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Diaz","sequence":"additional","affiliation":[{"name":"Department Obstetrics and Gynecology, Hospital Fundaci\u00f3n Calahorra, 26500 Calahorra, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7653-3047","authenticated-orcid":false,"given":"Beatriz","family":"Valero","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology, and Reproduction, Hospital Universitari Dexeus, 08028 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6087-9932","authenticated-orcid":false,"given":"Mar\u00eda Jos\u00e9","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Central University Hospital Asturias, 33011 Oviedo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Redondo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University Hospital Virgen Macarena, 41009 Seville, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7757-1050","authenticated-orcid":false,"given":"Bego\u00f1a","family":"D\u00edaz-de la Noval","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Central University Hospital Asturias, 33011 Oviedo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5095-6981","authenticated-orcid":false,"given":"Maria Angela","family":"Pascual","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology, and Reproduction, Hospital Universitari Dexeus, 08028 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Ajossa","sequence":"additional","affiliation":[{"name":"Centro Integrato di Procreazione Medicalmente Assistita (PMA) e Diagnostica Ostetrico-Ginecologica, Azienda Ospedaliero Universitaria\u2014Policlinico Duilio Casula, Monserrato, University of Cagliari, 09042 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1359-7155","authenticated-orcid":false,"given":"Stefano","family":"Guerriero","sequence":"additional","affiliation":[{"name":"Centro Integrato di Procreazione Medicalmente Assistita (PMA) e Diagnostica Ostetrico-Ginecologica, Azienda Ospedaliero Universitaria\u2014Policlinico Duilio Casula, Monserrato, University of Cagliari, 09042 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9700-0853","authenticated-orcid":false,"given":"Juan Luis","family":"Alc\u00e1zar","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, 31008 Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1097\/01.grf.0000159538.27221.8c","article-title":"Role, epidemiology, and natural history of benign uterine mass lesions","volume":"48","author":"Ryan","year":"2005","journal-title":"Clin. Obstet. Gynecol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Zimmermann, A., Bernuit, D., Gerlinger, C., Schaefers, M., and Geppert, K. (2012). Prevalence, symptoms and management of uterine fibroids: An international internet-based survey of 21,746 women. BMC Women Health, 12.","DOI":"10.1186\/1472-6874-12-6"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.bpobgyn.2016.09.010","article-title":"Structured imaging technique in the gynecologic office for the diagnosis of abnormal uterine bleeding","volume":"40","author":"Dueholm","year":"2017","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1002\/uog.14806","article-title":"Terms, definitions and measurements to describe sonographic features of myometrium and uterine masses: A consensus opinion from the Morphological Uterus Sonographic Assessment (MUSA) group","volume":"46","author":"Dueholm","year":"2015","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"FIGO Commitee on Gynecologic Oncology (2009). FIGO staging for uterine Sarcomas. Int. J. Gyn. Obst, 104, 179.","DOI":"10.1016\/j.ijgo.2008.12.009"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"39.e1","DOI":"10.1016\/j.ajog.2019.02.051","article-title":"Prevalence, characteristics, and risk factors of occult uterine cancer in presumed benign hysterectomy","volume":"221","author":"Desai","year":"2019","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1016\/j.jmig.2019.06.013","article-title":"Incidence of Leiomyosarcoma at Surgery for Presumed Uterine Myomas in Different Age Groups","volume":"27","author":"Valzacchi","year":"2019","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.ygyno.2009.09.023","article-title":"Uterine sarcomas: A review","volume":"116","author":"Prat","year":"2010","journal-title":"Gynecol. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/j.maturitas.2014.12.021","article-title":"Benign leiomyoma or malignant sarcoma: The difficult differential diagnosis","volume":"80","author":"Ulrich","year":"2015","journal-title":"Maturitas"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1097\/AOG.0000000000001187","article-title":"Occult Uterine Sarcoma and Leiomyosarcoma: Incidence of and Survival Associated with Morcellation","volume":"127","author":"Tucker","year":"2016","journal-title":"Obstet. Gynecol."},{"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."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"ACOG Committee (2019). Opinion No. 770 Summary: Uterine Morcellation for Presumed Leiomyomas. Obstet. Gynecol., 133, 604\u2013605.","DOI":"10.1097\/AOG.0000000000003129"},{"key":"ref_13","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_14","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.bpobgyn.2015.11.014","article-title":"Imaging techniques for evaluation of uterine myomas","volume":"34","author":"Testa","year":"2016","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"100","DOI":"10.15557\/JoU.2022.0017","article-title":"Uterine Myomas and Sarcomas-Clinical and Ultrasound Characteristics and Differential Diagnosis Using Pulsed and Color Doppler Techniques","volume":"22","author":"Wojtowicz","year":"2022","journal-title":"J. Ultrason."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1016\/j.ejogrb.2022.01.013","article-title":"Preoperative clinical characteristics between uterine sarcoma and leiomyoma in patients with uterine mass, a case-control study","volume":"270","author":"Chantasartrassamee","year":"2022","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_17","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_18","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_19","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_20","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1007\/s00404-017-4568-5","article-title":"The growth of uterine myomas in untreated women: Influence factors and ultrasound monitoring","volume":"297","author":"Armbrust","year":"2018","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"\u017bak, K., Zaremba, B., Rajtak, A., Kotarski, J., Amant, F., and Bobi\u0144ski, M. (2022). Preoperative Differentiation of Uterine Leiomyomas and Leiomyosarcomas: Current Possibilities and Future Directions. Cancers, 14.","DOI":"10.3390\/cancers14081966"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1067\/mob.2002.121725","article-title":"Accuracy of magnetic resonance imaging and transvaginal ultrasonography in the diagnosis, mapping, and measurement of uterine myomas","volume":"186","author":"Dueholm","year":"2002","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1111\/jog.12915","article-title":"Differential diagnosis between uterine sarcoma and leiomyoma using preoperative clinical characteristics","volume":"42","author":"Cho","year":"2016","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_24","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_25","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1006\/gyno.1995.9965","article-title":"Uterine sarcoma: A report of 10 cases studied by transvaginal color and pulsed Doppler sonography","volume":"59","author":"Kurjak","year":"1995","journal-title":"Gynecol. Oncol."},{"key":"ref_26","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_27","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1046\/j.1469-0705.1997.10010054.x","article-title":"Expression of thymidine phosphorylase in uterine sarcoma and uterine leiomyoma: Association with microvessel density and Doppler blood flow analysis","volume":"10","author":"Hata","year":"1997","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_28","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_29","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_30","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_31","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1002\/uog.24855","article-title":"Ultrasound features of highly vascularized uterine myomas (uterine smooth muscle tumors) and correlation with histopathology","volume":"60","author":"Russo","year":"2022","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1097\/MNM.0000000000000612","article-title":"Diffusion-weighted MRI and 18F-FDG-PET\/CT imaging: Competition or synergy as diagnostic methods to manage sarcoma of the uterus? A systematic review of the literature","volume":"38","author":"Dubreuil","year":"2017","journal-title":"Nucl. Med. Commun."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Suzuki, A., Aoki, M., Miyagawa, C., Murakami, K., Takaya, H., Kotani, Y., Nakai, H., and Matsumura, N. (2019). Differential Diagnosis of Uterine Leiomyoma and Uterine Sarcoma using Magnetic Resonance Images: A Literature Review. Healthcare, 7.","DOI":"10.3390\/healthcare7040158"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/3\/501\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:19:45Z","timestamp":1760120385000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/3\/501"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,30]]},"references-count":33,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["diagnostics13030501"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics13030501","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,30]]}}}