The Importance of Preoperative Laboratory Evaluations in the Differential Diagnosis of Uterine Leiomyosarcomas from Leiomyomas

Authors : Ferhat Çetin, İlkan Kayar, Özer Birge

Pages : 283-294

View : 55 | Download : 71

Publication Date : 2025-09-15

Article Type : Research Paper

Abstract :Background: Preoperative diagnosis of uterine leiomyosarcomas (ULMS) is challenging, as it may mimic degenerative uterine leiomyosarcoma (DULM) and benign uterine leiomyoma (ULM). This study investigates the role of preoperative clinical features and hematological parameters in the differential diagnosis of ULMS, DULM, and ULM. In light of the literature, this study was planned to perform the required surgical and medical treatments correctly and completely by predicting the malignant transformation of the leiomyoma mass in patients who are usually young, symptomatic, and planning to undergo surgery. Methods: Clinical records of 336 patients who underwent surgery due to uterine mass lesions in gynecological oncology clinics between 2022 and 2025 were retrospectively analyzed. A total of 272 patients diagnosed with benign uterine leiomyoma (Group 1, benign, ULM), 43 patients in whom malignancy could not be ruled out (Group 2, presumed malignant or degenerated uterine leiomyoma, DULM), and 21 patients with leiomyosarcoma (Group 3, malignant, ULMS) were included in the study. In the uterine leiomyosarcoma group and control groups (ULM, DULM), data about demographic, clinical, pathological, and ultrasonography features, laboratory tests, and surgical methods used were obtained retrospectively. Ultrasonography features included the largest diameter of the uterus, the number of myomas, and the diameter of the largest myoma. Laboratory tests included hemoglobin (HGB), hematocrit (HTC), white blood cell (WBC), neutrophil count, lymphocyte, neutrophil to lymphocyte ratio (NLR), platelet count (PLT), mean platelet volume (MPV), thyroid stimulating hormone (TSH), fasting blood glucose (FBG), cancer antigen-125 (CA-125), carcino-embryonic antigen (CEA), C-reactive protein (CRP), cancer antigen 15-3 (CA-15-3), erythrocyte sedimentation rate (ESR), alpha-fetoprotein (AFP), cancer antigen 19-9 (CA-19-9), and serum lactate dehydrogenase (LDH) level. Ultrasonography and laboratory tests were performed within one month before surgery. Results: The mean age of the patients was 47.2±12.6 years, and the BMI was 26.1±6 kg/m2. A statistically significant difference was found between Group I and II with regard to neutrophil count 3650 (1560-12150)/4200 (1990-12490) and NLR 1,44 (0,52-7,31)/1,85 (0,74-6,51) (p: 0.029 and 0.004, respectively). In post hoc analysis of biochemical values among three groups, CRP values were 4,6 (1,1-26,3) in Group I, they were 7,3 (1,8-45,1) in Group II, and the difference was statistically significant (p: 0,029). A statistically significant difference was found between Group I and II, and between Group I and III (Group I: 11,2 (6,4-29,2), Group II: 20,3 (8,5-32,2), and Group III: 22,8 (17,5-30,8) (p: <0,001 and <0,001, respectively). LDH values were 182 (112-295) in Group I, 196 (126-381) in Group II, and 246 (164-373) in Group III, and a statistically significant difference was found between Group I and II, between Group I and III, and between Group II and III (p: <0,001, <0,001, and <0,001, respectively). Conclusion: It should be kept in mind that preoperative ESR and LDH values are significant in the differential diagnosis of benign uterine leiomyoma, degenerative uterine leiomyoma, and malignant uterine leiomyosarcoma. Postoperative histopathological examination is the gold standard; however, the value of preoperative laboratory biomarkers may be revealed through multi-center prospective studies.
Keywords : Uterine leiomyoma, Dejenere Uterin Leiomyoma, Uterin leiomyosarkoma, Laktat dehidrogenaz, Nötrofil-lenfosit oranı, Eritrosit sedimentasyon hızı.

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