Diagnosis of gynecologic malignancy after the treatment of presumed benign fibroid disease with interventional radiology procedures: a retrospective cohort study

Abstract

Objective: To ascertain the finding of future diagnosis of malignancy in women who undergo nonsurgical treatment for uterine fibroid disease with interventional radiology (IR) procedures.

Design: Mixed-methods retrospective cohort study.

Setting: Two tertiary care academic hospitals in Boston, Massachusetts.

Patient(s): A total of 491 women who underwent radiologic intervention for fibroids between 2006 and 2016.

Intervention(s): Uterine artery embolization or high-intensity focused ultrasound ablation.

Main outcome measure(s): Subsequent surgical interventions and diagnosis of gynecologic malignancy after the IR procedure.

Result(s): During the study period, 491 women underwent treatment of fibroids with IR procedures; follow-up information was available for 346 cases. The mean age was 45.3 ± 4.8 years, and 69.7% were between the ages of 40 and 49 years. Regarding ethnicity, 58.9% of patients were white, and 26.1% were black. The most common symptoms were abnormal uterine bleeding (87%), pelvic pressure (62.3%), and pelvic pain (60.9%). A total of 106 patients underwent subsequent surgical treatment of fibroids. Of the 346 patients who had follow-up, 4 (1.2%) were diagnosed with leiomyosarcoma after their interventional treatment for fibroids. An additional 2 cases of endometrial adenocarcinoma and 1 case of a premalignant lesion of the endometrium were noted.

Conclusion(s): The proportion of patients who went on to be diagnosed with leiomyosarcoma after conservative IR treatments appears to be higher than previously reported. A thorough preprocedural workup and patient counseling regarding the possibility of underlying uterine malignancy should be undertaken.

Keywords: Leiomyoma; interventional radiology; leiomyosarcoma; occult uterine malignancy; uterine fibroid embolization.