1485O - Percutaneous uterine needle biopsy with microscopic and array-CGH analyses in patients with suspicious myometrial tumors on MRI: A prospective study

Background

Preoperative diagnosis of uterine tumors is of utmost importance to avoid inadvertent morcellation of leiomyosarcoma (LMS) and unnecessary hysterectomy in childbearing patients. There are no pathognomonic criteria for malignancy on Magnetic Resonance Imaging (MRI). The diagnosis of malignancy includes microscopic and genomic analyses with array-Comparative Genomic Hybridization (CGH). To date, no study has evaluated preoperative percutaneous uterine needle biopsy (PUB) with microscopic examination (M-PUB) and array-CGH analyses (MCGH-PUB).

Methods

This is a prospective single-center cohort study including all consecutive patients who had uterine LMS suspicion on MRI and for whom a PUB was performed. Microscopic and array-CGH analyses with genomic index (GI) count for myometrial tumors were performed in order to guide the therapeutic strategy. Suspicious myometrial tumors after microscopic examination, including STUMP, were assessed malignant with a GI superior to 15. Preoperative diagnoses based on M-PUB and MCGH-PUB were compared to the postsurgical pathological examination or follow-up for non-operated tumors.

Results

A total of 36 patients were included from November 2016 to December 2021. Ten tumors were ultimately sarcomas, 25 were leiomyomas and one was an inflammatory myofibroblastic tumor. Six of the sarcomas and 18 of the benign tumors received surgery. The median follow-up time was 12 months (IQR= 6-35). The diagnostic accuracy, sensitivity, specificity and Negative Predictive Value of MCGH-PUB were 100%. A high GI was significantly associated with malignancy (p<0.001). High GI allowed correct malignancy upgrade for three tumors after suspicious microscopic examination. There was no PUB complication and no dissemination on the biopsy track.

Conclusions

MCGH-PUB is safe and accurate to discriminate pre operatively benign tumors from uterine sarcoma.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

S. Bonvalot.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.