(1)針生検による子宮筋腫管理の実際とその問題点(<特集>第59回シンポジウム1「子宮筋腫の発育制御とその管理」)

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Background Recent clinical introductions of GnRH agonists and uterine artery embolization have meant that the patients with uterine myoma, who might have previously undergone surgery, are now often managed conservatively. In both of the above situations, there is an important common clinical problem ; that is distinguishing uterine sarcomas from benign leiomyomas. However, clinical differential diagnosis between uterine sarcomas and benign leiomyomas is difficult even with magnetic resonance imaging(MRI). The most reliable preoperative diagnostic method is a biopsy of the tumor. We have evaluated the accuracy and the practical problem of needle biopsy for uterine myoma-like tumors, a procedure that has been infrequently performed. Methods Transcervical needle biopsy was performed in 694 patients with uterine myoma-like tumors. The biopsy specimens were classified into 5 groups for degree of malignancy according to the histopathological criteria proposed by Bell et al. Immunohistochemical analysis(49 cases) using Ki67(MIB1), P53 and hTERT, and telomerase activity measured using TRAP(62 cases) were also evaluated for differential diagnosis. Histopathological evaluation of surgical specimens and clinical outcome of 2 years of follow-up were used as the reference standards. Results Among 694 patients, 11 had uterine sarcomas. Six cases, judged as Group V, were diagnosed as 'sarcoma' by needle biopsy alone. No sarcoma cases were included in those patients with Group I, II, and III. The cutoff level combining the highest sensitivity and specificity with respect to distinguishing uterine leiomyosarcoma from uterine leiomyoma was obtained was Group VI; sensitivity, specificity, positive, and negative predictive values were 100%, 98.9%, 69%, and 100.0%, respectively. Of the 3 immunohistochemical analyses, the evaluation using Ki67 showed the highest accuracy. At cutoff values of 20 units, telomerase activity in needle biopsy sample showed the highest accuracy ; sensitivity and specificity were 85% and 100%, respectively. Conclusions Transcervical needle biopsy using histopathological grouping is a reliable diagnostic test for differential diagnosis between uterine sarcomas and leiomyomas. This diagnostic method, combined with MRI screening, could support the conservative management for patients with uterine myoma more safely.
社団法人日本産科婦人科学会の論文
2007-09-01

(1)針生検による子宮筋腫管理の実際とその問題点(<特集>第59回シンポジウム1「子宮筋腫の発育制御とその管理」)

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