Comparing Leiomyoma and Leiomyosarcoma with Non-Invasive Medical Imaging Methods

Background: Preoperative diagnosis might be challenging when trying to differentiate between uterine leiomyoma and leiomyosarcoma due to their shared imaging and clinical features. Accurate distinction is a key to avoiding unnecessary delays in cancer diagnosis or aggressive therapy. In order to distinguish between leiomyoma and leiomyosarcoma, this study investigated the diagnostic role of non-invasive imaging modalities without diffusion-weighted imaging (DWI). Methods: From 2012 through 2024, researchers at Iraq's Al-Amal Oncology Teaching Hospital tracked patients' vitals in a retrospective case-control study. Using size-matched criteria, the researchers identified 23 individuals with preoperative imaging showing histopathologically proven uterine leiomyosarcoma (n = 8, CT n = 9, and MRI n = 6). They compared these patients to 34 patients who had their tumors removed. Six blinded radiologists, three of whom were consultants and three of whom were residents, independently evaluated tumor margins, necrosis, bleeding, vascularity, calcifications, heterogeneity, and overall probability of malignancy using a standardized 5-point grading system. The results of the logistic regression and receiver operating characteristic (ROC) analyses were used to ascertain the diagnostic performance. Results: The mean malignancy suspicion ratings (2.4 +- 1.1 for leiomyoma and 2.8 +- 1.3 for leiomyosarcoma, respectively) did not differ significantly between the benign and malignant groups. Ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) did not differ significantly in terms of diagnostic accuracy (P =.29-.93), and the ROC curve areas were 0.35 to 0.68. Reading proficiency had no effect on diagnosis accuracy, and no morphologic trait was a reliable predictor of cancer (P =.12-.95). Conclusions: Differentiating between uterine leiomyoma and leiomyosarcoma is not reliably achieved by conventional ultrasonography, CT, and MRI due to the absence of diffusion-weighted imaging. These findings support the idea that diffusion-weighted MRI and advanced functional imaging should be used together to improve pre-operative diagnostics and guide optimal therapeutic treatment.