Transcervical needle biopsy of uterine myoma-like tumors using an automatic biopsy gun.

OBJECTIVE: To describe a practical procedure of transcervical needle biopsy of uterine myoma-like tumors using an automatic biopsy gun and its potential risks. DESIGN: Description of new biopsy procedure. SETTING: University teaching hospital. PATIENT(S): Three hundred twelve patients who had been recommended for surgery for uterine myoma-like tumors by the hospital's outside doctors. INTERVENTION(S): Transcervical needle biopsy of uterine myoma-like tumors. MAIN OUTCOME MEASURE(S): Successful sampling rate, duration of procedure, estimated blood loss, patient discomfort, and complications. RESULT(S): Of the 312 patients who underwent transcervical needle biopsy, specimens were obtained from 311 (99.7%). The mean (+/- SD) duration of procedure was 6.3 +/- 5.2 minutes. The mean estimated blood loss was 10.4 +/- 10.9 g. There were two cases (0.6%) in which the blood loss during the procedure was in excess of 50 g, but bleeding can be conservatively controlled in such cases with an intrauterine tamponade using gauze or a balloon catheter. The level of patient pain and discomfort during the needle biopsy was significantly lower than that during endometrial curettage. No major complications requiring surgery occurred. CONCLUSION(S): Transcervical needle biopsies of uterine myoma-like tumors using an automatic biopsy gun are practical, simple, and safe. This new procedure can be of routine clinical use.

Transcervical needle biopsy for the differential diagnosis between uterine sarcoma and leiomyoma.

BACKGROUND: The clinical differential diagnosis between uterine sarcoma and benign leiomyoma is difficult even with magnetic resonance imaging (MRI). Therefore, a considerable number of patients have undergone hysterectomies due to an indication of "suspected malignancy" based on tumor size alone. However, approximately 80% of these hysterectomies have been judged to have been recommended inappropriately. In such situations, reliable preoperative diagnostic tests are required. The authors have evaluated the accuracy of needle biopsy for uterine myoma-like tumors, a procedure that to the authors' knowledge has been performed infrequently. METHODS: Transcervical needle biopsy was performed in 435 patients with uterine myoma-like tumors. The biopsy specimens were scored for degree of malignancy according to the histopathologic criteria proposed by Bell et al. Histopathologic evaluation of surgical specimens and clinical outcome after 2 years of follow-up were used as the reference standards. RESULTS: Of 435 patients, 7 had uterine sarcomas, 4 of which were scored as > or = 4 points and were diagnosed as "sarcoma" by needle biopsy alone. No sarcoma cases were included in the group of patients with a score of 0. The cutoff score combining the highest sensitivity and specificity with respect to distinguishing uterine leiomyosarcoma from uterine leiomyoma was 2; sensitivity, specificity, and positive and negative predictive values were 100%, 98.6%, 58%, and 100.0%, respectively. CONCLUSIONS: Transcervical needle biopsy using histopathologic scoring is a reliable diagnostic test for the differential diagnosis between uterine sarcoma and leiomyoma. This diagnostic method, combined with MRI screening, could reduce the number of patients currently undergoing unnecessary surgery.

Shrinkage effect of gonadotropin releasing hormone agonist treatment on uterine leiomyomas and t(12;14).

Specific chromosomal abnormalities, e.g. del(7q), t(12;14), 12 trisomy, and the rearrangement of 6p, are seen in approximately 30% of uterine leiomyomas. We investigated the association between the shrinkage effect of GnRH agonist on uterine leiomyomas and t(12;14), the second most frequent chromosomal abnormality in myomas. This study involved 42 women with uterine leiomyomas treated with a gonadotropin releasing hormone (GnRH) agonist before surgery. The volume of the largest myoma nodule was measured by MRI before and at 12 weeks after the beginning of GnRH agonist treatment, and the percentage change in volume was calculated. A specific chromosomal abnormality, t(12;14), was examined on thin sections of frozen leiomyomas by fluorescence in situ hybridization with chromosome-specific probes. Of the 42 tumors, 8 (19%) showed translocation. The mean (+/- SD) percentages change in volume of the largest myomas without and with translocation were -32+/-24 and 23+/-60%, respectively (p=0.006). The myomas showing translocation had significantly less reduction in size with GnRH treatment than did those without translocation. No myoma with trisomy 12 was found. On the basis of our results, we assumed that uterine leiomyomas showing t(12;14) are not so dependent on ovarian hormones for growth.