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Chapter 16 - Leiomyosarcoma

Implications for the Treatment of Fibroids

Published online by Cambridge University Press:  10 October 2020

By
Elizabeth A. Pritts
Edited by
Mostafa Metwally  and
Tin-Chiu Li
Mostafa Metwally
Affiliation:
University of Sheffield
Tin-Chiu Li
Affiliation:
The Chinese University of Hong Kong
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Summary

The risk of finding an occult leiomyosarcoma (LMS) at surgery for presumed leiomyomas and subsequent outcomes for patients who have these tumours morcellated is a subject of conflict in gynaecology today. This dispute arose in 2013 from a single case in which a physician underwent surgery for fibroids and power morcellation was utilized. This physician ultimately was diagnosed with an LMS and she and her family began a media campaign and created a public forum to effect a ban on power morcellation. They argued that prevalence of these occult tumours was much higher than originally believed, and the use of power morcellation worsened outcomes. Originally, a friend of the physician performed a cursory meta-analysis using incomplete data suggesting that the rate of uterine sarcoma in women having surgery for presumed fibroids was 1 in 323. The US Food and Drug Administration (FDA) used similar but slightly different methodology and found a prevalence of 1 in 352 for uterine sarcoma, and 1 in 498 for leiomyosarcoma [1]. Neither analysis has been published in a peer-reviewed journal, and both represent incomplete and biased attempts at establishing a prevalence rate.

Type
Chapter
Information
Modern Management of Uterine Fibroids , pp. 155 - 164
Publisher: Cambridge University Press
Print publication year: 2020

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References

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