Diagnostic accuracy of ultrasound in the differential diagnosis between uterine leiomyomas and sarcomas

Background: Differential diagnosis between uterine leiomyomas and sarcomas is challenging. Ultrasound shows an uncertain role in the clinical practice as pooled estimates about its diagnostic accuracy are lacking. Objectives: To assess the accuracy of ultrasound in the differential diagnosis between uterine leiomyomas and sarcomas. Data sources: A systematic review was performed searching 5 electronic databases (MEDLINE, Web of Sciences, Google Scholar, Scopus, and ClinicalTrial.gov) from their inception to June 2023. Methods of study selection: All peer-reviewed observational or randomized clinical trials that reported an unbiased postoperative histological diagnosis of uterine leiomyoma or uterine sarcoma which also comprised a preoperative ultrasonographic evaluation of the uterine mass. Tabulation, integration and results: Sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratio, and area under the curve on summary receiver operating characteristic were calculated for each included study and as pooled estimate, with 95% confidence interval. 972 women (694 with uterine leiomyomas and 278 with uterine sarcomas), were included. Ultrasound showed pooled sensitivity of 0.76 (95%CI:0.70-0.81), specificity of 0.89 (95%CI:0.87-0.92), LR+ and LR- of 6.65 (95%CI:4.45-9.93) and 0.26 (95%CI:0.07-1.0) respectively, DOR of 23.06 (95%CI:4.56-116.53), and AUC of 0.8925. Conclusions: Ultrasound seems to have only a moderate diagnostic accuracy in the differential diagnosis between uterine leiomyomas and sarcomas, with a lower sensitivity than specificity.