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Article Title

Using Tumor Registry and Electronic Medical Record Databases to Determine Incidence of Uterine Sarcoma and Occult Malignancy Within an Integrated Health Care System

Publication Date

4-30-2015

Keywords

leiomyosarcoma, hysterectomy

Abstract

Background/Aims: There are currently no reliable estimates of uterine sarcoma incidence and occult malignancy at hysterectomy to aid decision-making about surgical route and policy formulation.

Methods: We identified women 18 years or older who underwent a hysterectomy and had a new diagnosis of uterine sarcoma in 2006–2013 in a large integrated health care system. Clinical presentation including when the diagnosis was not suspected or known preoperatively was assessed. Age- and race-specific total and annual incidence of uterine sarcoma and leiomyosarcoma and occult malignancy were calculated and evaluated for trends over time.

Results: From 2006 to 2013, there were 93,153 hysterectomies, of which 49,314 (52.9%) were for leiomyoma or abnormal bleeding. There were 298 new cases of uterine sarcoma, more than half (58%) of which were suspected or known preoperatively. The incidence of occult uterine sarcoma and leiomyosarcoma among women having hysterectomies for presumed benign leiomyoma and abnormal bleeding was 2.51 and 1.66 per 1,000 hysterectomies, respectively. The incidence was significantly higher for women over age 50; however, there was no significant difference in incidence by race/ethnicity. The annual incidence of uterine sarcoma did not increase over the 8-year period.

Discussion: Data from a large, diverse, community-based U.S. population confirms that uterine sarcomas are rare. The risk of occult malignancy must be weighed against the known benefits of minimally invasive hysterectomy. Our estimates of the risk of occult malignancy add important information for discussions between patients and clinicians when considering minimally invasive surgery and power morcellation and providing informed consent.

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