Development and optimization of a predictive score for the risk of malignancy in uterine masses based on elastosonography: A pilot study

Uterine leiomyosarcoma (LMS) is a rare but highly lethal malignancy, with preoperative diagnosis being challenging as its ultrasound characteristics resemble those of benign leiomyomas (LM) and Smooth Muscle Tumors of Uncertain Malignant Potential (STUMP). Ultrasound elastography (UE), an emerging technique that measures tissue stiffness and generates a colorimetric image (elastogram), may enhance the differential diagnosis of myometrial masses. This pilot study utilized elastography to estimate the stiffness of uterine masses, expressed as the hardness ratio (HR%), and its correlation with ultrasound features and final histological diagnosis. In this prospective observational study, symptomatic patients with myometrial masses underwent 2D transvaginal ultrasound, SWE, and subsequent surgery with histological examination. Results showed that malignant masses had significantly lower HR values compared to benign ones, with a statistically significant difference (p < 0.0001). A cut-off HR value, determined using the ROC curve, enabled discrimination between malignant and benign masses with high sensitivity. Additionally, Spearman’s correlation analysis revealed a strong correlation between HR and histological findings. In conclusion, transvaginal elastography has emerged as a promising diagnostic tool to differentiate myometrial neoplasms.