Proposed Uterus Imaging Reporting and Data System (UI-RADS).

The proposed Uterus Imaging Reporting and Data System (UI-RADS) could read something like the following:

·     UI-RADS 0: Need further imaging because of poor-quality study

·     UI-RADS 1: Normal uterus, no masses

·     UI-RADS 2: Uterine tumor present, benign (single tumor, < 5 cm, no necrosis, echogenicity consistent with benign fibroid)

·     UI-RADS 3: Uterine tumor(s) present, cannot be classified as most likely benign (multiple tumors, size 5-10 cm, no central necrosis, indeterminate echogenicity)

·     UI-RADS 4: Uterine tumors(s) present, concerning findings for malignancy (multiple tumors, size > 10 cm, < 10% central necrosis present, indeterminate echogenicity)

·     UI-RADS 5: Uterine tumor(s) present, most likely malignant (multiple tumors, size > 10 cm, > 10% central necrosis, echogenicity consistent with malignancy)

·     UI-RADS 6: Uterine tumor(s) present, previously established malignancy present

A woman's UI-RADS grade can then be assessed for its "concordance" with clinical and, potentially, pathological findings to determine the necessary clinical action.

Each of these classifications would lead to the following clinical actions by the gynecologist:

·     UI-RADS 0: Repeat imaging

·     UI-RADS 1: Routine screening

·     UI-RADS 2: Follow-up imaging at one year; if unchanged, proceed with routine imaging follow-up. If growing > 50% in one year, upgrade to UI-RADS 3. If clinical symptoms require myomectomy, perform with intraoperative biopsy to establish a reasonable assurance of benignity before surgically violating the uterine capsule. If clinical symptoms require total uterine resection, perform without tumor disruption.

·     UI-RADS 3: Follow-up imaging at six months and one year; if unchanged, proceed with routine imaging follow-up. A stable UI-RADS 3 downgrades to UI-RADS 2. If growing > 50% in one year, upgrade to UI-RADS 4. If clinical symptoms require myomectomy, perform with intraoperative biopsy to establish a reasonable assurance of benignity before surgically violating the uterine capsule. If clinical symptoms require total uterine resection, perform without tumor disruption.

·     UI-RADS 4: Establish clinical concordance (i.e., severe bleeding, anemia, pelvic pressure, dyspareunia, urinary frequency), measure LDH level, and perform abdominal CT or MRI. Perform screening chest CT. In "concordant" cases, proceed with an oncologically safe uterine resection as soon as possible, given the high likelihood of malignancy. If the woman is interested in maintaining her fertility, myomectomy can be considered only after tissue biopsy provides a reasonable assurance of benignity. In "discordant" cases, offer UI-RADS 4 patients an oncologically safe uterine resection or, if the patient prefers to maintain her uterus for family planning reasons, perform a biopsy to establish a reasonable assurance of benignity.

·     UI-RADS 5: Establish clinical concordance. Perform alternative imaging to better characterize the tumor(s). Perform a staging chest CT. Proceed to an oncologically safe uterine resection. Do not offer myomectomy.

·     UI-RADS 6: Patient under direct care of a gynecologic oncologist and medical oncologist.

UI-RADS ought to be a standardized risk assessment tool to help ob/gyn physicians generate a stringent screening scheme for uterine tumors, and to prevent the gynecological assumption of benignity about uterine tumors. It would rely on the establishment of routine uterine ultrasound screening in women, similar to the mammography paradigm. Of course, in clinically symptomatic women, the UI-RADS score would allow risk stratification and a more stringent and aggressive approach to diagnosing and resecting malignant tumors.

Given the incidence of malignancy in tumors of the uterine corpus, as delineated by the CDC, it is unacceptable for ob/gyn physicians to act only when the patient becomes symptomatic. Nor is it acceptable for physicians to simply assume that uterine tumors are benign -- especially when patients are symptomatic.

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Dr. Hooman Noorchashm, PhD, is a physician-scientist. He is an advocate for ethics, patient safety, and women's health. He and his six children live in Pennsylvania. This article was adapted from one published by the author on Medium.com.

The comments and observations expressed are those of the author and do not necessarily reflect the opinions of AuntMinnie.com.

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Last Updated np 2/1/2019 10:37:10 AM