The relationship between torsion and of the length of the peduncle in patients with uterine subserosal leiomyoma

Abstract

Objective: To clarify the characteristics of twistable pedunculated subserosal uterine leiomyomas. Methods: A retrospective study was conducted of female subserosal uterine leiomyoma patients who were treated by laparoscopic myomectomy at Showa University Hospital, Tokyo, Japan, between January 2011 and September 2015. The patients were classified according to their intraoperative findings. The maximum diameter and volume of the subserosal uterine leiomyoma, and the length and thickness of the peduncle were evaluated by magnetic resonance imaging, and torsion and nontorsion cases were compared. Results: A total of eight torsion cases and 20 nontorsion cases were analyzed. The average peduncle length was significantly higher in the torsion cases (18.7±3.5 mm) than in the nontorsion cases (9.0±3.9 mm). The maximum diameter and volume of subserosal uterine leiomyoma and the thickness of the peduncle did not differ between the groups. The length to thickness ratio (length to thickness index) was more clearly associated with the torsion than the length of the peduncle or the ratio of the maximum diameter of the leiomyoma to the length. Receiver operating characteristic curve analysis showed that a length to thickness ratio of > 1.0 was associated with a higher detection rate, with an area under the receiver operating characteristic curve of 0.95 (95% confidence interval 0.86–1.00, p<0.001). Conclusions: In the preoperative period, the length of the peduncle was associated with the subsequent occurrence of torsion in patients with subserosal uterine leiomyoma. The length to thickness index is useful for predicting the torsion of a subserosal uterus leiomyoma.

Keywords

• peduncle length
• subserosal uterine leiomyoma
• torsion