Importance of a reliable diagnosis of myometrial lesions using ultrasonography and liquid biopsy biomarkers in clinical gynecological practice.

Malignant myometrial lesions (sarcomas) are highly aggressive and require radical surgery in an oncological centre. Benign myometrial lesions (myomas) may either be managed expectantly, treated medically or by selective uterine artery embolisation or surgically by laparoscopic myomectomy with morcellation. It is of utmost importance to accurately identify sarcomas, not only because any delay in diagnosis is associated with lower survival rates, but also because the inadvertent morcellation of a sarcoma may lead to diffuse intraabdominal spreading of malignant tissue and hence to a dramatic worsening of the patient’s prognosis. However, clinical research so far demonstrated that medical imaging is not able to reliably discriminate between benign and malignant myometrial lesions. The recent development in liquid biopsies might prove to be the key to better preoperative diagnosis. Our research group already performed research on liquid biopsies in ovarian cancer. The knowledge about biomarkers in malignant myometrial disease, however, is low. Our research aims to identify new liquid biopsy biomarkers that enable to differentiate a sarcoma from a myoma. Additionally, we aim to define sonographic features enabling a better management in benign myometrial lesions. Our translational research primarily aims to propose a novel diagnostic algorithm differentiating between benign and malignant myometrial lesions based on ultrasonographic features and liquid biopsy biomarkers.