Smooth muscle tumors of uncertain malignant potential of the uterus : A single-center 9-year retrospective cohort study with a record-based diagnostic consistency audit
- 1Department of Obstetrics and Gynecology, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Türkiye.
Abstract
Uterine smooth muscle tumors of uncertain malignant potential (STUMP) are diagnosed by integrating cytological atypia, mitotic activity, and coagulative tumor cell necrosis, yet retrospective series often rely on historical reports that document these features incompletely. This study aimed to describe an institutional STUMP cohort and to determine whether its recorded category labels were supported by the pathological variables recorded for each case. This single-center retrospective cohort study included 20 patients who underwent surgery between January 2017 and March 2026 and received an institutional diagnosis of STUMP, epithelioid STUMP, or STUMP/leiomyosarcoma (LMS) interface. In a post hoc, record-based audit, the 18 labels recorded as Criterion A, B, or C were compared with explicit operational definitions adapted from a published 3-pattern formulation and classified as discordant, indeterminate, or consistent on record. Slides were not reexamined, and original diagnoses were retained. Exact 95% confidence intervals (CIs) and 3 sensitivity analyses were calculated. The mean age was 41.6 ± 7.2 years. All patients underwent surgery for presumed leiomyoma, 11 by hysterectomy and 9 by uterus-sparing procedures. All 7 Criterion C labels were accompanied by recorded mitotic counts below 15 per 10 high-power fields (7/7; 95% CI, 59.0–100.0%). Of the 18 audited labels, 10 were discordant (55.6%; 95% CI, 30.8–78.5%), six were indeterminate, and two were consistent on record. No recorded mitotic-count range crossed an audit threshold; lower range bounds and a stricter mitotic threshold changed no audit status, whereas 14 labels were discordant when only absent atypia was accepted as nonsignificant. One STUMP/LMS interface case was subsequently managed as LMS. Sixteen patients had no recorded recurrence or progression during a median follow-up of 11 months; the outcome was unknown in 3. STUMP was not recognized preoperatively in this cohort, but without a leiomyoma comparator, no conclusion about clinical distinguishability is possible. The audit demonstrates discordance between recorded labels and recorded variables rather than diagnostic error, and the affected cases remain provisional pending slide-level gynecological pathology review. The data support no inference about recurrence risk, the safety or reproductive benefit of uterus-sparing surgery, or biomarker-based prognosis.
Related
- Reply to Comment on Diagnostic Accuracy of a Sonographic Scoring System in Predicting the Malignant Potential of a Soft-tissue Swelling.
- Diagnostic Accuracy of Multiparametric Ultrasound Versus Cross-Sectional Imaging for Differentiating Benign and Malignant Cervical Lymph Nodes: A Histopathology-Referenced Retrospective Study
- Preoperative Inflammatory Markers in Relation to the Malignant Potential of Cartilaginous Tumors: A Retrospective Cohort Study
- Resistance to Thyroid Hormone Beta or Thyroid-Stimulating Hormone (TSH)-Secreting Pituitary Adenoma: A Diagnostic Dilemma With a THRB Variant of Uncertain Significance
- Quantifying the diagnostic time gap in precision oncology: A retrospective analysis of potential time savings from same-day cartridge-based molecular testing versus next-generation sequencing in cytology specimens
BibTeX
@article{ekmez2026smooth,
title = {{Smooth muscle tumors of uncertain malignant potential of the uterus : A single-center 9-year retrospective cohort study with a record-based diagnostic consistency audit}},
author = {Firat Ekmez and Numan Cim},
journal = {Medicine},
year = {2026},
month = oct,
doi = {10.1097/md.0000000000051288},
url = {https://europepmc.org/article/PMC/PMC13727265},
note = {CC BY},
}
RIS
TY - JOUR
TI - Smooth muscle tumors of uncertain malignant potential of the uterus : A single-center 9-year retrospective cohort study with a record-based diagnostic consistency audit
AU - Firat Ekmez
AU - Numan Cim
PY - 2026
DA - 2026/10/30
JO - Medicine
DO - 10.1097/md.0000000000051288
UR - https://europepmc.org/article/PMC/PMC13727265
AB - Uterine smooth muscle tumors of uncertain malignant potential (STUMP) are diagnosed by integrating cytological atypia, mitotic activity, and coagulative tumor cell necrosis, yet retrospective series often rely on historical reports that document these features incompletely. This study aimed to describe an institutional STUMP cohort and to determine whether its recorded category labels were supported by the pathological variables recorded for each case. This single-center retrospective cohort study included 20 patients who underwent surgery between January 2017 and March 2026 and received an institutional diagnosis of STUMP, epithelioid STUMP, or STUMP/leiomyosarcoma (LMS) interface. In a post hoc, record-based audit, the 18 labels recorded as Criterion A, B, or C were compared with explicit operational definitions adapted from a published 3-pattern formulation and classified as discordant, indeterminate, or consistent on record. Slides were not reexamined, and original diagnoses were retained. Exact 95% confidence intervals (CIs) and 3 sensitivity analyses were calculated. The mean age was 41.6 ± 7.2 years. All patients underwent surgery for presumed leiomyoma, 11 by hysterectomy and 9 by uterus-sparing procedures. All 7 Criterion C labels were accompanied by recorded mitotic counts below 15 per 10 high-power fields (7/7; 95% CI, 59.0–100.0%). Of the 18 audited labels, 10 were discordant (55.6%; 95% CI, 30.8–78.5%), six were indeterminate, and two were consistent on record. No recorded mitotic-count range crossed an audit threshold; lower range bounds and a stricter mitotic threshold changed no audit status, whereas 14 labels were discordant when only absent atypia was accepted as nonsignificant. One STUMP/LMS interface case was subsequently managed as LMS. Sixteen patients had no recorded recurrence or progression during a median follow-up of 11 months; the outcome was unknown in 3. STUMP was not recognized preoperatively in this cohort, but without a leiomyoma comparator, no conclusion about clinical distinguishability is possible. The audit demonstrates discordance between recorded labels and recorded variables rather than diagnostic error, and the affected cases remain provisional pending slide-level gynecological pathology review. The data support no inference about recurrence risk, the safety or reproductive benefit of uterus-sparing surgery, or biomarker-based prognosis.
SN - 0304-5412
SN - 1536-5964
SN - 0025-7974
ER -