Diagnostic Performances of Preoperative Echo-guided Uterine Biopsy in the Management of Suspect Uterine Sarcoma Tumors (BIOPSAR)

This is a prospective multi-center interventional study that will be performed in an effort to assess the diagnostic accuracy performance of preoperative vaginal ultrasound-guided biopsy (VUGB) to detect the exact histology of uterine tumors and thereafter triage cases being eligible for morcellation during laparoscopic resection. Ten tertiary French centers will participate in the present study.

Prior to carrying out the research, the informed consent of the person must be obtained after being informed of the purpose of the research, its conduct and duration, benefits, potential risks and constraints of the study.

During the inclusion check-up, exams must be performed within 30 days before the guided echo biopsy: clinical examination, gynecological examination, pain assessment (visual or verbal scale), biological and radiological assessment (Doppler ultrasound Pelvis and MRI pelvis).

The echo-guided biopsy will be performed by a specialized radiologist by transvaginal and exclusive transuterine approach. Local anesthesia will be performed. A pain assessment will be performed during the biopsy (visual or verbal scale).

Between the biopsy and the procedure, the patient will be reviewed by the investigating surgeon to check the outcome of the biopsy, any pain or complications of the biopsy.

The surgical procedure will be performed by laparotomy and will consist of an extra-facial hysterectomy without fragmentation of the surgical specimen (extraction technique "in block"). During the procedure, the investigating surgeon will perform a description of the abdominal and pelvic cavity and perform a block excision of the tumor.

At one month of the surgery, patient will be reviewed by the investigating surgeon for a postoperative visit with clinical examination, gynecological and histopathological results.

Thereafter, the follow-up of the patients will be carried out according to the standards of care according to the histopathological results.

Eligibility Criteria:
Inclusion Criteria:

1. Woman \>= 35 years old
2. Diagnosis of suspicious uterine tumor involving surgical management by laparoscopic hysterectomy with possible morcellation. Fibroma must be considered suspect, if at least one of the following characteristics is fulfilled:

   1. Rapid tumor growth defined as ≥30% of the maximum diameter in 1-year interval based on imaging findings, or,
   2. Symptomatic tumors in postmenopausal women presenting vaginal bleeding or pelvic pain or palpable masses or symptoms caused by pressure of neighbor organs such as dysuria and gastrointestinal symptoms, or,
   3. Tumors characterized by certain suspicious ultrasound criteria such as size \> 8 cm, presence and distribution of vascularization, presence of intratumoral lesions, ultrasound heterogeneity, necrosis, cystic components, presence of calcification.
   4. Genetical predisposal to cancer syndromes such as Lynch syndrome, hereditary leiomyomatosis or "renal cell cancer".
3. MRI performed according to the technical and interpretation criteria stipulated in the study within 30 days before the biopsy.
4. Uterine fibroma accessible to transvaginal echo-guided biopsy exclusively.
5. No contraindication to performing laparotomy surgery.
6. Voluntary signed written informed consent.
7. Patient with a social security in compliance with the French law.

Exclusion Criteria:

1. General contraindication(s) to performing a transvaginal echo-guided biopsy.
2. Biopsy by peritoneal approach (surgical or percutaneous).
3. History of treated cancer in the two years preceding inclusion or in progressive continuation.
4. Unfavorable anesthetic assessment that does not allow general anesthesia for the planned surgery.
5. Coagulation disorders contraindicating biopsy.
6. Pregnancy project.
7. Pregnant or lactating woman.
8. Impossibility of submitting to the medical examination of the test for geographical, social or psychological reasons.
9. Patient deprived of liberty under legal protection measure or unable to express her consent.