Accuracy of Ultrasound in the Diagnosis of Uterine Fibroids and Malignant Uterine Lesions among Saudi Women

Background: Uterine fibroids, the most frequent benign uterus tumors, often cannot be distinguished from malignant uterine tumors using clinical criteria. Due to their potential overlapping characteristics, imaging differentiation between both entities is commonly challenging. This study aims to evaluate the diagnostic accuracy of ultrasound (US) in the diagnosis of uterine fibroids and malignant uterine lesions among Saudi women. Methods and Results: Eighty Saudi women aged between 20 and 70 years were retrospectively collected from two different centers in Riyadh, Saudi Arabia. All patients were subjected to a presurgical US scan, and the diagnosis was histopathologically proven. The US accurately detected uterine fibroids in 43 (53.75%) of cases with different locations. Intramural fibroids [62.8% (27/43)] were the most common, followed by subserosal fibroids [25.6% (11/43)], submucosal fibroids [7.0% (3/43)], and pedunculated fibroids [4.6% (2/43)]. Signs of endometrial cancer were US found in 7 (8.75%) cases that were histologically proven. Ultrasound features suspicious of uterine cancer were found in 30 (37.5%) cases that were not confirmed by histopathological examination. The sensitivity and specificity of ultrasound for uterine cancer diagnosis were 100% (95% CI: 59.04% to 100.00%) and 58.9% (95% CI: 46.77% to 70.29%), respectively. Cancer incidence was more frequent among postmenopausal patients (n=5) compared to premenopausal patients (n=2) (P=0.028). Conclusion: The US is a good and accurate diagnostic method in differentiating types of uterine fibroids in Saudi women. The sensitivity and specificity of ultrasound in diagnosing uterine cancer are 100% and 58.9%, respectively. The incidence of cancer is higher among postmenopausal patients compared to premenopausal patients.