Uterine Fibroid FIGO Classification + Sarcoma Differentiation

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Benign fibroid vs sarcoma red flags
   Typical fibroid features vs sarcoma red flags? (Typical fibroid MRI: well-defined, T2-low signal, DWI-low + ADC-low (T2 blackout effect). FIGO classification 0–8 locates it (submucosal 0–2/intramural 3–5/subserosal 6–7/other 8), TVUS preferred, SIS improves submucosal typing, MRI for multiple/large/preoperative planning.)
   • Typical benign fibroid (T2-low, well-defined, ADC-low) → Typical fibroid · manage by FIGO classification
   • Sarcoma red flags (irregular border, heterogeneous T2-high signal, necrosis, ADC-low, hemorrhage, rapid growth) → Sarcoma red flags → gynecologic oncology consult
2. [End] Typical fibroid · manage by FIGO classification
   Typical fibroid: manage by FIGO 0–8 location (submucosal 0–2 hysteroscopy; intramural/subserosal by symptoms medical/UAE/HIFU/myomectomy); periodic follow-up. The classification is by anatomy only, not size or number.
3. [End] Sarcoma red flags → gynecologic oncology consult
   Leiomyosarcoma red flags (irregular border, markedly heterogeneous T2 with intermediate-high signal, central non-enhancing necrosis, restricted diffusion + ADC-low, hemorrhage, rapid growth especially postmenopausal): no single reliable sign, the combination matters more → gynecologic oncology consult, avoid morcellation when malignancy is suspected; LMS occurs in about 1/340 presumed fibroids.

Source guidelines & references

• Uterine smooth muscle tumor MRI and FIGO classification (RadioGraphics 2022) · source ↗
• Uterine fibroid FIGO classification 0–8 (StatPearls)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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