Uterine Fibroids

Key clinical point: Long noncoding ribonucleic acid (lncRNA) H19 and 10-11 translocation enzyme 1 (TET1) messenger RNA expression levels showed high diagnostic and predictive values for determining postoperative recurrence of uterine fibroids (UFs).

Major finding: lncRNA H19 (P = .010) and TET1 (P = .014) levels independently predicted UF recurrence. The area under the curve values of lncRNA H19 and TET1 for predicting UF recurrence were 0.814 (sensitivity, 81.13%; specificity, 77.27%) and 0.765 (sensitivity, 69.81%; specificity, 77.27%), respectively.

Study details: This study enrolled 75 patients with UFs who underwent surgical treatment and 60 healthy controls. Patients with UF were followed up for 2 years to evaluate postoperative recurrence of UFs.

Disclosures: No information on funding was available. The authors declared no conflict of interests.

Source: Zhan X et al. Clinics. 2021 Sep 28. doi: 10.6061/clinics/2021/e2671.

Key clinical point: Long noncoding ribonucleic acid (lncRNA) H19 and 10-11 translocation enzyme 1 (TET1) messenger RNA expression levels showed high diagnostic and predictive values for determining postoperative recurrence of uterine fibroids (UFs).

Major finding: lncRNA H19 (P = .010) and TET1 (P = .014) levels independently predicted UF recurrence. The area under the curve values of lncRNA H19 and TET1 for predicting UF recurrence were 0.814 (sensitivity, 81.13%; specificity, 77.27%) and 0.765 (sensitivity, 69.81%; specificity, 77.27%), respectively.

Study details: This study enrolled 75 patients with UFs who underwent surgical treatment and 60 healthy controls. Patients with UF were followed up for 2 years to evaluate postoperative recurrence of UFs.

Disclosures: No information on funding was available. The authors declared no conflict of interests.

Source: Zhan X et al. Clinics. 2021 Sep 28. doi: 10.6061/clinics/2021/e2671.

Key clinical point: Long noncoding ribonucleic acid (lncRNA) H19 and 10-11 translocation enzyme 1 (TET1) messenger RNA expression levels showed high diagnostic and predictive values for determining postoperative recurrence of uterine fibroids (UFs).

Major finding: lncRNA H19 (P = .010) and TET1 (P = .014) levels independently predicted UF recurrence. The area under the curve values of lncRNA H19 and TET1 for predicting UF recurrence were 0.814 (sensitivity, 81.13%; specificity, 77.27%) and 0.765 (sensitivity, 69.81%; specificity, 77.27%), respectively.

Study details: This study enrolled 75 patients with UFs who underwent surgical treatment and 60 healthy controls. Patients with UF were followed up for 2 years to evaluate postoperative recurrence of UFs.

Disclosures: No information on funding was available. The authors declared no conflict of interests.

Source: Zhan X et al. Clinics. 2021 Sep 28. doi: 10.6061/clinics/2021/e2671.

Key clinical point: Signal intensity of the predominant uterine fibroid (UF) on T2-weighted images could predict volume reduction rate (VRR) after gonadotropin-releasing hormone (GnRH)-agonist treatment before uterine artery embolization.

Major finding: The ratio between the mean signal intensity of UF and mean signal intensity of the rectus abdominis (F/R) at an optimal cutoff value of 2.58 and 1.69 could predict VRR 50% or more and less than 30% with an area under the curve of 0.81 (95% confidence interval [CI], 0.62-0.96; sensitivity and specificity, 80%) and 0.84 (95% CI, 0.63-1.00; sensitivity, 100%; specificity, 70%), respectively.

Study details: This was a retrospective analysis of 30 women with a large UF who underwent magnetic resonance imaging (MRI) both before and after GnRH-agonist administration.

Disclosures: This study did not report any source of funding. The authors declared no conflict of interests.

Source: Lee WJ et al. Acta Radiol. 2021 Sep 25. doi: 10.1177/02841851211038802.

Key clinical point: Signal intensity of the predominant uterine fibroid (UF) on T2-weighted images could predict volume reduction rate (VRR) after gonadotropin-releasing hormone (GnRH)-agonist treatment before uterine artery embolization.

Major finding: The ratio between the mean signal intensity of UF and mean signal intensity of the rectus abdominis (F/R) at an optimal cutoff value of 2.58 and 1.69 could predict VRR 50% or more and less than 30% with an area under the curve of 0.81 (95% confidence interval [CI], 0.62-0.96; sensitivity and specificity, 80%) and 0.84 (95% CI, 0.63-1.00; sensitivity, 100%; specificity, 70%), respectively.

Study details: This was a retrospective analysis of 30 women with a large UF who underwent magnetic resonance imaging (MRI) both before and after GnRH-agonist administration.

Disclosures: This study did not report any source of funding. The authors declared no conflict of interests.

Source: Lee WJ et al. Acta Radiol. 2021 Sep 25. doi: 10.1177/02841851211038802.

Key clinical point: Signal intensity of the predominant uterine fibroid (UF) on T2-weighted images could predict volume reduction rate (VRR) after gonadotropin-releasing hormone (GnRH)-agonist treatment before uterine artery embolization.

Major finding: The ratio between the mean signal intensity of UF and mean signal intensity of the rectus abdominis (F/R) at an optimal cutoff value of 2.58 and 1.69 could predict VRR 50% or more and less than 30% with an area under the curve of 0.81 (95% confidence interval [CI], 0.62-0.96; sensitivity and specificity, 80%) and 0.84 (95% CI, 0.63-1.00; sensitivity, 100%; specificity, 70%), respectively.

Study details: This was a retrospective analysis of 30 women with a large UF who underwent magnetic resonance imaging (MRI) both before and after GnRH-agonist administration.

Disclosures: This study did not report any source of funding. The authors declared no conflict of interests.

Source: Lee WJ et al. Acta Radiol. 2021 Sep 25. doi: 10.1177/02841851211038802.

Key clinical point: Nearly half the patients with uterine fibroids (UF) considered nonresponders to elagolix plus add-back therapy in the 2 phase 3 trials showed a clinically meaningful reduction in menstrual blood loss (MBL).

Major finding: Overall, 24% of patients treated with elagolix+add-back therapy were considered nonresponders as they did not meet 1 or more criteria among MBL less than 80 mL, 50% or more reduction in MBL, and/or premature treatment discontinuation. Of these, 19% met both the bleeding criterion but discontinued treatment and 26% met 1 bleeding criterion. At month 1, the least mean percent change in MBL in nonresponders who met both bleeding criteria was 80.3%.

Study details: Findings are from a pooled post hoc analysis of phase 3 Elaris UF-1 and UF-2 trials, including 549 premenopausal women with UF and heavy menstrual bleeding who received elagolix+add-back therapy or placebo.

Disclosures: This study was funded by AbbVie. Some investigators reported ties with various sources including Abbvie. Three authors declared being current/former employees and/or shareholders of AbbVie.

Source: Stewart EA et al. J Womens Health. 2021 Sep 28. doi: 10.1089/jwh.2021.0152.

Key clinical point: Nearly half the patients with uterine fibroids (UF) considered nonresponders to elagolix plus add-back therapy in the 2 phase 3 trials showed a clinically meaningful reduction in menstrual blood loss (MBL).

Major finding: Overall, 24% of patients treated with elagolix+add-back therapy were considered nonresponders as they did not meet 1 or more criteria among MBL less than 80 mL, 50% or more reduction in MBL, and/or premature treatment discontinuation. Of these, 19% met both the bleeding criterion but discontinued treatment and 26% met 1 bleeding criterion. At month 1, the least mean percent change in MBL in nonresponders who met both bleeding criteria was 80.3%.

Study details: Findings are from a pooled post hoc analysis of phase 3 Elaris UF-1 and UF-2 trials, including 549 premenopausal women with UF and heavy menstrual bleeding who received elagolix+add-back therapy or placebo.

Disclosures: This study was funded by AbbVie. Some investigators reported ties with various sources including Abbvie. Three authors declared being current/former employees and/or shareholders of AbbVie.

Source: Stewart EA et al. J Womens Health. 2021 Sep 28. doi: 10.1089/jwh.2021.0152.

Key clinical point: Nearly half the patients with uterine fibroids (UF) considered nonresponders to elagolix plus add-back therapy in the 2 phase 3 trials showed a clinically meaningful reduction in menstrual blood loss (MBL).

Major finding: Overall, 24% of patients treated with elagolix+add-back therapy were considered nonresponders as they did not meet 1 or more criteria among MBL less than 80 mL, 50% or more reduction in MBL, and/or premature treatment discontinuation. Of these, 19% met both the bleeding criterion but discontinued treatment and 26% met 1 bleeding criterion. At month 1, the least mean percent change in MBL in nonresponders who met both bleeding criteria was 80.3%.

Study details: Findings are from a pooled post hoc analysis of phase 3 Elaris UF-1 and UF-2 trials, including 549 premenopausal women with UF and heavy menstrual bleeding who received elagolix+add-back therapy or placebo.

Disclosures: This study was funded by AbbVie. Some investigators reported ties with various sources including Abbvie. Three authors declared being current/former employees and/or shareholders of AbbVie.

Source: Stewart EA et al. J Womens Health. 2021 Sep 28. doi: 10.1089/jwh.2021.0152.

Key clinical point: Preliminary data showed a low risk for uterine rupture with single-layer closure of the myometrium after laparoscopic myomectomy (LM) and therefore can be considered a safe option for subsequent pregnancies.

Major finding: Overall, 24 pregnant women underwent single-layer closure of the myometrium after LM. The mean duration between the operation and the first pregnancy was 10.2 months. Overall, 24 patients needed a cesarean section (C-section) delivery, 6 had a miscarriage, and 2 had an intrauterine pregnancy. Of these, 8 patients were pregnant again and underwent a C-section delivery. No cases of uterine rupture were observed.

Study details: Findings are from a retrospective study including 102 women who underwent single-layer sutured LM to remove uterine fibroids larger than 5 cm and associated with the myometrium.

Disclosures: The study did not report any source of funding. The authors declared no conflict of interests.

Source: Aksin S et al. Int J Clin Pract. 2021 Sep 15. doi: 10.1111/ijcp.14870.

Key clinical point: Preliminary data showed a low risk for uterine rupture with single-layer closure of the myometrium after laparoscopic myomectomy (LM) and therefore can be considered a safe option for subsequent pregnancies.

Major finding: Overall, 24 pregnant women underwent single-layer closure of the myometrium after LM. The mean duration between the operation and the first pregnancy was 10.2 months. Overall, 24 patients needed a cesarean section (C-section) delivery, 6 had a miscarriage, and 2 had an intrauterine pregnancy. Of these, 8 patients were pregnant again and underwent a C-section delivery. No cases of uterine rupture were observed.

Study details: Findings are from a retrospective study including 102 women who underwent single-layer sutured LM to remove uterine fibroids larger than 5 cm and associated with the myometrium.

Disclosures: The study did not report any source of funding. The authors declared no conflict of interests.

Source: Aksin S et al. Int J Clin Pract. 2021 Sep 15. doi: 10.1111/ijcp.14870.

Key clinical point: Preliminary data showed a low risk for uterine rupture with single-layer closure of the myometrium after laparoscopic myomectomy (LM) and therefore can be considered a safe option for subsequent pregnancies.

Major finding: Overall, 24 pregnant women underwent single-layer closure of the myometrium after LM. The mean duration between the operation and the first pregnancy was 10.2 months. Overall, 24 patients needed a cesarean section (C-section) delivery, 6 had a miscarriage, and 2 had an intrauterine pregnancy. Of these, 8 patients were pregnant again and underwent a C-section delivery. No cases of uterine rupture were observed.

Study details: Findings are from a retrospective study including 102 women who underwent single-layer sutured LM to remove uterine fibroids larger than 5 cm and associated with the myometrium.

Disclosures: The study did not report any source of funding. The authors declared no conflict of interests.

Source: Aksin S et al. Int J Clin Pract. 2021 Sep 15. doi: 10.1111/ijcp.14870.

Key clinical point: The uterine radial artery resistance index (RA-RI) was impaired after laparoscopic myomectomy (LM) and took almost 3 months to return to postoperative levels. However, restoration correlated negatively with the age of the patient.

Major finding: The median impedance of RA-RI was significantly higher 1 week after LM (0.87) vs before (0.73) and 3 months after (0.76) surgery (P < .001). There was a moderately significant correlation between the patient’s age and the rate of recovery at 3 months after LM (Pearson’s correlation coefficient, 0.54; P = .002).

Study details: Findings are from a retrospective study including 19 infertile women with uterine fibroid who underwent LM.

Disclosures: This work was funded by a grant from the Japanese Foundation for Research and Promotion of Endoscopy. The authors declared no conflict of interests.

Source: Ota K et al. J Obstet Gynaecol. 2021 Sep 23. doi: 10.1080/01443615.2021.1945011.

Key clinical point: The uterine radial artery resistance index (RA-RI) was impaired after laparoscopic myomectomy (LM) and took almost 3 months to return to postoperative levels. However, restoration correlated negatively with the age of the patient.

Major finding: The median impedance of RA-RI was significantly higher 1 week after LM (0.87) vs before (0.73) and 3 months after (0.76) surgery (P < .001). There was a moderately significant correlation between the patient’s age and the rate of recovery at 3 months after LM (Pearson’s correlation coefficient, 0.54; P = .002).

Study details: Findings are from a retrospective study including 19 infertile women with uterine fibroid who underwent LM.

Disclosures: This work was funded by a grant from the Japanese Foundation for Research and Promotion of Endoscopy. The authors declared no conflict of interests.

Source: Ota K et al. J Obstet Gynaecol. 2021 Sep 23. doi: 10.1080/01443615.2021.1945011.

Key clinical point: The uterine radial artery resistance index (RA-RI) was impaired after laparoscopic myomectomy (LM) and took almost 3 months to return to postoperative levels. However, restoration correlated negatively with the age of the patient.

Major finding: The median impedance of RA-RI was significantly higher 1 week after LM (0.87) vs before (0.73) and 3 months after (0.76) surgery (P < .001). There was a moderately significant correlation between the patient’s age and the rate of recovery at 3 months after LM (Pearson’s correlation coefficient, 0.54; P = .002).

Study details: Findings are from a retrospective study including 19 infertile women with uterine fibroid who underwent LM.

Disclosures: This work was funded by a grant from the Japanese Foundation for Research and Promotion of Endoscopy. The authors declared no conflict of interests.

Source: Ota K et al. J Obstet Gynaecol. 2021 Sep 23. doi: 10.1080/01443615.2021.1945011.

Key clinical point: Single-port laparoscopic myomectomy (LM) for treatment of uterine fibroids (UF) showed characteristics of lesser trauma, faster recovery, and higher patient satisfaction than the traditional 3-port LM.

Major finding: The specimen removal time, postoperative ambulation time, first exhaust time after surgery, and postoperative hospital stay were lower for single-port vs traditional 3-port LM (all P < .05). After 30 days of operation, the abdominal scar satisfaction score was higher in the single-port vs 3-port LM group (4.17 vs 3.47; P = .00). Intraoperative blood loss was similar in both groups (P > .05).

Study details: Findings are from a retrospective review of 120 patients with UFs who underwent LM. Overall, 60 patients underwent single-port LM, and the remaining 60 were treated with traditional 3-port LM.

Disclosures: This study was funded by the Liaoning Provincial Department of Science and Technology. The authors declared no conflict of interests.

Source: Jiang L et al. Front Oncol. 2021 Sep 24. doi: 10.3389/fonc.2021.722084.

Key clinical point: Single-port laparoscopic myomectomy (LM) for treatment of uterine fibroids (UF) showed characteristics of lesser trauma, faster recovery, and higher patient satisfaction than the traditional 3-port LM.

Major finding: The specimen removal time, postoperative ambulation time, first exhaust time after surgery, and postoperative hospital stay were lower for single-port vs traditional 3-port LM (all P < .05). After 30 days of operation, the abdominal scar satisfaction score was higher in the single-port vs 3-port LM group (4.17 vs 3.47; P = .00). Intraoperative blood loss was similar in both groups (P > .05).

Study details: Findings are from a retrospective review of 120 patients with UFs who underwent LM. Overall, 60 patients underwent single-port LM, and the remaining 60 were treated with traditional 3-port LM.

Disclosures: This study was funded by the Liaoning Provincial Department of Science and Technology. The authors declared no conflict of interests.

Source: Jiang L et al. Front Oncol. 2021 Sep 24. doi: 10.3389/fonc.2021.722084.

Key clinical point: Single-port laparoscopic myomectomy (LM) for treatment of uterine fibroids (UF) showed characteristics of lesser trauma, faster recovery, and higher patient satisfaction than the traditional 3-port LM.

Major finding: The specimen removal time, postoperative ambulation time, first exhaust time after surgery, and postoperative hospital stay were lower for single-port vs traditional 3-port LM (all P < .05). After 30 days of operation, the abdominal scar satisfaction score was higher in the single-port vs 3-port LM group (4.17 vs 3.47; P = .00). Intraoperative blood loss was similar in both groups (P > .05).

Study details: Findings are from a retrospective review of 120 patients with UFs who underwent LM. Overall, 60 patients underwent single-port LM, and the remaining 60 were treated with traditional 3-port LM.

Disclosures: This study was funded by the Liaoning Provincial Department of Science and Technology. The authors declared no conflict of interests.

Source: Jiang L et al. Front Oncol. 2021 Sep 24. doi: 10.3389/fonc.2021.722084.

Key clinical point: T2 relaxation time of uterine fibroids (UF) obtained before treatment with magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU) was an important predictor of nonperfused volume ratio (NPVr) and outperformed existing T2-weighted imaging methods like Funaki classification.

Major finding: T2 relaxation time correlated negatively with NPVr (correlation coefficient, −0.54; P < .001). The area under the curve value was higher for T2 relaxation time classification (T2 I, 0.69; T2 II, 0.69; and T2 III, 0.84; whole model P = .0019) vs corresponding Funaki classification (Funaki I, 0.57; Funaki II, 0.40; and Funaki III, 0.66; P = 0.56).

Study details: Findings are from a prospective analysis of 30 women with 32 UFs who underwent T2 relaxation time mapping before MRgHIFU treatment.

Disclosures: This study was funded by The Finnish Cultural Foundation, TYKS Foundation, and Instrumentarium Science Foundation. The authors declared no conflict of interests.

Source: Sainio T et al. Int J Hyperthermia. 2021 Sep 19. doi: 10.1080/02656736.2021.1976850.

Key clinical point: T2 relaxation time of uterine fibroids (UF) obtained before treatment with magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU) was an important predictor of nonperfused volume ratio (NPVr) and outperformed existing T2-weighted imaging methods like Funaki classification.

Major finding: T2 relaxation time correlated negatively with NPVr (correlation coefficient, −0.54; P < .001). The area under the curve value was higher for T2 relaxation time classification (T2 I, 0.69; T2 II, 0.69; and T2 III, 0.84; whole model P = .0019) vs corresponding Funaki classification (Funaki I, 0.57; Funaki II, 0.40; and Funaki III, 0.66; P = 0.56).

Study details: Findings are from a prospective analysis of 30 women with 32 UFs who underwent T2 relaxation time mapping before MRgHIFU treatment.

Disclosures: This study was funded by The Finnish Cultural Foundation, TYKS Foundation, and Instrumentarium Science Foundation. The authors declared no conflict of interests.

Source: Sainio T et al. Int J Hyperthermia. 2021 Sep 19. doi: 10.1080/02656736.2021.1976850.

Key clinical point: T2 relaxation time of uterine fibroids (UF) obtained before treatment with magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU) was an important predictor of nonperfused volume ratio (NPVr) and outperformed existing T2-weighted imaging methods like Funaki classification.

Major finding: T2 relaxation time correlated negatively with NPVr (correlation coefficient, −0.54; P < .001). The area under the curve value was higher for T2 relaxation time classification (T2 I, 0.69; T2 II, 0.69; and T2 III, 0.84; whole model P = .0019) vs corresponding Funaki classification (Funaki I, 0.57; Funaki II, 0.40; and Funaki III, 0.66; P = 0.56).

Study details: Findings are from a prospective analysis of 30 women with 32 UFs who underwent T2 relaxation time mapping before MRgHIFU treatment.

Disclosures: This study was funded by The Finnish Cultural Foundation, TYKS Foundation, and Instrumentarium Science Foundation. The authors declared no conflict of interests.

Source: Sainio T et al. Int J Hyperthermia. 2021 Sep 19. doi: 10.1080/02656736.2021.1976850.

A second study also evaluated the growth uterine fibroids during a different time during a woman’s lifespan - pregnancy. While it’s commonly thought that fibroids grow during pregnancy, a prospective cross-sectional study in the International Journal of Gynecology & Obstetrics (Tian et al) evaluated 394 women with uterine fibroids and found that growth depended on gestational age. In this group, ultrasound examinations were conducted to measure the size of uterine fibroids during weeks 6–7, 11–14, 22–24 and 28–34 of pregnancy and before delivery. The study team found that uterine fibroid size commonly increased before 22–24 weeks of pregnancy with the fastest growth occurring before 11–14 weeks gestation. Later in pregnancy, from 22–24 weeks to the date of delivery, uterine fibroid size remained unchanged.

Lin et al published a large-scale nationwide cohort study in PLoS One that evaluated whether women with uterine fibroids were at increased risk of developing endometriosis. Overall, 31,239 women with uterine fibroids were matched to 124, 956 control participants and followed for 14 years. Compared to controls, patients with uterine fibroids were at a higher risk of developing endometriosis (adjusted hazard ratio [aHR] 6.44, P < 0.05). Other conditions associated with a higher risk of endometriosis included history of tubo-ovarian infection (aHR 2.86, P = 0.01), endometritis (aHR 1.14, P < 0.001), infertility (aHR 1.26, P < 0.001) and allergic diseases (aHR, 1.11, P < .001). Similarly, having both uterine fibroids and infertility significantly increased the risk of endometriosis (aHR 6.95; P < 0.001).

A second study also evaluated the growth uterine fibroids during a different time during a woman’s lifespan - pregnancy. While it’s commonly thought that fibroids grow during pregnancy, a prospective cross-sectional study in the International Journal of Gynecology & Obstetrics (Tian et al) evaluated 394 women with uterine fibroids and found that growth depended on gestational age. In this group, ultrasound examinations were conducted to measure the size of uterine fibroids during weeks 6–7, 11–14, 22–24 and 28–34 of pregnancy and before delivery. The study team found that uterine fibroid size commonly increased before 22–24 weeks of pregnancy with the fastest growth occurring before 11–14 weeks gestation. Later in pregnancy, from 22–24 weeks to the date of delivery, uterine fibroid size remained unchanged.

Lin et al published a large-scale nationwide cohort study in PLoS One that evaluated whether women with uterine fibroids were at increased risk of developing endometriosis. Overall, 31,239 women with uterine fibroids were matched to 124, 956 control participants and followed for 14 years. Compared to controls, patients with uterine fibroids were at a higher risk of developing endometriosis (adjusted hazard ratio [aHR] 6.44, P < 0.05). Other conditions associated with a higher risk of endometriosis included history of tubo-ovarian infection (aHR 2.86, P = 0.01), endometritis (aHR 1.14, P < 0.001), infertility (aHR 1.26, P < 0.001) and allergic diseases (aHR, 1.11, P < .001). Similarly, having both uterine fibroids and infertility significantly increased the risk of endometriosis (aHR 6.95; P < 0.001).

A second study also evaluated the growth uterine fibroids during a different time during a woman’s lifespan - pregnancy. While it’s commonly thought that fibroids grow during pregnancy, a prospective cross-sectional study in the International Journal of Gynecology & Obstetrics (Tian et al) evaluated 394 women with uterine fibroids and found that growth depended on gestational age. In this group, ultrasound examinations were conducted to measure the size of uterine fibroids during weeks 6–7, 11–14, 22–24 and 28–34 of pregnancy and before delivery. The study team found that uterine fibroid size commonly increased before 22–24 weeks of pregnancy with the fastest growth occurring before 11–14 weeks gestation. Later in pregnancy, from 22–24 weeks to the date of delivery, uterine fibroid size remained unchanged.

Lin et al published a large-scale nationwide cohort study in PLoS One that evaluated whether women with uterine fibroids were at increased risk of developing endometriosis. Overall, 31,239 women with uterine fibroids were matched to 124, 956 control participants and followed for 14 years. Compared to controls, patients with uterine fibroids were at a higher risk of developing endometriosis (adjusted hazard ratio [aHR] 6.44, P < 0.05). Other conditions associated with a higher risk of endometriosis included history of tubo-ovarian infection (aHR 2.86, P = 0.01), endometritis (aHR 1.14, P < 0.001), infertility (aHR 1.26, P < 0.001) and allergic diseases (aHR, 1.11, P < .001). Similarly, having both uterine fibroids and infertility significantly increased the risk of endometriosis (aHR 6.95; P < 0.001).

Q1: How do/can fibroids influence fertility?

When considering how uterine fibroids influence fertility, it's important to understand that uterine fibroids are very common. Uterine fibroids are the most common pelvic tumor in women, and they're non-cancerous tumors that are developed from the muscle cells of the uterus. The lifetime risk, before the age of 50, of a woman having fibroids varies by race and ethnicity, but in general, about 80% of Black women and 70% of Caucasian women will have at least one uterine fibroid diagnosed before the age of 50.

It's also important to understand when considering fertility that the prevalence of uterine fibroids increases as someone gets older. So uterine fibroids are much less common in younger women in their 20s as they are in women in their upper 30s and 40s. That's important to understand when looking at fertility because we also know that with age, fertility decreases. Thus, uterine fibroids also can impact fertility. There's also this age-related factor, which makes it difficult to really look at fibroids as far as being a causative agent for infertility.

We do know that approximately 10% of women with infertility will be diagnosed with uterine fibroids during their evaluation, and there's multiple ways that uterine fibroids impact fertility. In general, it's going to depend on the location of the uterine fibroids, the size and the bulk or the number of uterine fibroids that a woman has.  But when we look at the ways that uterine fibroids can impact fertility, what they can do is they distort the uterine cavity. This is the most common for submucosal fibroids or fibroids that have a component that's present inside the uterine cavity. Fibroids that are submucosal or intramural fibroids  are in the muscle of the uterus and have an intracavitary component. They're well-known to distort the uterine cavity and that can impact implantation of an embryo. There's also thought that it can impact an ongoing pregnancy.

There's speculation that uterine fibroids can impact the blood flow to a pregnancy as well and they may impact fertility. Depending on the size of the uterine fibroid, they may block the fallopian tubes. And so, if you have a uterine fibroid that's in the corner of the uterus, that could cause a tubal factor type of infertility where there's occlusion of the fallopian tube. But in general, the most concern we have for uterine fibroids is how those fibroids impact the uterine lining and implantation of an embryo, and it's thought that those are most likely due to submucosal fibroids, or some intramural fibroids that may be particularly large, or that have a component that's inside the cavity.

Q2. Several studies have attempted to clarify the influence of fibroids on fertility, however, there have been various, sometimes contradictory findings and a lack of well-designed trials. Why is this?

One of the challenges in counseling patients regarding uterine fibroids is that there's really a lack of  high-quality studies assessing uterine fibroids and fertility. And we all know that the gold standard research study is a randomized control trial, as they provide the highest level of evidence, but those are very difficult to conduct especially for women with uterine fibroids, as many women will decline randomization.

It's difficult to design a study where there's one treatment that can be beneficial versus no treatment. That's one challenge. Because of that, the study designs that we've had to date have mostly been retrospective, and there's been some observational studies. But even those studies, unfortunately, are complicated by the fact that fibroids themselves are very heterogeneous. It's a very heterogeneous condition. There's a lot of difference between the size of the uterine fibroids, the location and the bulk of the fibroid, and then there's also going to be the issue with age. If you have a woman who's older with uterine fibroids, obviously her age is also going to impact her fertility. We know that women with uterine fibroids tend to be older and that also impacts fertility. So that's going to have an impact on any research as well.

What we do know from some of the research to date is that it's well-known that submucosal fibroids impair fertility, that's well established. We do know that subserosal fibroids or the fibroids on the surface of the uterus do not impact uterine fibroids. The question that really hasn't been answered because there hasn't been adequate research and there's just not enough data of high quality is, whether intramural fibroids or fibroids inside the uterine muscle, whether they impact fertility.

Many women who have intramural uterine fibroids are asymptomatic. They don't have symptoms at all. So, the question is whether a woman should undergo an invasive procedure to remove that fibroid and if it’s going to help or not? That's one of the questions that we just don't have enough adequate research on because there are some limitations in the literature.

Q3. What are the current treatments, both surgical and nonsurgical, for patients with fibroids who may want to become pregnant?

I think if there's a patient, a woman with uterine fibroids who's interested in fertility, she may be a patient who is diagnosed with symptomatic fibroids, who wants to preserve her fertility, or she may be a patient who's an infertility patient who during her fertility evaluation discovers she has fibroids. It is important to determine whether treatment is appropriate for that patient, and as we just discussed, there's not a lot of answers in the literature for some patients. I think the most important thing to do first before deciding on a treatment is  to determine the best type of treatment. At Johns Hopkins, for many of our patients with uterine fibroids, they'll undergo a pelvic MRI because the pelvic MRI can provide the most detailed information regarding the size and exact location of the uterine fibroids.

We then have a multidisciplinary conference every two weeks where we review the MRIs with a group of minimally invasive surgeons, interventional radiologists, and fertility specialist where we can really decide the best treatment for the individual patient. In deciding on a patient, it's important to make the right decision and have the most information. So as far as treatments that are available, for women who are wanting to preserve their fertility or planning to get pregnant very soon, the most common options are going to be surgical.

The least invasive surgical treatment would be a hysteroscopic myomectomy where we would do a hysteroscopy and remove the uterine fibroids by either shaving the pieces of the submucosal fibroid or we can remove it with a hysteroscopic morcellator. There are various techniques. But for the submucosal fibroids that are inside the uterine cavity, hysteroscopic myomectomy is very minimally invasive. It's an outpatient procedure. It's very safe and it's something that we will typically offer to patients who have submucosal fibroids.

For patients who have symptomatic uterine fibroids and may have bulk symptoms, or have numerous uterine fibroids, we typically would recommend either a laparoscopic robotic-assisted myomectomy, sometimes just a laparoscopic myomectomy, or for women who have the most severe, a very large fibroid uterus, let's say greater than 20 centimeters, they may actually need to undergo an exploratory laparotomy or abdominal myomectomy. For patients who have symptomatic subserosal fibroids and large intramural fibroids that need to be removed, it really depends on the size, location, and bulk of the uterine fibroids. And that's where the pelvic MRI becomes very useful.

I would say that for the majority of my patients that have a large amount of fibroids, are still able to undergo a robotic-assisted laparoscopic hysterectomy which oftentimes can be an outpatient procedure just because we've had this improvement in technology with robotic and laparoscopic surgery. But surgery can be very beneficial as far as removing the bulk of the uterine fibroids. And so that is typically our treatments that we would recommend for those who want future fertility or who are imminently trying to get pregnant.

There are medical treatments as well or non-surgical treatments such as GnRH analogs that can shrink the size of the uterine fibroids. Unfortunately, the uterine fibroids are still there and typically will still impact fertility. So that's not something that we do often for those that are actively trying to get pregnant. The same for uterine artery embolization or uterine fibroids embolization. We will not recommend that for patients who want to have future fertility because the fibroids will still be in that location and they're typically in a location that's impairing fertility.

Q4. How long do patients have to wait after a fibroid treatment to try to get pregnant?

The length of time that a patient needs to wait after having fibroids removed for surgical treatment typically depends on the type of surgery the patient undergoes as well as the size of the fibroids and the extent of the surgery. For a patient who's undergoing a hysteroscopic myomectomy, they typically only must wait a month or two. Once they're assessed that there's no residual fibroid that's left, then they can try to conceive.

For patients who need to undergo abdominal myomectomy or laparoscopic myomectomy, those are much more extensive procedures. Typically, surgeons will recommend a patient wait three to six months to try to conceive. It's also important for the surgeon to discuss with the patient the extent of the myomectomy and whether that patient, when she does become pregnant, will require a c-section because typically if the uterine cavity is entered or if there are multiple incisions on the uterus during the myomectomy surgery, surgeons will recommend a c-section for that patient when she does become pregnant to decrease the risk of uterine rupture. And typically, that will be documented in the operative note, but the surgeon will also counsel the patient regarding this.

Q1: How do/can fibroids influence fertility?

When considering how uterine fibroids influence fertility, it's important to understand that uterine fibroids are very common. Uterine fibroids are the most common pelvic tumor in women, and they're non-cancerous tumors that are developed from the muscle cells of the uterus. The lifetime risk, before the age of 50, of a woman having fibroids varies by race and ethnicity, but in general, about 80% of Black women and 70% of Caucasian women will have at least one uterine fibroid diagnosed before the age of 50.

It's also important to understand when considering fertility that the prevalence of uterine fibroids increases as someone gets older. So uterine fibroids are much less common in younger women in their 20s as they are in women in their upper 30s and 40s. That's important to understand when looking at fertility because we also know that with age, fertility decreases. Thus, uterine fibroids also can impact fertility. There's also this age-related factor, which makes it difficult to really look at fibroids as far as being a causative agent for infertility.

We do know that approximately 10% of women with infertility will be diagnosed with uterine fibroids during their evaluation, and there's multiple ways that uterine fibroids impact fertility. In general, it's going to depend on the location of the uterine fibroids, the size and the bulk or the number of uterine fibroids that a woman has.  But when we look at the ways that uterine fibroids can impact fertility, what they can do is they distort the uterine cavity. This is the most common for submucosal fibroids or fibroids that have a component that's present inside the uterine cavity. Fibroids that are submucosal or intramural fibroids  are in the muscle of the uterus and have an intracavitary component. They're well-known to distort the uterine cavity and that can impact implantation of an embryo. There's also thought that it can impact an ongoing pregnancy.

There's speculation that uterine fibroids can impact the blood flow to a pregnancy as well and they may impact fertility. Depending on the size of the uterine fibroid, they may block the fallopian tubes. And so, if you have a uterine fibroid that's in the corner of the uterus, that could cause a tubal factor type of infertility where there's occlusion of the fallopian tube. But in general, the most concern we have for uterine fibroids is how those fibroids impact the uterine lining and implantation of an embryo, and it's thought that those are most likely due to submucosal fibroids, or some intramural fibroids that may be particularly large, or that have a component that's inside the cavity.

Q2. Several studies have attempted to clarify the influence of fibroids on fertility, however, there have been various, sometimes contradictory findings and a lack of well-designed trials. Why is this?

One of the challenges in counseling patients regarding uterine fibroids is that there's really a lack of  high-quality studies assessing uterine fibroids and fertility. And we all know that the gold standard research study is a randomized control trial, as they provide the highest level of evidence, but those are very difficult to conduct especially for women with uterine fibroids, as many women will decline randomization.

It's difficult to design a study where there's one treatment that can be beneficial versus no treatment. That's one challenge. Because of that, the study designs that we've had to date have mostly been retrospective, and there's been some observational studies. But even those studies, unfortunately, are complicated by the fact that fibroids themselves are very heterogeneous. It's a very heterogeneous condition. There's a lot of difference between the size of the uterine fibroids, the location and the bulk of the fibroid, and then there's also going to be the issue with age. If you have a woman who's older with uterine fibroids, obviously her age is also going to impact her fertility. We know that women with uterine fibroids tend to be older and that also impacts fertility. So that's going to have an impact on any research as well.

What we do know from some of the research to date is that it's well-known that submucosal fibroids impair fertility, that's well established. We do know that subserosal fibroids or the fibroids on the surface of the uterus do not impact uterine fibroids. The question that really hasn't been answered because there hasn't been adequate research and there's just not enough data of high quality is, whether intramural fibroids or fibroids inside the uterine muscle, whether they impact fertility.

Many women who have intramural uterine fibroids are asymptomatic. They don't have symptoms at all. So, the question is whether a woman should undergo an invasive procedure to remove that fibroid and if it’s going to help or not? That's one of the questions that we just don't have enough adequate research on because there are some limitations in the literature.

Q3. What are the current treatments, both surgical and nonsurgical, for patients with fibroids who may want to become pregnant?

I think if there's a patient, a woman with uterine fibroids who's interested in fertility, she may be a patient who is diagnosed with symptomatic fibroids, who wants to preserve her fertility, or she may be a patient who's an infertility patient who during her fertility evaluation discovers she has fibroids. It is important to determine whether treatment is appropriate for that patient, and as we just discussed, there's not a lot of answers in the literature for some patients. I think the most important thing to do first before deciding on a treatment is  to determine the best type of treatment. At Johns Hopkins, for many of our patients with uterine fibroids, they'll undergo a pelvic MRI because the pelvic MRI can provide the most detailed information regarding the size and exact location of the uterine fibroids.

We then have a multidisciplinary conference every two weeks where we review the MRIs with a group of minimally invasive surgeons, interventional radiologists, and fertility specialist where we can really decide the best treatment for the individual patient. In deciding on a patient, it's important to make the right decision and have the most information. So as far as treatments that are available, for women who are wanting to preserve their fertility or planning to get pregnant very soon, the most common options are going to be surgical.

The least invasive surgical treatment would be a hysteroscopic myomectomy where we would do a hysteroscopy and remove the uterine fibroids by either shaving the pieces of the submucosal fibroid or we can remove it with a hysteroscopic morcellator. There are various techniques. But for the submucosal fibroids that are inside the uterine cavity, hysteroscopic myomectomy is very minimally invasive. It's an outpatient procedure. It's very safe and it's something that we will typically offer to patients who have submucosal fibroids.

For patients who have symptomatic uterine fibroids and may have bulk symptoms, or have numerous uterine fibroids, we typically would recommend either a laparoscopic robotic-assisted myomectomy, sometimes just a laparoscopic myomectomy, or for women who have the most severe, a very large fibroid uterus, let's say greater than 20 centimeters, they may actually need to undergo an exploratory laparotomy or abdominal myomectomy. For patients who have symptomatic subserosal fibroids and large intramural fibroids that need to be removed, it really depends on the size, location, and bulk of the uterine fibroids. And that's where the pelvic MRI becomes very useful.

I would say that for the majority of my patients that have a large amount of fibroids, are still able to undergo a robotic-assisted laparoscopic hysterectomy which oftentimes can be an outpatient procedure just because we've had this improvement in technology with robotic and laparoscopic surgery. But surgery can be very beneficial as far as removing the bulk of the uterine fibroids. And so that is typically our treatments that we would recommend for those who want future fertility or who are imminently trying to get pregnant.

There are medical treatments as well or non-surgical treatments such as GnRH analogs that can shrink the size of the uterine fibroids. Unfortunately, the uterine fibroids are still there and typically will still impact fertility. So that's not something that we do often for those that are actively trying to get pregnant. The same for uterine artery embolization or uterine fibroids embolization. We will not recommend that for patients who want to have future fertility because the fibroids will still be in that location and they're typically in a location that's impairing fertility.

Q4. How long do patients have to wait after a fibroid treatment to try to get pregnant?

The length of time that a patient needs to wait after having fibroids removed for surgical treatment typically depends on the type of surgery the patient undergoes as well as the size of the fibroids and the extent of the surgery. For a patient who's undergoing a hysteroscopic myomectomy, they typically only must wait a month or two. Once they're assessed that there's no residual fibroid that's left, then they can try to conceive.

For patients who need to undergo abdominal myomectomy or laparoscopic myomectomy, those are much more extensive procedures. Typically, surgeons will recommend a patient wait three to six months to try to conceive. It's also important for the surgeon to discuss with the patient the extent of the myomectomy and whether that patient, when she does become pregnant, will require a c-section because typically if the uterine cavity is entered or if there are multiple incisions on the uterus during the myomectomy surgery, surgeons will recommend a c-section for that patient when she does become pregnant to decrease the risk of uterine rupture. And typically, that will be documented in the operative note, but the surgeon will also counsel the patient regarding this.

Q1: How do/can fibroids influence fertility?

When considering how uterine fibroids influence fertility, it's important to understand that uterine fibroids are very common. Uterine fibroids are the most common pelvic tumor in women, and they're non-cancerous tumors that are developed from the muscle cells of the uterus. The lifetime risk, before the age of 50, of a woman having fibroids varies by race and ethnicity, but in general, about 80% of Black women and 70% of Caucasian women will have at least one uterine fibroid diagnosed before the age of 50.

It's also important to understand when considering fertility that the prevalence of uterine fibroids increases as someone gets older. So uterine fibroids are much less common in younger women in their 20s as they are in women in their upper 30s and 40s. That's important to understand when looking at fertility because we also know that with age, fertility decreases. Thus, uterine fibroids also can impact fertility. There's also this age-related factor, which makes it difficult to really look at fibroids as far as being a causative agent for infertility.

We do know that approximately 10% of women with infertility will be diagnosed with uterine fibroids during their evaluation, and there's multiple ways that uterine fibroids impact fertility. In general, it's going to depend on the location of the uterine fibroids, the size and the bulk or the number of uterine fibroids that a woman has.  But when we look at the ways that uterine fibroids can impact fertility, what they can do is they distort the uterine cavity. This is the most common for submucosal fibroids or fibroids that have a component that's present inside the uterine cavity. Fibroids that are submucosal or intramural fibroids  are in the muscle of the uterus and have an intracavitary component. They're well-known to distort the uterine cavity and that can impact implantation of an embryo. There's also thought that it can impact an ongoing pregnancy.

There's speculation that uterine fibroids can impact the blood flow to a pregnancy as well and they may impact fertility. Depending on the size of the uterine fibroid, they may block the fallopian tubes. And so, if you have a uterine fibroid that's in the corner of the uterus, that could cause a tubal factor type of infertility where there's occlusion of the fallopian tube. But in general, the most concern we have for uterine fibroids is how those fibroids impact the uterine lining and implantation of an embryo, and it's thought that those are most likely due to submucosal fibroids, or some intramural fibroids that may be particularly large, or that have a component that's inside the cavity.

Q2. Several studies have attempted to clarify the influence of fibroids on fertility, however, there have been various, sometimes contradictory findings and a lack of well-designed trials. Why is this?

One of the challenges in counseling patients regarding uterine fibroids is that there's really a lack of  high-quality studies assessing uterine fibroids and fertility. And we all know that the gold standard research study is a randomized control trial, as they provide the highest level of evidence, but those are very difficult to conduct especially for women with uterine fibroids, as many women will decline randomization.

It's difficult to design a study where there's one treatment that can be beneficial versus no treatment. That's one challenge. Because of that, the study designs that we've had to date have mostly been retrospective, and there's been some observational studies. But even those studies, unfortunately, are complicated by the fact that fibroids themselves are very heterogeneous. It's a very heterogeneous condition. There's a lot of difference between the size of the uterine fibroids, the location and the bulk of the fibroid, and then there's also going to be the issue with age. If you have a woman who's older with uterine fibroids, obviously her age is also going to impact her fertility. We know that women with uterine fibroids tend to be older and that also impacts fertility. So that's going to have an impact on any research as well.

What we do know from some of the research to date is that it's well-known that submucosal fibroids impair fertility, that's well established. We do know that subserosal fibroids or the fibroids on the surface of the uterus do not impact uterine fibroids. The question that really hasn't been answered because there hasn't been adequate research and there's just not enough data of high quality is, whether intramural fibroids or fibroids inside the uterine muscle, whether they impact fertility.

Many women who have intramural uterine fibroids are asymptomatic. They don't have symptoms at all. So, the question is whether a woman should undergo an invasive procedure to remove that fibroid and if it’s going to help or not? That's one of the questions that we just don't have enough adequate research on because there are some limitations in the literature.

Q3. What are the current treatments, both surgical and nonsurgical, for patients with fibroids who may want to become pregnant?

I think if there's a patient, a woman with uterine fibroids who's interested in fertility, she may be a patient who is diagnosed with symptomatic fibroids, who wants to preserve her fertility, or she may be a patient who's an infertility patient who during her fertility evaluation discovers she has fibroids. It is important to determine whether treatment is appropriate for that patient, and as we just discussed, there's not a lot of answers in the literature for some patients. I think the most important thing to do first before deciding on a treatment is  to determine the best type of treatment. At Johns Hopkins, for many of our patients with uterine fibroids, they'll undergo a pelvic MRI because the pelvic MRI can provide the most detailed information regarding the size and exact location of the uterine fibroids.

We then have a multidisciplinary conference every two weeks where we review the MRIs with a group of minimally invasive surgeons, interventional radiologists, and fertility specialist where we can really decide the best treatment for the individual patient. In deciding on a patient, it's important to make the right decision and have the most information. So as far as treatments that are available, for women who are wanting to preserve their fertility or planning to get pregnant very soon, the most common options are going to be surgical.

The least invasive surgical treatment would be a hysteroscopic myomectomy where we would do a hysteroscopy and remove the uterine fibroids by either shaving the pieces of the submucosal fibroid or we can remove it with a hysteroscopic morcellator. There are various techniques. But for the submucosal fibroids that are inside the uterine cavity, hysteroscopic myomectomy is very minimally invasive. It's an outpatient procedure. It's very safe and it's something that we will typically offer to patients who have submucosal fibroids.

For patients who have symptomatic uterine fibroids and may have bulk symptoms, or have numerous uterine fibroids, we typically would recommend either a laparoscopic robotic-assisted myomectomy, sometimes just a laparoscopic myomectomy, or for women who have the most severe, a very large fibroid uterus, let's say greater than 20 centimeters, they may actually need to undergo an exploratory laparotomy or abdominal myomectomy. For patients who have symptomatic subserosal fibroids and large intramural fibroids that need to be removed, it really depends on the size, location, and bulk of the uterine fibroids. And that's where the pelvic MRI becomes very useful.

I would say that for the majority of my patients that have a large amount of fibroids, are still able to undergo a robotic-assisted laparoscopic hysterectomy which oftentimes can be an outpatient procedure just because we've had this improvement in technology with robotic and laparoscopic surgery. But surgery can be very beneficial as far as removing the bulk of the uterine fibroids. And so that is typically our treatments that we would recommend for those who want future fertility or who are imminently trying to get pregnant.

There are medical treatments as well or non-surgical treatments such as GnRH analogs that can shrink the size of the uterine fibroids. Unfortunately, the uterine fibroids are still there and typically will still impact fertility. So that's not something that we do often for those that are actively trying to get pregnant. The same for uterine artery embolization or uterine fibroids embolization. We will not recommend that for patients who want to have future fertility because the fibroids will still be in that location and they're typically in a location that's impairing fertility.

Q4. How long do patients have to wait after a fibroid treatment to try to get pregnant?

The length of time that a patient needs to wait after having fibroids removed for surgical treatment typically depends on the type of surgery the patient undergoes as well as the size of the fibroids and the extent of the surgery. For a patient who's undergoing a hysteroscopic myomectomy, they typically only must wait a month or two. Once they're assessed that there's no residual fibroid that's left, then they can try to conceive.

For patients who need to undergo abdominal myomectomy or laparoscopic myomectomy, those are much more extensive procedures. Typically, surgeons will recommend a patient wait three to six months to try to conceive. It's also important for the surgeon to discuss with the patient the extent of the myomectomy and whether that patient, when she does become pregnant, will require a c-section because typically if the uterine cavity is entered or if there are multiple incisions on the uterus during the myomectomy surgery, surgeons will recommend a c-section for that patient when she does become pregnant to decrease the risk of uterine rupture. And typically, that will be documented in the operative note, but the surgeon will also counsel the patient regarding this.

Key clinical point: Diagnostic specificity and sensitivity were high enough to distinguish uterine fibroids (UFs) from adenomyosis when a combination of transvaginal ultrasound (TVUS) and strain ratio (SR) elastography (SE) techniques was implemented.

Major finding: Patients with histologically confirmed UFs vs. those with adenomyosis had a significantly lower mean (5.20±1.81 vs 11.42±1.87) and max (5.78±2.08 vs 13.43±4.10) SR values (both P < .001). Diagnostic sensitivity (90.56% vs. 86.2%) and specificity (96.15% vs 91.37%) were higher for UFs than adenomyosis.

Study details: Findings are from a pilot, prospective study including 79 patients who underwent hysterectomy for suspicion of either UF (n=53) or adenomyosis (n=25), diagnosed on the basis of 2-dimensional TVUS in combination with SE findings.

Disclosures: This study did not receive any funding. The authors declared no conflict of interests.

Source: Săsăran V et al. J Pers Med. 2021 Aug 23. doi: 10.3390/jpm11080824.

Key clinical point: Diagnostic specificity and sensitivity were high enough to distinguish uterine fibroids (UFs) from adenomyosis when a combination of transvaginal ultrasound (TVUS) and strain ratio (SR) elastography (SE) techniques was implemented.

Major finding: Patients with histologically confirmed UFs vs. those with adenomyosis had a significantly lower mean (5.20±1.81 vs 11.42±1.87) and max (5.78±2.08 vs 13.43±4.10) SR values (both P < .001). Diagnostic sensitivity (90.56% vs. 86.2%) and specificity (96.15% vs 91.37%) were higher for UFs than adenomyosis.

Study details: Findings are from a pilot, prospective study including 79 patients who underwent hysterectomy for suspicion of either UF (n=53) or adenomyosis (n=25), diagnosed on the basis of 2-dimensional TVUS in combination with SE findings.

Disclosures: This study did not receive any funding. The authors declared no conflict of interests.

Source: Săsăran V et al. J Pers Med. 2021 Aug 23. doi: 10.3390/jpm11080824.

Key clinical point: Diagnostic specificity and sensitivity were high enough to distinguish uterine fibroids (UFs) from adenomyosis when a combination of transvaginal ultrasound (TVUS) and strain ratio (SR) elastography (SE) techniques was implemented.

Major finding: Patients with histologically confirmed UFs vs. those with adenomyosis had a significantly lower mean (5.20±1.81 vs 11.42±1.87) and max (5.78±2.08 vs 13.43±4.10) SR values (both P < .001). Diagnostic sensitivity (90.56% vs. 86.2%) and specificity (96.15% vs 91.37%) were higher for UFs than adenomyosis.

Study details: Findings are from a pilot, prospective study including 79 patients who underwent hysterectomy for suspicion of either UF (n=53) or adenomyosis (n=25), diagnosed on the basis of 2-dimensional TVUS in combination with SE findings.

Disclosures: This study did not receive any funding. The authors declared no conflict of interests.

Source: Săsăran V et al. J Pers Med. 2021 Aug 23. doi: 10.3390/jpm11080824.