A Comparison of Transvaginal Ultrasound and Intraabdominal Ultrasound Fibroid Assessments

Abstract

Study Objective: To study the relationship between preoperative transvaginal ultrasound (TVUS) fibroid assessment and intraabdominal ultrasound (IAUS) fibroid assessment for a laparoscopic radiofrequency ablation procedure.Design: Prospective, multicenter, clinical trial analyzing 40 consecutive cases of ultrasound-guided radiofrequency ablation (RFA) of symptomatic fibroids. Preoperative fibroid measurements were made using a standard TVUS transducer; intraoperative measurements were made using a 10- or 12-mm video-guided IAUS transducer.Setting: Seven investigational centers in the United States and Latin America.Patients: Forty patients seeking treatment for symptomatic fibroids.Intervention: Laparoscopic radiofrequency ablation.Measurements and Main Results: The first forty women treated in the Halt Fibroid Study were analyzed; follow-up is ongoing. Fibroids seen preoperatively and intraoperatively were measured and classified according to types and location. Preoperatively, TVUS permitted visualization of 89 fibroids in 39 study subjects: 33 (84.6%) had 1-3 fibroids, 5 (12.8%) had 4-5 fibroids, 0 (0%) had 6-7 fibroids, and 1 (2.6%) had 8 fibroids. Twenty-three of the 89 fibroids (23/89; 25.8%) were characterized as subserosal, 54/89 (60.7%) as intramural, 8/89 (9.0%) as transmural, and 15/89 (16.9%) as submucosal. Intraoperatively, IAUS visualized 179 fibroids in the same 40 subjects: 16 (40.0%) had 1-3 fibroids, 12 (30.0%) had 4-5 fibroids, 4 (10.0%) had 6-7 fibroids, 7 (17.5%) had 8-9 fibroids, and 1 (2.5%) had 11 fibroids. IAUS-visualized fibroids were characterized as follows: 57/179 (31.8%) subserosal; 105/179 (58.7%) intramural, 4/179 (2.2%) transmural, 40/179 (22.3%) submucosal, and 4 (2.2%) were uncategorized.Conclusion: TVUS is useful for general baseline evaluation of the uterus but grossly underestimates the number of fibroids present in a myomatous uterus. In this study population, TVUS alone would have excluded 50% of the fibroids that IAUS later detected. Laparoscopic IAUS during RFA identifies more numerous and problematic fibroids and may lead to higher treatment efficacy. Study Objective: To study the relationship between preoperative transvaginal ultrasound (TVUS) fibroid assessment and intraabdominal ultrasound (IAUS) fibroid assessment for a laparoscopic radiofrequency ablation procedure. Design: Prospective, multicenter, clinical trial analyzing 40 consecutive cases of ultrasound-guided radiofrequency ablation (RFA) of symptomatic fibroids. Preoperative fibroid measurements were made using a standard TVUS transducer; intraoperative measurements were made using a 10- or 12-mm video-guided IAUS transducer. Setting: Seven investigational centers in the United States and Latin America. Patients: Forty patients seeking treatment for symptomatic fibroids. Intervention: Laparoscopic radiofrequency ablation. Measurements and Main Results: The first forty women treated in the Halt Fibroid Study were analyzed; follow-up is ongoing. Fibroids seen preoperatively and intraoperatively were measured and classified according to types and location. Preoperatively, TVUS permitted visualization of 89 fibroids in 39 study subjects: 33 (84.6%) had 1-3 fibroids, 5 (12.8%) had 4-5 fibroids, 0 (0%) had 6-7 fibroids, and 1 (2.6%) had 8 fibroids. Twenty-three of the 89 fibroids (23/89; 25.8%) were characterized as subserosal, 54/89 (60.7%) as intramural, 8/89 (9.0%) as transmural, and 15/89 (16.9%) as submucosal. Intraoperatively, IAUS visualized 179 fibroids in the same 40 subjects: 16 (40.0%) had 1-3 fibroids, 12 (30.0%) had 4-5 fibroids, 4 (10.0%) had 6-7 fibroids, 7 (17.5%) had 8-9 fibroids, and 1 (2.5%) had 11 fibroids. IAUS-visualized fibroids were characterized as follows: 57/179 (31.8%) subserosal; 105/179 (58.7%) intramural, 4/179 (2.2%) transmural, 40/179 (22.3%) submucosal, and 4 (2.2%) were uncategorized. Conclusion: TVUS is useful for general baseline evaluation of the uterus but grossly underestimates the number of fibroids present in a myomatous uterus. In this study population, TVUS alone would have excluded 50% of the fibroids that IAUS later detected. Laparoscopic IAUS during RFA identifies more numerous and problematic fibroids and may lead to higher treatment efficacy.