Abstract No. 262: Retrospective Review of Uterine Fibroid Patients and Therapy Recommendations in a Tertiary Care Setting

Abstract

Choosing among effective uterine fibroid interventions (uterine fibroid embolization (UFE), myomectomy, hysterectomy, and hormonal therapy) is a challenge. Little attention has been focused to date on the development of a validated decision model for fibroid intervention. This review seeks to characterize patients presenting with uterine fibroids in a tertiary care setting, describe the rationale behind treatment recommendations and compare recommendation groups. Patients referred to a single radiologist at a tertiary care center for uterine fibroid consultation within a 15 month period were included. Each patient underwent a history and physical examination and MR imaging review. Data pertaining to demographics, history, fertility, uterine and fibroid imaging, therapy recommendations, and rationale were collected. Data were analyzed comparing those recommended for embolization versus those for whom embolization was not the primary recommendation using t-tests, Fisher's Exact test, and chi-square testing. During 15 months, 629 patients were scheduled for 811 appointments. Of 629 scheduled patients, records for 78 were unavailable. Of the 551 remaining, 509 appeared for fibroid consultation. Of these, 336 (66%) were recommended UFE. 51 (10%) hysterectomy, 41 (8%) myomectomy, 32 (6%) conservative management, and 37 (7%) were advised further evaluation. Twelve patients did not receive a recommendation due to a lack/inadequacy of imaging studies. Differences between those recommended UFE and those recommended an alternative course included desire for future fertility (9.6% vs. 25.6%, p=0.001), smaller volume of largest fibroid (324.9cc vs. 636.5cc, p=0.001), and stronger preference against surgery (10.4% vs. 5.0%). Those recommended UFE were less likely to have a history of previous UFE intervention (2.68% vs. 6.83%, p=0.0475). Of patients presenting for evaluation for UFE, 34% were recommended an alternative therapy. Those recommended for UFE alternatives were more desirous of future fertility, had a larger dominant fibroid, and were less likely to voice preference against surgical intervention.