Myoma Volume Reduction Research Articles

Efficacy, Complications, and Factors Predictive of Response to Treatment with Transvaginal Radiofrequency Ablation for Symptomatic Uterine Myomas

Transvaginal radiofrequency ablation is a minimally invasive treatment for myomas in women who wish to preserve their uterus. This study aimed to evaluate the efficacy and safety of transvaginal radiofrequency to treat myomas and to identify factors predictive of the response to treatment. Prospective case series. Virgen de las Nieves University Hospital, a tertiary center in Granada, Spain. The participants were 59 patients with myomas. Transvaginal radiofrequency ablation. The variables recorded were personal (age and type of myoma), procedure dependent (pain, need for analgesia, duration of sick leave, procedure duration, and complications), clinical (total days of menstrual bleeding and days of heavy menstrual bleeding), and score on the symptom severity scale of the Uterine Fibroid Symptom and Quality of Life Questionnaire. Myoma volume was determined by ultrasonography. Changes in clinical variables and myoma volume were analyzed 2, 6, and 12 months after the procedure. Moreover, the influence of age, initial myoma size, type of myoma, and duration of the procedure on the outcomes of treatment were analyzed. Statistically significant improvements in symptoms were seen in all variables analyzed for bleeding at 0, 2, 6, and 12 months, and a significant improvement was seen in the symptom severity scale score 12 months after the procedure. Mean myoma volume (in milliliters) was significantly lower 2, 6, and 12 months after treatment (p <.05). At 12 months, the mean reduction in myoma volume was more than 80%. Patient age and initial myoma size were identified as factors predictive of the outcomes. Transvaginal radiofrequency ablation was an effective and safe technique for the treatment of myomas. The patient's age and initial size of the myoma influenced the outcome of treatment.

Clinical investigation of fertility after uterine artery embolization

Uterine artery embolization is an effective and safe technique for the treatment of uterine fibroids, but its use remains controversial for women who wish to procreate. This study aimed to study the clinical, anatomic, and obstetrical results of uterine artery embolization in patients of childbearing age not eligible for myomectomy. This was a retrospective cohort study of 398 female patients under the age of 43 years who were treated by uterine artery embolization between 2003 and 2017 for symptomatic fibroids and/or adenomyosis. Uterine artery embolization was performed according to a standardized procedure (fertility-sparing uterine artery embolization technique), with ovarian protection in the event of dangerous utero-ovarian anastomosis. Magnetic resonance imaging and pelvic ultrasounds were performed before and after uterine artery embolization. The overall clinical success rate (ie, resolution of preembolization symptoms such as heavy menstrual bleeding, iron-deficiency anemia, pelvic pressure) was 91.2%, and there were no major complications. One year after uterine artery embolization, we observed a mean 73% reduction in myoma volume. A total of 108 patients (49.3%) presented with dangerous utero-ovarian anastomosis and 33 (14.5%) benefited from ovarian protection. In our group, there were 148 pregnancies and 109 live births; 74 children were born at term; 23 were born preterm, on average at 35.12±2.78 weeks. Including preterm births, the mean birthweight and birth length of the children were within normal limits. Restoration of uterine anatomy and ovarian protection were identified as the main predictive factors for obstetrical success. Restoration was also a major predictive factor for clinical success and was associated with a lower rate of miscarriage. This study provided detailed clinical and obstetrical outcomes for 398 female patients who underwent uterine artery embolization for fibroid treatment; it contributes to the identification of anatomic and technical factors that could have an impact on fertility after uterine artery embolization. Further controlled clinical trials are needed to confirm our findings and reevaluate this procedure's indications and limitations for women with a desire to procreate.

Molecular mechanisms responsible for myoma volume reduction after ulipristal acetate

Molecular mechanisms responsible for myoma volume reduction after ulipristal acetate

Matrix Metalloproteinase Activity Correlates With Uterine Myoma Volume Reduction After Ulipristal Acetate Treatment.

Ulipristal acetate (UPA), a selective progesterone receptor modulator, clinically reduces uterine myoma size in 80% of cases. However, the molecular mechanism of action is still poorly understood, as is the reason why 20% of myomas do not respond to treatment. To elucidate whether matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) are associated with myoma volume shrinkage after UPA therapy. Prospective study. Academic research unit of a university hospital. Uterine biopsies were obtained from 59 patients with symptomatic myomas undergoing myomectomy, 45 of whom were treated preoperatively with either one or greater than or equal to two, 3-month courses of UPA and 14 not given any hormone therapy to serve as controls. Myoma volume was individually monitored during UPA therapy to determine any substantial clinical response (defined as a reduction in volume of >25%). Three groups were established based on the response to treatment: responsive (R) after one course (n = 12); R after two to four courses (n = 15); and nonresponsive (NR; n = 18). UPA treatment given as preoperative management for symptomatic myomas. MMP and TIMP expression assessed by zymography and immunohistochemistry. Compared with controls and NR myomas, responders showed significantly higher expression levels for MMP-1 (P < 0.0001) and MMP-2 (P = 0.009) and significantly lower expression levels for TIMP-1 (P = 0.040). The correlation found between MMP expression and volume fold change supports the notion that MMPs play a key role in UPA-induced myoma shrinkage.

Pilot Study of the Mirabilis System Prototype for Rapid Noninvasive Uterine Myoma Treatment Using an Ultrasound-Guided Volumetric Shell Ablation Technique

Study ObjectiveThe primary objective of this pilot study was to evaluate the safety and acute tissue ablation efficacy of a transabdominal high-intensity focused ultrasound (HIFU) prototype device that uses ultrasound imaging guidance for rapid noninvasive ablation of uterine myomas. The secondary objective was to assess preliminary myoma-related symptom improvement and myoma volume reduction at 3 to 6 months post-treatment in subsets of patients. DesignMulticenter prospective single-arm pilot study (Canadian Task Force classification II-2). SettingUniversity-affiliated teaching hospital and private community hospital. PatientsWomen with a diagnosis of symptomatic uterine myomas planning to undergo hysterectomy. InterventionsSeventy-three women underwent transabdominal ultrasound-guided HIFU treatment using a volumetric ablation technique referred to as “shell ablation,” in which the HIFU energy is deposited in patterns that partially encapsulate the peripheral region of the targeted myoma(s). Patients were divided into 2 sequential cohorts, the development cohort (the first 37 patients treated) and the validation cohort (the final 36 patients treated). Development cohort treatments were performed for dose-ranging purposes to identify the optimum HIFU treatment parameters, whereas the validation cohort treatments were performed to validate these final settings. Sixty-five patients (89.0%) received only prophylactic oral, sublingual, or intramuscular analgesia before treatment, sometimes with oral anxiolytics. The remaining 8 patients (11.0%) were anesthetized before treatment. Sixty-seven patients (91.8%) then had scheduled hysterectomies between 0 and 179 days after treatment completion. Adverse events were monitored until study exit, which ranged from 10 to 191 days post-treatment. Measurements and Main ResultsThe primary efficacy endpoint measured in all 73 patients was the nonperfused volume (NPV) of tissue produced, which was assessed between 0 and 7 days post-treatment either by tissue sectioning after hysterectomy or by gadolinium-enhanced magnetic resonance imaging. Secondary efficacy endpoints were also measured in subsets of patients who were prospectively scheduled for delayed hysterectomies: Changes in menstrual blood loss (MBL), symptom severity (SS), and quality of life (QOL) scores were assessed using validated techniques at 3 months post-treatment in 10 patients and changes in treated myoma volume were assessed using magnetic resonance imaging at 3 to 6 months post-treatment in 14 patients. In all 73 patients, there were no reports of any serious adverse device effects, including no damage to any extrauterine collateral tissues or the abdominal skin. In the development cohort, a mean NPV of 17.9 ± 24.9 cm3 (range, 0–123.0) was produced in a mean total treatment time of 4.9 ± 2.4 minutes (range, 1.1–11.3). These metrics improved in the validation cohort, where a mean NPV of 44.9 ± 58.5 cm3 (range, 0–284.7) was produced in a mean total treatment time of 3.6 ± 2.1 minutes (range, 1.5–9.5). In the subsets of patients with data available, there was a significant improvement in QOL score (median, 16.5 point increase; p = .011), an improving trend in SS score (median, 13.5 point decrease; p = .254), and a significant improvement in treated myoma volume (mean, 24.0% decrease; p = .013). In 8 patients who had above-average MBL scores at baseline and regular menstrual cycle lengths during follow-up, there was also a significant improvement in MBL score (median, 40.8% decrease; p = .035). ConclusionUltrasound-guided HIFU ablation with the prototype device demonstrated an excellent safety profile and produced clinically relevant NPVs in a mean total treatment time of under 4 minutes using the final validated treatment settings. Short-term clinical efficacy metrics assessed in subsets of patients were encouraging, and larger studies should be conducted to confirm these results (ClinicalTrials.gov, NCT01946178).

In vivo mechanisms of uterine myoma volume reduction with ulipristal acetate treatment

To study the in vivo mechanisms of action of ulipristal acetate (UPA) on uterine myomas. Retrospective histologic and immunohistochemical (IHC) study of myomas. Academic research unit. Among 59 women with symptomatic myomas who underwent myomectomy, 42 were treated preoperatively with UPA, while 17 were not. Histology and IHC were analyzed on tissue microarrays obtained from surgical specimens. Proliferation, apoptosis, extracellular matrix (ECM) remodeling, and matrix metalloproteinase 2 (MMP-2) expression. Proliferation was low in all conditions, with no statistical difference between groups. Terminal deoxynucleotide transferase-mediated dUTP nick-end labeling assay showed an increase in cell death in UPA-treated myomas compared with untreated myomas, but only after short-term treatment; this was not associated with elevated levels of cleaved caspase-3. After long-term treatment, cell density was higher and the ECM volume fraction lower in UPA-treated myomas than in untreated myomas. MMP-2 expression was found to be increased after treatment, showing the highest level after long-term treatment, compared with untreated myomas. Regarding sustained clinical volume reduction of myomas, this study strongly points to multifactorial mechanisms of action of UPA, involving: 1) a persistently low cell proliferation rate; 2) a limited period of cell death; and 3) ECM remodeling concomitant with stimulation of MMP-2 expression.

Ultrasound-guided transvaginal radiofrequency myolysis for symptomatic uterine myomas

ObjectiveTo investigate the feasibility, efficacy and safety of ultrasound-guided transvaginal radiofrequency myolysis for symptomatic uterine myomas. Study designForty-six premenopausal women with symptomatic uterine myomas received ultrasound-guided transvaginal radiofrequency myolysis as an outpatient procedure. Outcomes were assessed by measuring myoma volume at baseline and at 3-, 6- and 12-month follow-up; and by calculating the myoma volume reduction rate. Clinical improvement was assessed by calculating the menorrhagia score, the symptom severity score and the health-related quality-of-life score (Uterine Fibroids Symptom and Health-related Quality-of-life Questionnaire) before and after myolysis. ResultsThe mean age of patients was 40.8 [standard deviation (SD) 6.5] years. The mean diameter of the dominant myoma at baseline was 4.8 (SD 1.1) cm and the mean volume of the dominant myoma at baseline was 67.4 (SD 51.1)cm3. The size of the myoma decreased gradually and an overall volume reduction rate of 83.0% was achieved at 12-month follow-up. The mean symptom severity score decreased and mean health-related quality-of-life score increased; the Uterine Fibroids Symptom and Health-related Quality-of-life Questionnaire showed a significant clinical improvement after myolysis compared with baseline (p<0.001). The menorrhagia score decreased significantly from baseline (p<0.05), showing an improvement in menorrhagia at 3-, 6- and 12-month follow-up. No major complications were observed or reported. The re-operation rate was 8.7%. Fifteen and eighteen months after myolysis, two patients delivered infants with no complications during or after delivery. ConclusionUltrasound-guided transvaginal radiofrequency myolysis may be a safe, effective and minimally invasive outpatient procedure for the treatment of symptomatic uterine myomas.

Ultrasound-Guided Percutaneous Microwave Ablation for Submucosal Uterine Fibroids

Study ObjectiveTo prospectively evaluate the efficiency and safety of ultrasound-guided percutaneous microwave ablation (PMWA) in treating symptomatic submucosal uterine myomas. DesignSelf-controlled study (Canadian Task Force classification II-1). SettingSingle center. PatientsTwenty-two premenopausal women with 22 symptomatic submucosal uterine myomas. InterventionAll patients underwent ultrasound-guided PMWA. Measurements and Main ResultsPMWA was performed in 22 premenopausal women with 22 symptomatic submucosal uterine myomas. Mean (SD) patient age was 42 (4.60) years (95% confidence interval [CI], 39.96–44.04). Five symptomatic submucosal uterine myomas were identified as type 0, 7 as type 1, and 10 as type 2. Contrast-enhanced ultrasound and magnetic resonance imaging were performed before and after surgery. Myoma volume, hemoglobin concentration, and scores on the UFS-QOL (Uterine Fibroid Symptom and Quality of Life) questionnaire were recorded before and at 3 and 12 months after ablation. Complications were also recorded. In all patients, therapy was completed with a single ablation. The baseline diameter of the symptomatic submucosal uterine myomas was 4.90 (1.60) cm. Mean myoma volume reduction rate was 81.46% (16.33%) (95% CI, 73.06%–89.86%) at 3 months (p < .001) and reached 90.00% (9.79%) (95% CI, 85.07–95.13) at 12 months (p < .001). At 3 months after ablation, hemoglobin concentration increased from 88.64 (21.87) g/L (95% CI, 78.94–98.34) to 123.21 (15.77) g/L (95% CI, 115.10–131.32) (p < .001), and remained stable at 12 months, with a value of 125.92 (14.90) g/L (95% CI, 117.98–133.86). Scores on the UFS-QOL were comparable, with normal levels observed at 1 year. No major complications were observed. Nine patients were discharged with necrotic masses. ConclusionPMWA seems to be effective and safe for treatment of submucosal myomas.

Résultats préliminaires de la destruction des fibromes utérins par ultrasons focalisés contrôlée par résonance magnétique

Objective Many women with myomas desire uterine conservation. Magnetic resonance-guided focused ultrasound surgery (MRgFUS) is a new non-invasive therapy. We describe our early results regarding efficacy and safety of MRgFUS for the treatment of uterine leiomyomas. Patients and methods Fifty-two French women, over 18 years of age, who were candidates for surgical myomectomy, hysterectomy or uterine artery embolization due to symptomatic myomas were treated by MRgFUS (ExAblate 2000 ®, InSightec) and followed up for at least 6 months. Intramural or subserous myomas with a size between 4–12 cm and a T2 low intensity MRI image were selected in women with no abdominal scar and no bowel interposition. The modified symptom severity score (SSS) was examined before and after the treatment at 6 months. Second treatment rate during the first follow-up year was reported. Results No serious complications were recorded during the treatments or follow-up period. Seven women had initial failure mostly because of bowel interposition, six of them had uterine artery embolisation. The mean modified SSS value for patients before MRgFUS was 41/100 and the values diminished significantly to a mean value of 22/100. A total of 65% of women had a reduction of at least 10 points ( n = 22) (initial score of 41 [29; 62] and 22 [16; 46] at 6 month follow-up). Good correlation was observed between myomas destruction and the symptoms score. During the follow-up period, ten patients (19%) required invasive interventions (six hysterectomies, two embolisations and two myomectomies). The average reduction in myoma volume determined by MR imaging at 6 months after treatment was 14%. This volume reduction is poorly correlated with the myoma's treated volume of 36.4% (6–74%). Conclusion MRgFUS can safely be used for symptomatic treatment and avoid the need for surgical intervention in most patients. Additional follow-up is needed to determine the long-term durability of this promising non-invasive approach and to obtain reimbursement.

Reduction by 98% in Uterine Myoma Volume Associated with Significant Symptom Relief After Peripheral Treatment with Magnetic Resonance Imaging–Guided Focused Ultrasound Surgery

Magnetic resonance imaging–guided focused ultrasound surgery is a noninvasive treatment for symptomatic uterine myomas. Previous studies have demonstrated a correlation between the treated volume of the myoma, improvement in symptoms, and lesion shrinkage. We report a case in which MRgFUS treatment only at the periphery of the myoma resulted in a 98% reduction in tumor volume at 8 months posttreatment, and at 12-month follow-up, only a small lesion was visible at magnetic resonance imaging. The patient's symptoms, as assessed using the Uterine Fibroids Symptom and Quality of life (UFS-QOL) questionnaire, were substantially improved at both 6 and 12 months posttreatment. We also provide a hypothesis to explain this dramatic reduction in myoma volume after only partial MRgFUS treatment of the lesion.

Midterm outcome of radiofrequency thermal ablation for symptomatic uterine myomas

Over the past decade an increasing demand for uterine-sparing treatment to manage symptomatic uterine myomas has become apparent in women's health care. A preliminary report showed that radiofrequency ablation (RFA) of uterine fibroids under laparoscopic guidance was a safe and effective minimally invasive approach with encouraging short-term results. The purpose of this study was to evaluate the midterm outcomes of radiofrequency ablation (RFA) of uterine myomas in terms of durability of symptom control and level of health-related quality of life. Consecutive women with symptomatic uterine myomas, no plans for future pregnancy, and who declined hysterectomy were offered RFA ablation of uterine fibroids under laparoscopic guidance. Only 25 patients who completed at least the one-year follow-up assessment were included in the study group. Follow-up evaluations were scheduled at 1, 3, 6, 9, and 12 months and thereafter annually following the procedure. Improvement in myoma-related symptoms and impact on quality of life were assessed using a validated questionnaire (UFS-QOL). The median number of myomas treated per patient was 1 (range = 1-3). The median baseline volume of the dominant myoma was 76.8 cm3 (range = 14.8-332.8). No intraoperative or postoperative complications occurred. The median follow-up time was 24 months, with nine women completing three years of follow-up. The median reduction in myoma volume was 68.8% and 77.9% at six months and one year, respectively. No further change in fibroid size was observed at two years and three years. One year after the procedure, one woman (4%) underwent hysterectomy for recurrence of fibroid-related symptoms. Quality-of-life measures showed significant and durable improvement compared with baseline. RFA of symptomatic fibroids seems a valuable alternative to major surgery, with durable symptom relief for most patients and a low chance of recurrence at midterm.

Laparoscopic Coagulation of Uterine Myomas With the Use of a Unipolar Electrode

The aim of this study was to evaluate the effectiveness of a laparoscopic myolysis with the use of a unipolar electrode. Forty-six patients, 25 to 52 years old with symptomatic myomas (menometrorrhagia or/and pelvic pain) were included in the study. A transvaginal ultrasound showed 1 or 2 intramural or/and subserosal leiomyomata of 1 to 4.5 cm in diameter. Patients were selected to undergo a laparoscopic coagulation of myomas. Subsequently, they were followed-up 6 months after the treatment. Symptoms reduction and myoma size reduction were evaluated. In addition, all the patients underwent transvaginal Doppler ultrasounds to assess the blood flow in the uterine arteries. In the study group, the disappearance of myomas was observed in 52.2% of patients 6 months after the therapy. In other patients, the mean myoma shrinkage amounted to 76%. The myoma-volume reduction was correlated with an increase in the resistance index (P=0.02) and the pulsatility index (P=0.11) of the right and left uterine arteries.

GnRH agonist therapy before myomectomy or hysterectomy

1Which of the following mechanism(s) is/are responsible for the reduction in myoma volume associated with gonadotropin-releasing hormone (GnRH) agonist treatment? areduction in serum estradiol levelsbvasoconstriction in intramyomatous vasculaturecreduction in insulin-like growth factor Idall of the above2The greatest reduction in uterine size associated with GnRH agonist treatment is seen within the first a6 weeks of treatmentb12 weeks of treatmentc24 weeks of treatmentd52 weeks of treatment3Which one of the following is the most commonly used regimen of GnRH agonist administration as a monthly intramuscular injection of leuprolide acetate? a1.88 mgb3.75 mgc7.5 mgd11.25 mg4Which of the following is/are common side effect(s) associated with GnRH agonist treatment? avaginal hemorrhagebosteoporosiscvasomotor symptomsdall of the above5After cessation of GnRH agonist therapy, uterine volume typically acontinues to decreasebremains unchangedcreturns to pretreatment size within 3 monthsdreturns to pretreatment size within 6 months6In randomized trials, the use of GnRH agonists before myomectomy has been shown to areduce intraoperative blood lossbfacilitate “shelling out” of the myomascreduce operating timedfacilitate vertical skin incision7In randomized trials, GnRH agonist treatment before hysterectomy has been shown to areduce intraoperative blood lossbreduce operating timecfacilitate vaginal hysterectomydall of the above8In randomized trials, pretreatment with GnRH agonists has been shown to areduce postoperative complications after myomectomybreduce duration of hospital stay after myomectomycreduce mortality rate for hysterectomydreduce duration of hospital stay after hysterectomy9Use of GnRH agonists before hysteroscopic myomectomy has been shown to areduce operating timebreduce blood losscreduce amount of distention medium requireddall of the above10A potential disadvantage of the use of GnRH agonists before surgical treatment of uterine myomas is aincreased risk of adhesion formationbincreased risk of myoma recurrencecincreased risk of infertilitydincreased risk of pelvic pain

Vaginal Expulsion of Submucous Myomas after Laparoscopic-Assisted Uterine Depletion of the Myomas

Study Objective To determine the safety and side effects that may be caused by laparoscopic-assisted uterine depletion (LAUD) of submucous myomas. Design Retrospective chart review and follow-up (Canadian Task Force classification II-2). Setting University-affiliated tertiary referral center. Patients Five hundred twenty women with symptomatic myomas warranting surgical treatment, who wished to retain their uteri. Intervention Laparoscopic bipolar coagulation of uterine arteries and anastomotic sites of uterine arteries with ovarian arteries. Measurements and Main Results Postoperative sonographs showed submucous myomas in 53 (10.2%) women. During follow-up for a mean of 8.6 months very few complications occurred; however, nine women (1.7%) experienced vaginal expulsion of myomas from 2 weeks to 5 months postoperatively. Four of them were readmitted within 43 days with high fever and fetid discharge, and cervical cultures revealed heavy growth of Escherichia coli in three. Vaginal myomectomy was performed in six patients, and one woman passed the myoma spontaneously. Histopathologic studies of these nine specimens showed that two had infarction, three had coagulative necrosis, and four had degeneration. After treatment, all nine women had normal menstruation and their symptoms resolved during follow-up of at least 3 months. Conclusion In our experience LAUD led to satisfactory symptomatic improvement and reduction in myoma volume and few complications. If vaginal expulsion of submucous fibroids can be viewed as a side effect, we should pay close attention to women with submucous myomas, especially within 2 months of LAUD. Otherwise, more dangerous complications could occur.

Ultrastructural comparison of uterine leiomyoma cells from the same myoma nodule before and after gonadotropin-releasing hormone agonist treatment

Objective: To compare ultrastructural features of leiomyoma cells from the same uterine myoma nodule before and after GnRH agonist (GnRH-a) treatment and to examine the relation between these ultrastructural changes and the extent of myoma volume reduction with GnRH-a treatment. Design: Prospective clinical study. Setting: University teaching hospital. Patient(s): Twenty women with uterine leiomyomas who were scheduled for surgery. Intervention(s): Transcervical needle biopsy of uterine myoma, s.c. leuprolide acetate injection (3.75 mg) at least three times every 4 weeks before surgery, and hysterectomy or myomectomy. Main Outcome Measure(s): The changes in ultrastructural features of uterine leiomyoma cells and the percentage decrease in the volume of the largest myoma at 12 weeks of GnRH-a treatment measured by magnetic resonance imaging. Result(s): A decrease in myofilaments, mitochondrial swelling, and emergence of the lysosomal body were observed in relation to GnRH-a treatment. Furthermore, a positive correlation was observed between the decrease in myofilaments and myoma shrinkage. Conclusion(s): Cellular atrophy due to a decrease in myofilaments plays a major role in the reversible myoma shrinkage resulting from GnRH-a treatment.

Differential efficacy of gonadotropin-releasing hormone (GnRH) agonist treatment on pedunculated and degenerated myomas: a retrospective study of 630 women

This study was designed to compare the anatomical location of myomas (submucous, intramural, subserous, or cervical), whether pedunculated or non-pedunculated if degenerated or undegenerated and relating these findings to myoma volume reduction in women treated with gonadotropin-releasing hormone agonist (GnRHa). Our retrospective study group included 630 patients with symptoms attributed to fibroids. They were treated with a single GnRH agonist for 20 weeks and the size of the myoma was monitored by magnetic resonance imaging and/or ultrasonographic scan. During a 20 week-treatment, submucous, intramural, or subserous fibroids showed an overall reduction of 63% ( P <0.01) with little variation between these types. No reduction in size was seen in cases of pedunculated, degenerated, or cervical myomas. These data suggest that GnRH agonist therapy might be used primarily for non-pedunculated and undegenerated myomas.

Correlation between shrinkage of uterine leiomyoma treated with buserelin acetate and histopathologic findings of biopsy specimen before treatment

Objective: To analyze histopathologic features related to myoma volume reduction after treatment with a GnRH agonist, buserelin acetate, in needle biopsy specimens obtained before treatment. Design: Prospective clinical study. Setting: University teaching hospital. Patient(s): Twenty women with normal menstrual cycles and symptomatic uterine myomas. Intervention(s): Buserelin acetate was administered intranasally (900μg/d) for at least 16 weeks; transcervical needle biopsy of the uterine myoma was done before this treatment. Main Outcome Measure(s): The relation between histopathologic features (degree of cellularity, hyaline change, and collagen content) and the percent decrease in the volume of the largest myoma at 16 weeks measured by magnetic resonance imaging. Result(s): The correlation between the degree of hyaline change and the percent decrease in the myoma volume was significant, as was that with the proportion of collagenous tissue in the specimens. Conclusion(s): We predicted myoma volume reduction after treatment with a GnRH agonist by histologic analysis of the uterine leiomyoma before treatment.