Treatment Of Uterine Fibroids Research Articles

Overview of Uterine Fibroid Treatment Procedures; Review Article

Myomas are benign uterine tumours found in 40-70% of women of reproductive age. About 30% of them cause various ailments (bleeding, pain, infertility) that reduce the quality of women’s life. Uterine fibromas are the cause of 40-60% of hysterectomies. Different treatment methods are used depending on the size, number, location of myomas and the patient's preferences. Conservative treatment includes nonsteroidal anti-inflammatory drugs, hormonal therapies as contraceptives, GnRH agonists or antagonists, selective progesterone receptor modulators and levonorgestrel. Radiologic intervention types include are UAE (uterine artery embolization), high-intensity focused ultrasound (HIFU), magnetic resonance (MRgFUS), and radiofrequency ablation (RFA). There are also more radical methods, namely surgical treatments, such as myomectomy (hysteroscopic, laparoscopic, robotic or abdominal) and hysterectomy. The oldest of methods is abdominal hysterectomy, while in some women, vaginal hysterectomy can be applied. Recently, laparoscopic or robotic hysterectomy (using the da Vinci robot) has been used. The latter procedures are associated with a better quality of life following treatment.

A study on the efficacy and safety of long-term adjusted low-dose gonadotropin-releasing hormone agonist therapy for uterine fibroids and adenomyosis.

To investigate the efficacy and safety of long-term adjusted low-dose gonadotropin-releasing hormone agonist therapy (GnRH agonist drawback therapy) with nafarelin acetate in patients with uterine fibroids and/or adenomyosis with menstrual symptoms. This single-center, retrospective, observational study initially included 118 patients with uterine fibroids and/or adenomyosis with menstrual symptoms who had received GnRH agonist (nafarelin acetate) drawback therapy for at least 7 months between 2010 and 2020. Blood hemoglobin level, maximum fibroid diameter, area of the corpus uteri, blood estradiol level, daily dosage of nafarelin acetate, and bone density in the lumbar spine and femoral neck were assessed before and after the treatment initiation. The median treatment period was 28 months. Menstruation had ceased in all patients. The median hemoglobin level significantly increased from 8.6 to 13.2 g/dL before treatment and at 12 months after the treatment initiation in patients with fibroids and from 8.8 to 13.3 g/dL in patients with adenomyosis, respectively. Although the treatment did not exert a significant shrinking effect on the fibroids and adenomyosis, an increase in their size was not observed in any patient. The initial dose of nafarelin acetate was 400 μg/day and was lowered to 130 μg/day at 12 months. Only 29 patients (25%) had an estradiol level <30 pg/mL. The average rate of bone density change over 6 months was -1.23% in the lumbar spine and -1.12% in the femoral neck in patients with fibroids and -1.06% in the lumbar spine and -0.14% in the femoral neck in patients with adenomyosis, which were lower than the previously reported rates. GnRH agonist drawback therapy was found to be useful for the long-term conservative treatment of uterine fibroids and adenomyosis. The treatment was safely and inexpensively performed with few adverse events.

Pilot study on the impact of HIFU treatment on miRNA profiles in vaginal secretions of uterine fibroids and adenomyosis patients

Background High intensity focused ultrasound (HIFU) ablation treatment for uterine fibroids and adenomyosis has been long developed. The aim of this study is to investigate miRNA profile changes in vaginal secretions after HIFU treatment and their clinical relevance. Methods We prospectively collected vaginal secretions samples from 8 patients (1 with adenomyosis and 7 with fibroids) before and after HIFU treatment. RNA was isolated and miRNA profiles were analyzed using next-generation sequencing (NGS) sequencing. Results Our study showed miRNA profile change in vaginal secretion samples after HIFU treatment for uterine fibroids/adenomyosis, with 33 miRNAs upregulated and 6 downregulated overall. In fibroid cases, 31 miRNAs were upregulated and 7 downregulated, while in adenomyosis case, 41 miRNAs were upregulated and 71 downregulated. Four miRNAs (hsa-miR-7977, hsa-miR-155-5p, hsa-miR-191-5p, hsa-miR-223-3p) showed significant differences after HIFU treatment in fibroid cases, except in case 5 with the lowest treatment sonications (425 sonications) and energy input (170000 J). hsa-miR-7977 consistently showed downregulation after HIFU treatment. hsa-miR-155-5p were downregulated in case 4 with lowest treatment efficiency (2439.64 J/cm3), while they were upregulated in other cases. hsa-miR-191-5p and hsa-miR-223-3p were downregulated in cases 4 and 7, with case 7 influenced by high sonication and energy due to multiple fibroids. Conclusions HIFU treatment altered miRNA profiles in fibroids/adenomyosis patients. Notably, hsa-miR-7977, hsa-miR-155-5p, hsa-miR-191-5p, and hsa-miR-223-3p showed significant changes in fibroid cases, except in low-energy treatments. hsa-miR-7977 consistently decreased post-treatment, while hsa-miR-155-5p decreased in the least efficient cases. Further research is needed for validation.

Metabolomic Profiling and Network Toxicology: Mechanistic Insights into Effect of Gossypol Acetate Isomers in Uterine Fibroids and Liver Injury

Objective: Gossypol is a natural polyphenolic dialdehyde product that is primarily isolated from cottonseed. It is a racemized mixture of (−)-gossypol and (+)-gossypol that has anti-infection, antimalarial, antiviral, antifertility, antitumor and antioxidant activities, among others. Gossypol optical isomers have been reported to differ in their biological activities and toxic effects. Method: In this study, we performed a metabolomics analysis of rat serum using 1H-NMR technology to investigate gossypol optical isomers’ mechanism of action on uterine fibroids. Network toxicology was used to explore the mechanism of the liver injury caused by gossypol optical isomers. SD rats were randomly divided into a normal control group; model control group; a drug-positive group (compound gossypol acetate tablets); high-, medium- and low-dose (−)-gossypol acetate groups; and high-, medium- and low-dose (+)-gossypol acetate groups. Result: Serum metabolomics showed that gossypol optical isomers’ pharmacodynamic effect on rats’ uterine fibroids affected their lactic acid, cholesterol, leucine, alanine, glutamate, glutamine, arginine, proline, glucose, etc. According to network toxicology, the targets of the liver injury caused by gossypol optical isomers included HSP90AA1, SRC, MAPK1, AKT1, EGFR, BCL2, CASP3, etc. KEGG enrichment showed that the toxicity mechanism may be related to pathways active in cancer, such as the PPAR signaling pathway, glycolysis/glycolysis gluconeogenesis, Th17 cell differentiation, and 91 other closely related signaling pathways. Conclusions: (−)-gossypol acetate and (+)-gossypol acetate play positive roles in the treatment and prevention of uterine fibroids. Gossypol optical isomers cause liver damage through multiple targets and pathways.

Advantages, disadvantages and optimization of organ-sparing methods for uterine fibroids treatment

Introduction. Uterine fibroids (UF) are benign monoclonal hormone-depended tumors originating from smooth myocytes of cervix or body uterus affecting up to 29 % of women aged 15–45 years worldwide. Taking into account the current demographic situation and annually increasing tendency for pregnancy planning at older reproductive age, an organ-sparing strategy is becoming a first-priority approach for UF treatment.Aim: to investigate efficiency of selective progesterone receptors modulators (SPRM) for UF treatment in women of reproductive age.Materials and Methods. A prospective cohort study involved 40 patients with UF at average age of 39.3 ± 5.8 years. Using simple randomization, the patients were divided into 2 groups per 20 subjects in each. The average age of the patients was comparable and comprised 38.15 ± 5.65 and 40.5 ± 5.8 years in groups 1 and 2, respectively (p = 0.203). In both groups, after assessing liver function tests in accordance with the instructions, a treatment course with SPRM group drug (ulipristal acetate) was used at a daily dose of 5 mg for 84 days (1 course) with an interval until the onset of second menstruation after drug withdrawal. Group 1 and group 2 subjects received 2 and 3 therapy courses, respectively. After each course, patients underwent control ultrasound examinations (UE) by analyzing uterus volume and diameter of dominant myomatous node along with liver tests. A temporal quantitation of the difference between UF and dominant node two sizes as well as the maximum uterine volume size and effect size assessment was expressed as the difference of means (Δ) with a 95 % confidence interval (CI).Results. Based on UE data, the uterus size in group 1 was enlarged to an average of 129.49 ± 75.57 cm3, the maximum size of dominant node was 38.9 ± 17.38 mm; in group 2, the uterus was as large as 294.83 ± 161.37 cm3 with maximum size of the dominant node of 53.33 ± 25.48 mm. After therapy in group 1, dominant node size was significant regressed: after therapy course 1 an effect size of quantitated difference between UF two sizes and the dominant node (Δ) was 8.70 (4.11; 13.29) mm (p &lt; 0.001). After therapy course 2 vs. therapy course 1, a size stabilization (Δ) was noted comprising 1.00 (–1.39; 3.39) mm (p = 0.390); the total effect (Δ) was 9.67 (–14.59; –4.75) mm (p &lt;0.001). In group 2, after therapy course 1, the dominant node also regressed, with effect size (Δ) of 9.49 (7.08; 11.89) mm (p = 0.001). The effect (Δ) after therapy course 2 vs. therapy course 1 in group 2 was more prominent reaching 10.74 (5.86; 15.61) mm (p = 0.001). However, after therapy course 3, a larger node size was observed compared to therapy course 2 – (Δ) 8.25 (0.67; 15.83) mm (p = 0.329). Despite the lack of pronounced negative dynamics, based on medical indications 9 patients in group 2 underwent uterine artery embolization to prevent disease relapse.Conclusion. SPRM therapy can be used both as an independent means for MM therapy and in combination with surgical interventions. Such an approach allows for some women to become pregnant without preceding myomectomy, whereas for those approaching age-related menopause to avoid surgical treatment and gently enter natural postmenopause. Currently, conservative and surgical treatment methods for leiomyomas should complement each other to achieve the best clinical outcomes.

Continuous adaptation of conversation aids for uterine fibroids treatment options in a four-year multi-center implementation project

BackgroundFibroids are non-cancerous uterine growths that can cause symptoms impacting quality of life. The breadth of treatment options allows for patient-centered preference. While conversation aids are known to facilitate shared decision making, the implementation of these aids for uterine fibroids treatments is limited. We aimed to develop two end-user-acceptable uterine fibroids conversation aids for an implementation project. Our second aim was to outline the adaptations that were made to the conversation aids as implementation occurred.MethodsWe used a multi-phase user-centered participatory approach to develop a text-based and picture-enhanced conversation aid for uterine fibroids. We conducted a focus group with project stakeholders and user-testing interviews with eligible individuals with symptomatic uterine fibroids. We analyzed the results of the user-testing interviews using Morville’s Honeycomb framework. Spanish translations of the conversation aids occurred in parallel with the English iterations. We documented the continuous adaptations of the conversation aids that occurred during the project using an expanded framework for reporting adaptations and modifications to evidence-based interventions (FRAME).ResultsThe first iteration of the conversation aids was developed in December 2018. Focus group participants (n = 6) appreciated the brevity of the tools and suggested changes to the bar graphs and illustrations used in the picture-enhanced version. User-testing with interview participants (n = 9) found that both conversation aids were satisfactory, with minor changes suggested. However, during implementation, significant changes were suggested by patients, other stakeholders, and participating clinicians when they reviewed the content. The most significant changes required the addition or deletion of information about treatment options as newer research was published or as novel interventions were introduced into clinical practice.ConclusionsThis multi-year project revealed the necessity of continuously adapting the uterine fibroids conversation aids so they remain acceptable in an implementation and sustainability context. Therefore, it is important to seek regular user feedback and plan for the need to undertake updates and revisions to conversation aids if they are going to be acceptable for clinical use.

Transducer module apodization to reduce bone heating during focused ultrasound uterine fibroid ablation with phased arrays: A numerical study.

During magnetic resonance-guided focused ultrasound (MRgFUS) surgery for uterine fibroids, ablation of fibrous tissues in proximity to the hips and spine is challenging due to heating within the bone that can cause patients to experience pain and potentially damage nerves. This far-field bone heating limits the volume of fibroid tissue that is treatable viaMRgFUS. To investigate transducer module apodization for improving the ratio of focal-to-bone heating ( ) when targeting fibroid tissue close to the hips and spine, to enable MRgFUS treatments closer to thebone. Acoustic and thermal simulations were performed using 3D magnetic resonance imaging (MRI)-derived anatomies of ten patients who underwent MRgFUS ablation for uterine fibroids using a low-frequency ( ) 6144-element flat fully-populated modular phased array system (Arrayus Technologies Inc., Burlington, Canada) at our institution as part of a larger clinical trial (NCT03323905). Transducer modules ( per module) whose beams intersected with no-pass zones delineated within the field were identified, their output power levels were reduced by varying blocking percentage levels, and the resulting temperature field distributions were evaluated across multiple sonications near the hip and spine bones in each patient. Acoustic and thermal simulations took approximately ( ) and ( ) to run for a single near-spine (near-hip) target,respectively. For all simulated sonications, transducer module blocking improved compared to the no blocking case. In just over half of sonications, full module blocking maximized (increase of 82% 38% in 50% of hip targets and 49% 30% in 62% of spine targets vs. no blocking; mean±SD), at the cost of more diffuse focusing (focal heating volumes increased by 13%±13% for hip targets and 39%±27% for spine targets) and thus requiring elevated total (hip: 6%±17%, spine: 37%±17%) and peak module-wise (hip: 65%±36%, spine: 101%±56%) acoustic power levels to achieve equivalent focal heating as the no blocking control case. In the remaining sonications, partial module blocking provided further improvements in both (increased by 29%±25% in the hip and 15%±12% in the spine) and focal heating volume (decrease of 20%±10% in the hip and 34%±17% in the spine) relative to the full blocking case. The optimal blocking percentage value was dependent on the specific patient geometry and target location of interest. Although not all individual target locations saw the benefit, element-wise phase aberration corrections improved the average compared to the no correction case (increase of 52%±47% in the hip, 35%±24% in the spine) and impacted the optimal blocking percentage value. Transducer module blocking enabled ablative treatments to be carried out closer to both hip and spine without overheating or damaging the bone (no blocking: / , full blocking: / , optimal partial blocking: / for hip/spine). The proposed transducer apodization scheme shows promise for improving MRgFUS treatments of uterine fibroids, and may ultimately increase the effective treatment envelope of MRgFUS surgery in the body by enabling tissue ablation closer to bonystructures.

Tailoring the Diagnostic Pathway for Medical and Surgical Treatment of Uterine Fibroids: A Narrative Review.

Uterine leiomyomas are the most common benign uterine tumors in women and are often asymptomatic, with clinical manifestation occurring in 20-25% of cases. The diagnostic pathway begins with clinical suspicion and includes an ultrasound examination, diagnostic hysteroscopy, and, when deemed necessary, magnetic resonance imaging. The decision-making process should consider the impairment of quality of life due to symptoms, reproductive desire, suspicion of malignancy, and, of course, the woman's preferences. Despite the absence of a definitive cure, the management of fibroid-related symptoms can benefit from various medical therapies, ranging from symptomatic treatments to the latest hormonal drugs aimed at reducing the clinical impact of fibroids on women's well-being. When medical therapy is not a definitive solution for a patient, it can be used as a bridge to prepare the patient for surgery. Surgical approaches continue to play a crucial role in the treatment of fibroids, as the gynecologist has the opportunity to choose from various surgical options and tailor the intervention to the patient's needs. This review aims to summarize the clinical pathway necessary for the diagnostic assessment of a patient with uterine fibromatosis, presenting all available treatment options to address the needs of different types of women.

NnU-Net based segmentation and 3D reconstruction of uterine fibroids with MRI images for HIFU surgery planning

High-Intensity Focused Ultrasound (HIFU) ablation represents a rapidly advancing non-invasive treatment modality that has achieved considerable success in addressing uterine fibroids, which constitute over 50% of benign gynecological tumors. Preoperative Magnetic Resonance Imaging (MRI) plays a pivotal role in the planning and guidance of HIFU surgery for uterine fibroids, wherein the segmentation of tumors holds critical significance. The segmentation process was previously manually executed by medical experts, entailing a time-consuming and labor-intensive procedure heavily reliant on clinical expertise. This study introduced deep learning-based nnU-Net models, offering a cost-effective approach for their application in the segmentation of uterine fibroids utilizing preoperative MRI images. Furthermore, 3D reconstruction of the segmented targets was implemented to guide HIFU surgery. The evaluation of segmentation and 3D reconstruction performance was conducted with a focus on enhancing the safety and effectiveness of HIFU surgery. Results demonstrated the nnU-Net’s commendable performance in the segmentation of uterine fibroids and their surrounding organs. Specifically, 3D nnU-Net achieved Dice Similarity Coefficients (DSC) of 92.55% for the uterus, 95.63% for fibroids, 92.69% for the spine, 89.63% for the endometrium, 97.75% for the bladder, and 90.45% for the urethral orifice. Compared to other state-of-the-art methods such as HIFUNet, U-Net, R2U-Net, ConvUNeXt and 2D nnU-Net, 3D nnU-Net demonstrated significantly higher DSC values, highlighting its superior accuracy and robustness. In conclusion, the efficacy of the 3D nnU-Net model for automated segmentation of the uterus and its surrounding organs was robustly validated. When integrated with intra-operative ultrasound imaging, this segmentation method and 3D reconstruction hold substantial potential to enhance the safety and efficiency of HIFU surgery in the clinical treatment of uterine fibroids.

Efficacy and safety of robotic-assisted laparoscopic myomectomy for the treatment of uterine fibroids: an updated literature review

Efficacy and safety of robotic-assisted laparoscopic myomectomy for the treatment of uterine fibroids: an updated literature review

European Society for Gynaecological Endoscopy (ESGE) Good Practice Recommendations on surgical techniques for removal of fibroids: part 1 abdominal (laparoscopic and open) myomectomy.

Uterine fibroids are the most common benign tumours of the female reproductive tract and can cause a range of symptoms including abnormal uterine bleeding, pain, pressure symptoms and subfertility. Surgery may be required for some symptomatic fibroids via abdominal or transvaginal routes. The European Society for Gynaecological Endoscopy Uterine Fibroids Working Group developed recommendations based on the best available evidence and expert opinion for the surgical treatment of uterine fibroids. In this first part of the recommendations, abdominal approaches to surgical treatment of fibroids including laparoscopic, robot- assisted and open myomectomy are described.

Impact of ultrasound-guided high-intensity focused ultrasound for the treatment of uterine fibroids on ovarian reserve and quality of life: a single-center prospective cohort study

BackgroundWe aimed to evaluate changes in ovarian reserve and quality of life in women treated with ultrasound-guided high-intensity focused ultrasound (USgHIFU) for uterine fibroids.MethodsIn this single-center prospective study, a total of 69 patients with uterine fibroids treated with USgHIFU from October 2018 to November 2021 were enrolled. Fibroid volume, anti-Müllerian hormone (AMH) levels, uterine fibroid symptom scores, and uterine fibroid symptoms and quality of life (UFS-QOL) questionnaire scores before and 1, 3, and 6 months after USgHIFU treatment were analyzed. Correlations between AMH levels and age, fibroid type, and fibroid location were assessed.ResultsData from 54 of the 69 patients included in the present study were analyzed. The UFS-QOL scores at baseline and at 1 month and 6 months after USgHIFU treatment were 70 (50.75–87.50), 57 (44.75–80.00), and 52 (40.75–69.00) points, respectively (p < 0.001). The rate of fibroid volume reduction increased significantly at the 3-month follow-up compared with the 1-month follow-up (p < 0.001), and no significant change was observed between the 3-month and 6-month follow-ups (p > 0.99). The median AMH levels before and at 1, 3 and 6 months after treatment were 1.22 (0.16–3.28) ng/ml, 1.12 (0.18–2.52) ng/ml, 1.15 (0.19–2.08) ng/ml and 1.18 (0.36–2.43) ng/ml, respectively (p = 0.2). Multivariate linear regression analyses revealed that age was independently associated with AMH levels.ConclusionsUSgHIFU treatment for uterine fibroids can significantly improve quality of life with minimal adverse effects on ovarian function.

Synergic fabrication of gold – iron oxide magnetic nanohybrids as a potential agent for thermosensitizing and magnetic resonance-high intensity focused ultrasound (mr-HIFU) treatment in uterine myomas

The major aim of this research hyperthermia and magnetic resonance-high intensity focused ultrasound (MR-HIFU) focused on investigating the potential of aloe vera leaf extract-mediated gold-coated iron oxide nanohybrids (Au-IONPs) as a modern theragnostic material for the treatment of uterine myoma. To assess the cytotoxicity of Au-IONPs, induce hyperthermia, and apply radiotherapy to determine the level of apoptosis in the human ht-UtLM cells. Subsequently, it evaluated the cytotoxicity of the nanoparticles on human ht-UtLM cells by exposing the cells to various concentrations of Au-IONPs for a 4-hour incubation period. Based on the results, concentrations of 10 and 15 µg/mL were selected for further investigation. The MTT assay and flow cytometry results demonstrated that Au-IONPs significantly induce cell apoptosis. It allows the Au-IONPs to turn as an effective development mediator in the ablation of high-intensity focused ultrasound (HIFU) treatment. Finally, it could be suggested to developed material have excellent systemic toxicity, which promises well for treatment of uterine fibroids. HIGHLIGHTS Biosynthesis of gold – iron oxide nanohybrids (Au-IONPs) through a green approach. Physio-chemical properties of Au-IONPs have been characterized through various techniques. Investigating the anti-tumor effects of Au-IONPs in combination with thermo-radiotherapy for uterine myoma. Determine the level of apoptosis in the human myoma cells by inducing hyperthermia and radiotherapy. Observed the correlation behavior between the dose of the cell viability and Au-IONP nanoparticles. Au-IONPs had a significant impact on enhancing the effects of both hyperthermia and radiation therapies.

Ultrasound-Guided High-Intensity Focused Ultrasound of Uterine Fibroids and Adenomyosis: An 11-Year Experience from a Single Center in Hong Kong.

Introduction: This study evaluated the efficacy and safety of ultrasound-guided high-intensity focused ultrasound (HIFU) in treating symptomatic uterine fibroids and adenomyosis. Methods: HIFU treatments performed in premenopausal women with symptomatic uterine fibroids and adenomyosis were analyzed retrospectively. Lesion volume reduction, change in symptoms of menstrual pain, and quality of life were examined. Major and minor complications, together with re-intervention rates, were evaluated. Results: Eighty-one HIFU treatments were performed in seventy-nine premenopausal women. The follow-up period was up to 95 months. A total of 65 women underwent treatment for uterine fibroids and 14 were treated for adenomyosis. For patients with uterine fibroids, the baseline fibroid volume median was 190.1 cm3 (18.5-1729.4 cm3). Fibroid volume was reduced by 50.1% (-26.2-97.8, p < 0.0001) at 6 months and 66.9% (-33.7-98.3, p < 0.0001) at 12 months after treatment. The modified Uterine Fibroid Symptom and Quality of Life (UFS-QOL) scores had decreased by 43.5% (0-62.5%, p < 0.0001) at 6 months and 50% (0-73%, p < 0.0001) at 12 months after treatment. In the adenomyosis arm, the median baseline uterine volume was 97.7 cm3 (43.7-367.4 m3). Uterine volume was reduced by 19.6% (range: 1.2-42.0, p = 0.28) at 6 months and 41.9% (18.9-69.2, p = 0.04) at 12 months after treatment. UFS-QOL scores were reduced by 38.1% (6-66.7%, p < 0.0001) at 6 months and 40% (0-70%, p < 0.0001) at 12s month after treatment. Fourteen (21.5%) patients with uterine fibroid and five (35.7%) patients with adenomyosis required subsequent interventions. Conclusions: HIFU provides symptomatic relief to most patients with uterine fibroids and adenomyosis. It is a promising uterus-sparing treatment for patients with these conditions.

A novel scoring system based on magnetic resonance imaging for the prediction of the difficulty of ultrasound-guided high-intensity focused ultrasound ablation for uterine fibroids

Objective To develop a novel scoring system based on magnetic resonance imaging (MRI) for predicting the difficulty of ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation for uterine fibroids. Materials and methods A total of 637 patients with uterine fibroids were enrolled. Sonication time, non-perfused volume ratio (NPVR), and ultrasound energy delivered for ablating 1 mm3 of fibroid tissue volume (E/V) were each classified as three levels and assigned scores from 0 to 2, respectively. Treatment difficulty level was then assessed by adding up the scores of sonication time, NPVR and E/V for each patient. The patients with score lower than 3 were categorized into low difficulty group, with score equal to or greater than 3 were categorized into high difficulty group. The potential predictors for treatment difficulty were compared between the two groups. Multifactorial logistic regression analysis model was created by analyzing the variables. The difficulty score system was developed using the beta coefficients of the logistic model. Results Signal intensity on T2WI, fibroid location index, largest diameter of fibroids, abdominal wall thickness, homogeneity of the signal of fibroids, and uterine position were independent influencing factors for the difficulty of USgHIFU for uterine fibroids. A prediction equation was obtained: difficulty score = 17 × uterine position (anteverted =0, retroverted =1)+71 × signal intensity (hypointense = 0, isointense/hyperintense = 1) +8 × enhancement (homogenous = 0, heterogeneous = 1)+25×(largest diameter of fibroids-20) +35 × (fibroid location index −0.2) +1×(abdominal wall thickness −5). Conclusions This scoring system established based on MRI findings can be used to reliably predict the difficulty level of USgHIFU treatment of uterine fibroids.

Risk Factors and Prediction Nomogram of Local Regeneration After Ultrasound-Guided Microwave Ablation of Uterine Fibroids

To explore the risk factors associated with uterine fibroids (UFs) local regeneration of the treated UFs after microwave ablation (MWA) and to develop a nomogram model for predicting the risk of local regeneration. Retrospective study. The Eighth Affiliated Hospital of Sun Yat-sen University. Patients with UFs who underwent MWA at our hospital between October 2020 and April 2023 were included. MWA was used for the treatment of UFs. A total of 47 patients with 68 fibroids were included into this study. Over a median follow-up of 13 months (interquartile range: 8 to 22 months), local regeneration occurred in 11 UFs. The clinical and imaging characteristics of these patients were recorded and compared. Risk factors for local regeneration were determined through univariate and multivariate Cox regression analysis. Multivariate analysis revealed that the fertility desires, larger size of UFs (≥95.3cm3) and hyper-enhancement of UFs on contrast-enhanced ultrasound (CEUS) were independent risk factors for local regeneration after MWA. A predictive nomogram was constructed to predict the local regeneration after MWA of UFs. The concordance index (C-index = 0.924, internal validation C-index = 0.895) and the 1-year and 2-year area under the curve (AUC) values (0.962, 0.927) all indicated that the nomogram had good predictive performance. Calibration and decision curve analysis (DCA) curves further confirmed the model's accuracy and clinical utility. Fertility desires, larger size of UFs and hyper-enhancement on CEUS were independent predictors of UFs local regeneration after MWA in our study. The nomogram constructed based on the above independent risk factors may help predict which UFs will develop local regeneration after MWA.

Racial Disparities in Surgical Treatment of Uterine Fibroids During the COVID-19 Pandemic.

Objective: Analyze the association between race and surgery performed for uterine fibroids during the coronavirus disease 2019 (COVID-19) pandemic. Methods: Retrospective exploratory cross-sectional study of patients with fibroids who underwent surgery during the COVID-19 pandemic. We compared the type of surgery performed (minimally invasive hysterectomy [MIH], uterine-sparing procedure [USP], or total abdominal hysterectomy [TAH]) by White versus non-White patients. Absolute percentage differences were estimated with multinomial logistic regression adjusting for age, body mass index (BMI), parity, comorbidities, and maximum fibroid diameter. Results: Of 350 subjects, the racial composition was 1.7% Asian, 23.4% Black, and 74.9% White. Non-White patients had greater fibroid burden by mean maximum fibroid diameter, mean uterine weight, and mean fibroid weight. Although MIH occurred more frequently among White patients (7.5% points higher [95% confidence interval (CI) = -3.1 to 18.2]), USP and TAH were more commonly conducted for non-White patients (3.4% points higher [95% CI = -10.4 to 3.6] and 4.2% points higher [95% CI = -13.2 to 4.8], respectively). The overall complication rate was 18.6%, which was 6% points lower (95% CI = -15.8 to 3.7) among White patients. Conclusion: During the COVID-19 pandemic at a single-site institution, non-White patients were more likely to undergo a uterine-sparing procedure for surgical treatment of uterine fibroids, abdominal procedures, including both hysterectomy and myomectomy, and experience surgery-related complications.

Evaluation of the effectiveness of innovative methods of focused ultrasound and uterine artery embolization in the treatment of uterine fibroids

BACKGROUND: Uterine fibroids are one of the most common gynecological diseases. The application of innovative techniques such as focused ultrasound ablation and uterine artery embolization has improved the quality of life of many patients. However, despite significant advances in innovative therapies, there is no certainty about the long-term efficacy of focused ultrasound ablation and uterine artery embolization. AIM: The aim of this study was to compare the efficacy of focused ultrasound ablation and uterine artery embolization treatments of uterine fibroids. MATERIALS AND METHODS: This study analyzed observations of 112 patients with uterine fibroids. Patients in the first group were treated with focused ultrasound ablation (n = 44). The second group of patients underwent uterine artery embolization (n = 68). RESULTS: The study groups differed in the reduction of myomatous node sizes one, three, six and 12 months after surgery, depending on the chosen treatment method (p 0.001). In the first group, fibroid volume decreased by 14% after a month and by 35% after 12 months. In the second group, it decreased by 20% after a month and by 54% after a year. CONCLUSIONS: Treatment with the uterine artery embolization method reduced fibroid volume by 54%, which is 19% more effective than the focused ultrasound ablation method.

The importance of the 'uterine factor' in recurrent pregnancy loss: a retrospective cohort study on women screened through 3D transvaginal ultrasound.

What is the prevalence of congenital and acquired anomalies of the uterus in women with recurrent pregnancy loss (RPL) of unknown etiology examined using 3D transvaginal ultrasound (US)? Depending on the adopted diagnostic criteria, the prevalence of partial septate uterus varies between 7% and 14% and a T-shaped uterus is 3% or 4%, while adenomyosis is 23%, at least one of type 0, type 1 or type 2 myoma is 4%, and at least one endometrial polyp is 4%. ESHRE and the Royal College of Obstetricians and Gynaecologists guidelines on RPL recommend the adoption of the 3D transvaginal US to evaluate the 'uterine factor'. Nevertheless, there are no published studies reporting the prevalence of both congenital and acquired uterine anomalies as assessed by 3D transvaginal US and diagnosed according to the criteria proposed by the most authoritative panels of experts in a cohort of women with RPL. This was a retrospective cohort study including 442 women with at least two previous first-trimester spontaneous pregnancy losses (i.e. non-viable intrauterine pregnancies), who referred to the obstetrics and gynecology unit of two university hospitals between July 2020 and July 2023. Records of eligible women were reviewed. Women could be included in the study if: they were between 25 and 42 years old; they had no relevant comorbidities; they were not affected by infertility, and they had never undergone ART; they and their partner tested negative to a comprehensive RPL diagnostic work-up; and they had never undergone metroplasty, myomectomy, minimally invasive treatments for uterine fibroids or adenomyomectomy. Expert sonographers independently re-analyzed the stored 2- and 3D transvaginal US images of all included patients. Congenital uterine anomalies (CUAs) were reported according to the American Society for Reproductive Medicine (ASRM) 2021, the ESHRE/European Society for Gynaecological Endoscopy (ESGE) and the Congenital Uterine Malformation by Experts (CUME) criteria. Acquired uterine anomalies were reported according to the International Federation of Gynecology and Obstetrics (FIGO) and the Morphological Uterus Sonographic Assessment (MUSA) criteria. The partial septate uterus was diagnosed in 60 (14%; 95% CI: 11-17%), 29 (7%; 95% CI: 5-9%), and 47 (11%; 95% CI: 8-14%) subjects, according to the ESHRE/ESGE, the ASRM 2021, and the CUME criteria, respectively. The T-shaped uterus was diagnosed in 19 women (4%; 95% CI: 3-7%) according to the ESHRE/ESGE criteria and in 13 women (3%; 95% CI: 2-5%) according to the CUME criteria. The borderline T-shaped uterus (diagnosed when two out of three CUME criteria for T-shaped uterus were met) was observed in 16 women (4%; 95% CI: 2-6%). At least one of FIGO type 0, type 1, or type 2 myoma was detected in 4% of included subjects (95% CI: 3-6%). Adenomyosis was detected in 100 women (23%; 95% CI: 19-27%) and was significantly more prevalent in women with primary RPL and in those with three or more pregnancy losses. At least one endometrial polyp was detected in 4% of enrolled women (95% CI: 3-7%). The absence of a control group prevented us from investigating the presence of an association between both congenital and acquired uterine anomalies and RPL. Second, the presence as well as the absence of both congenital and acquired uterine anomalies detected by 3D US was not confirmed by hysteroscopy. Finally, the results of the present study inevitably suffer from the intrinsic limitations of the adopted classification systems. The prevalence of CUAs in women with RPL varies depending on the classification system used. For reasons of clarity, the US reports should always state the name of the uterine anomaly as well as the adopted classification and diagnostic criteria. Adenomyosis seems to be associated with more severe forms of RPL. The prevalence rates estimated by our study as well as the replicability of the adopted diagnostic criteria provide a basis for the design and sample size calculation of prospective studies. No specific funding was used. The authors have no conflicts of interest to declare. N/A.

Development and validation of a deep learning-based method for automatic measurement of uterus, fibroid, and ablated volume in MRI after MR-HIFU treatment of uterine fibroids

IntroductionThe non-perfused volume divided by total fibroid load (NPV/TFL) is a predictive outcome parameter for MRI-guided high-intensity focused ultrasound (MR-HIFU) treatments of uterine fibroids, which is related to long-term symptom relief. In current clinical practice, the MR-HIFU outcome parameters are typically determined by visual inspection, so an automated computer-aided method could facilitate objective outcome quantification. The objective of this study was to develop and evaluate a deep learning-based segmentation algorithm for volume measurements of the uterus, uterine fibroids, and NPVs in MRI in order to automatically quantify the NPV/TFL. Materials and MethodsA segmentation pipeline was developed and evaluated using expert manual segmentations of MRI scans of 115 uterine fibroid patients, screened for and/or undergoing MR-HIFU treatment. The pipeline contained three separate neural networks, one per target structure. The first step in the pipeline was uterus segmentation from contrast-enhanced (CE)-T1w scans. This segmentation was subsequently used to remove non-uterus background tissue for NPV and fibroid segmentation. In the following step, NPVs were segmented from uterus-only CE-T1w scans. Finally, fibroids were segmented from uterus-only T2w scans. The segmentations were used to calculate the volume for each structure. Reliability and agreement between manual and automatic segmentations, volumes, and NPV/TFLs were assessed. ResultsFor treatment scans, the Dice similarity coefficients (DSC) between the manually and automatically obtained segmentations were 0.90 (uterus), 0.84 (NPV) and 0.74 (fibroid). Intraclass correlation coefficients (ICC) were 1.00 [0.99, 1.00] (uterus), 0.99 [0.98, 1.00] (NPV) and 0.98 [0.95, 0.99] (fibroid) between manually and automatically derived volumes. For manually and automatically derived NPV/TFLs, the mean difference was 5% [-41%, 51%] (ICC: 0.66 [0.32, 0.85]). ConclusionThe algorithm presented in this study automatically calculates uterus volume, fibroid load, and NPVs, which could lead to more objective outcome quantification after MR-HIFU treatments of uterine fibroids in comparison to visual inspection. When robustness has been ascertained in a future study, this tool may eventually be employed in clinical practice to automatically measure the NPV/TFL after MR-HIFU procedures of uterine fibroids.