The use of 3D power Doppler ultrasound in the quantification of blood vessels in uterine fibroids: feasibility and reproducibility.

BACKGROUND: To evaluate the interobserver agreement and discriminating value of three-dimensional power Doppler ultrasound (3D PDUS) in patients with fibroids. METHODS: An observational prospective cohort study in 19 patients with fibroids. 3D PDUS was performed by one examiner and evaluated by three independent examiners in order to evaluate various vascular parameters: vascular index (VI), flow index, and vascular flow index of the fibroid, the vascular capsule and of its highest vascular area, using both manual and automatic contour modes. The intraclass correlation coefficient and discriminating values were calculated. The correlation between VI and volume was studied using Kendall's Tau test. RESULTS: In the manual contour mode, the VIs of the fibroid and of the vascular capsule had the highest interobserver agreements (intraclass correlation coefficients of 0.89 and 0.87, respectively). Both parameters seem to have good discriminating values, given the large range of these parameters between different fibroids, independent of their volume. The vascularity of the fibroid and capsule was related. VI was not related to the volume of the fibroid. CONCLUSIONS: VI assessed using 3D PDUS is a reproducible parameter in the assessment of fibroid vascularization with discriminating abilities. Additional studies are needed to further evaluate its validity and clinical relevance.

Hysteroscopic myomectomy and case volume hysteroscopic myomectomy performed by high- and low-volume surgeons.

OBJECTIVE: To determine whether surgical volume influences efficiency of hysteroscopic myomectomy as a treatment for uterine fibroids. STUDY DESIGN: This retrospective cross-sectional study performed at a university teaching hospital included all patients who underwent hysteroscopic myomectomy between 2001 and 2005 by a faculty surgeon. We used 3 outcomes as measures of efficiency: amount of tissue resected per case, operating department time per case and amount of tissue resected per minute. RESULTS: High-volume surgeons resected more tissue than low-volume surgeons (p = 0.01), had shorter operating department times (p = 0.018) and resected more tissue per time (p = 0.015). CONCLUSION: High-volume surgeons have higher efficiency performing hysteroscopic myomectomy as a treatment for uterine fibroids.