Neutrophil to lymphocyte ratio as an assessment tool to differentiate between uterine sarcoma and myoma: a systematic review and meta-analysis.

BACKGROUND: This systematic review and meta-analysis aimed to determine the potential value of neutrophil to lymphocyte ratio (NLR) as an assessment tool in the clinical distinction between uterine sarcoma and uterine leiomyoma. METHODS: We comprehensively searched Web of Science, Scopus, and PubMed for relevant papers published before March 19, 2023. The standardized mean difference (SMD) was provided, along with a 95% confidence interval (CI). The random-effects model was employed to derive pooled effects due to the high levels of heterogeneity. The Newcastle-Ottawa scale was used for the quality assessment. Our study was registered in PROSPERO (CRD42023478331). RESULTS: Overall, seven articles were included in the analysis. A random-effect model revealed that patients with uterine sarcoma had higher NLR levels compared to those with uterine myoma (SMD = 0.60, 95% CI = 0.22-0.98; p = 0.002). In the subgroup analysis according to sample size, we found that patients with uterine sarcoma had elevated levels of NLR compared to those with uterine myoma in either large studies (SMD = 0.58, 95% CI = 0.04-1.13; P < 0.001) or small studies (SMD = 0.64, 95% CI = 0.33-0.96; P = 0.32). In the sensitivity analysis, we found that the final result was not significantly changed when single studies were removed, suggesting that the finding of this meta-analysis was stable. The pooled sensitivity of NLR was 0.68 (95% CI = 0.61-0.73), and the pooled specificity was 0.64 (95% CI = 0.59-0.69). CONCLUSION: NLR might be utilized as an assessment tool in clinics to help clinicians differentiate between patients with uterine sarcoma and those with myoma.

Assessment of a Digital Symptom Checker Tool's Accuracy in Suggesting Reproductive Health Conditions: Clinical Vignettes Study.

BACKGROUND: Reproductive health conditions such as endometriosis, uterine fibroids, and polycystic ovary syndrome (PCOS) affect a large proportion of women and people who menstruate worldwide. Prevalence estimates for these conditions range from 5% to 40% of women of reproductive age. Long diagnostic delays, up to 12 years, are common and contribute to health complications and increased health care costs. Symptom checker apps provide users with information and tools to better understand their symptoms and thus have the potential to reduce the time to diagnosis for reproductive health conditions. OBJECTIVE: This study aimed to evaluate the agreement between clinicians and 3 symptom checkers (developed by Flo Health UK Limited) in assessing symptoms of endometriosis, uterine fibroids, and PCOS using vignettes. We also aimed to present a robust example of vignette case creation, review, and classification in the context of predeployment testing and validation of digital health symptom checker tools. METHODS: Independent general practitioners were recruited to create clinical case vignettes of simulated users for the purpose of testing each condition symptom checker; vignettes created for each condition contained a mixture of condition-positive and condition-negative outcomes. A second panel of general practitioners then reviewed, approved, and modified (if necessary) each vignette. A third group of general practitioners reviewed each vignette case and designated a final classification. Vignettes were then entered into the symptom checkers by a fourth, different group of general practitioners. The outcomes of each symptom checker were then compared with the final classification of each vignette to produce accuracy metrics including percent agreement, sensitivity, specificity, positive predictive value, and negative predictive value. RESULTS: A total of 24 cases were created per condition. Overall, exact matches between the vignette general practitioner classification and the symptom checker outcome were 83% (n=20) for endometriosis, 83% (n=20) for uterine fibroids, and 88% (n=21) for PCOS. For each symptom checker, sensitivity was reported as 81.8% for endometriosis, 84.6% for uterine fibroids, and 100% for PCOS; specificity was reported as 84.6% for endometriosis, 81.8% for uterine fibroids, and 75% for PCOS; positive predictive value was reported as 81.8% for endometriosis, 84.6% for uterine fibroids, 80% for PCOS; and negative predictive value was reported as 84.6% for endometriosis, 81.8% for uterine fibroids, and 100% for PCOS. CONCLUSIONS: The single-condition symptom checkers have high levels of agreement with general practitioner classification for endometriosis, uterine fibroids, and PCOS. Given long delays in diagnosis for many reproductive health conditions, which lead to increased medical costs and potential health complications for individuals and health care providers, innovative health apps and symptom checkers hold the potential to improve care pathways.

Assessment of Uterine Fibroid Knowledge and Educational Interests Among Health Care Professionals.

BACKGROUND: Uterine fibroid diagnosis and management can be delayed by a lack of access to care. To combat this barrier, this study aimed to determine gaps in knowledge and investigate areas of education interest. METHODS: Obstetrics-gynecology, family medicine, and internal medicine resident and attending physicians received an electronic survey via RedCap. Descriptive statistics were performed in Mintab and Excel. RESULTS: Seventy of the 316 physicians (22%) who received the survey completed it. Most participants answered questions regarding diagnosis timing, instruments for validated reported outcomes, and risk factors incorrectly. Seventy-six percent of respondents desired more education about treatment options and guidelines. DISCUSSION: This study provides insight regarding current knowledge of uterine fibroids and areas of educational interest among different physicians.

Quality assessment of pelvic ultrasound for uterine myoma according to the CNGOF guidelines.

INTRODUCTION: French guidelines regarding the minimum criteria for gynaecological ultrasound were given in a recent report in 2016, by the French National College of Obstetricians and Gynaecologists (CNGOF). An accurate report is essential for the optimal care of women, especially those presenting myomas. The goal of this study was to evaluate the quality of gynaecological ultrasound reports for women with type 0 to 2 uterine myomas, referring to the items contained in the French guidelines. MATERIALS AND METHODS: A retrospective descriptive study was conducted from reports of ultrasounds performed in private offices and in the gynaecologic department of a hospital, between June 2014 and June 2016 (before the report of CNGOF). These reports involved women who underwent hysteroscopic resection of myoma(s). A search of validated items was conducted for all of the reports, and the missing items were analysed. The different types of practitioners and between hospital and private medical offices were also compared with Chi-square tests. RESULTS: A total of 138 reports were analysed; 71 were performed in private offices and 67 were performed in the gynaecologic unit of the hospital. Many items were missing in the reports, with disparities between the type of institution (private offices or hospital) and the speciality of practitioners (radiologists or gynaecologists). Specific items regarding myomas, such as the International Federation of Gynaecologists and Obstetricians (FIGO) classification or measurement of the posterior wall, were more often missing in reports from radiologists (89.7% and 79.5%, respectively) than in reports from gynaecologists (21.2% and 34.3%, respectively) (P<0.05). A significant difference was also observed for these data between private offices' reports and hospitals' reports. Items relative to ultrasound structures, such as the appearance of myomas or associated abdominal effusion, were more frequently missing in gynaecologists' reports (88.9% and 49.5%, respectively) compared to radiologists' reports (56.4% and 12.8%, respectively) (P<0.05). CONCLUSIONS: Certain items are present in all the reports, while others are insufficiently mentioned. These inequalities can be explained in part by the type of practice; however, methods to overcome these difficulties must be developed. Information campaigns to educate professionals on the minimum reporting and training conducted jointly by radiologists and gynaecologist surgeons might improve reports and improve the care of women.

Preoperative assessment of factors associated with difficulty in performing total laparoscopic hysterectomy.

AIM: Our objective was to determine the preoperative factors associated with difficulty in total laparoscopic hysterectomy (TLH). METHODS: This retrospective clinical study included 157 patients who underwent TLH for leiomyoma or adenomyosis between 2009 and 2013. All patients underwent magnetic resonance imaging (MRI) before surgery. We categorized patients as 'difficult' if the operation time was > 243 min, if total blood loss was > 500 mL, or if conversion to laparotomy was necessary. Preoperative information, including MRI findings, was compared between the difficult and 'other' patients. Stepwise logistic regression analysis was used to control for covariates that were significant on univariate analysis (P < 0.05). RESULTS: The presence of an endometrioma, a previous cesarean section (CS), a wide uterus, and a high body mass index were independent risk factors for being a difficult patient. For adenomyosis patients, the presence of an endometrioma, a prior CS, subtype II adenomyosis, and high body mass index were independent risk factors for being a difficult patient. For leiomyoma patients, the presence of an endometrioma, a prior CS, and having at least seven leiomyomas were independent risk factors for being a difficult patient. All laparotomy conversion patients had multiple risk factors. CONCLUSION: We have elucidated the factors associated with difficult TLH patients using patients' background and preoperative MRI findings. Awareness of these predictive factors may enable surgeons to prepare for the operation, minimize complications, or choose another more appropriate route of hysterectomy than TLH.

Laparoscopic hysterectomy with morcellation vs abdominal hysterectomy for presumed fibroids: an updated decision analysis following the 2014 Food and Drug Administration safety communications.

Previous decision analyses demonstrate the safety of minimally invasive hysterectomy for presumed benign fibroids, accounting for the risk of occult leiomyosarcoma and the differential mortality risk associated with laparotomy. Studies published since the 2014 Food and Drug Administration safety communications offer updated leiomyosarcoma incidence estimates. Incorporating these studies suggests that mortality rates are low following hysterectomy for presumed benign fibroids overall, and a minimally invasive approach remains a safe option. Risk associated with morcellation, however, increases in women age >50 years due to increased leiomyosarcoma rates, an important finding for patient-centered discussions of treatment options for fibroids.

Healthcare utilization and costs among women diagnosed with uterine fibroids: a longitudinal evaluation for 5 years pre- and post-diagnosis.

OBJECTIVE: To evaluate the healthcare utilization, treatments, and costs incurred by women with uterine fibroids (UF), compared to those without UF, for 5 years before and 5 years after diagnosis. RESEARCH DESIGN AND METHODS: This is a longitudinal, retrospective case-control study. A total of 84,954 women with a diagnosis of UF, along with matched controls of women without UF, were selected from the Truven Health MarketScan claims database (2000-2010). The date of diagnosis of the UF patient was assigned as the index date for both the UF patient and her matched control. MAIN OUTCOME MEASURES: Healthcare resource utilization, treatments, and costs (in 2010 USD) were evaluated annually for the 5 year periods before and after the index date. RESULTS: UF patients had more outpatient and emergency room visits than controls before diagnosis, and more inpatient, outpatient, and emergency room visits than controls after diagnosis. Annual total healthcare costs were significantly higher for patients than controls during the last 3 years pre-index and all 5 years post-index. Overall, the difference was $12,623 over 10 years, with a difference of $1435 in the 5 years pre-diagnosis and a difference of $11,188 in the 5 years post-diagnosis. The cost difference between UF patients and controls was highest in the first year post-diagnosis, reaching $6131, and the difference was even larger when comparing clinically symptomatic UF patients to controls. The use of medications and surgical procedures related to UF peaked in the year post-diagnosis, with 39% of patients receiving a surgical treatment within the year. KEY LIMITATIONS: UF patients included in the study did not include undiagnosed and potentially asymptomatic UF patients; the impact of disease severity on the costs of UF patients was not evaluated. CONCLUSIONS: Patients with UF incurred significantly higher healthcare utilization and costs than those without UF, both pre- and post-diagnosis.

Effect of menses on standardized assessment of sexual dysfunction among women with uterine fibroids: a cohort study.

OBJECTIVE: To determine if assessment of sexual dysfunction by the Female Sexual Function Index (FSFI) is related to whether the FSFI is administered during or between menses, in women with symptomatic uterine fibroids. DESIGN: Prospective cohort. SETTING: Academic medical centers. PATIENT(S): Premenopausal women who had symptomatic uterine fibroids and were enrolled in fibroid treatment trials. INTERVENTION(S): Administration of FSFI during and between menses. MAIN OUTCOME MEASURE(S): Mean FSFI scores in each of 6 domains, and a discordance score to report individual differences in assessment. RESULT(S): Thirty-three women completed the FSFI, during menstruation, and at a time in their cycle when they were not menstruating. The mean FSFI scores for each domain did not differ based on when in the menstrual cycle the instrument was administered. However, on an individual level, nearly half of the women reported sexual dysfunction differently during menses than between menses. Of those that reported differences, the pain and desire domains improved; the lubrication and satisfaction domains worsened during menses. CONCLUSION(S): Although the mean values of the domain scores were not different, women did report differences in sexual functioning during vs. between menses. Timing of the questionnaire in relation to menses should be considered in sexual-dysfunction assessment for women with uterine fibroids. CLINICAL TRIALS REGISTRATION NUMBER: NCT00995878.

MRI in the assessment of prolapsed pedunculated submucous leiomyomas: two case reports.

Uterine leiomyomas are the most common benign gynecological tumors affecting 20-30% of women in reproductive age. Despite their benignity, in some cases several symptoms may require surgical intervention. Submucosal leiomyomas are less frequent (5-10%), but are usually symptomatic. Approximately 2.5% of the myomas are pedunculated and can protrude in the cervical canal. Symptomatic leiomyomas can be treated either by hysterectomy or myomectomy, and these procedures can be performed with several techniques. Whenever possible, hysteroscopic myomectomy is better because it has many advantages, as it also preserves future fertility. Two interesting cases of prolapsed pedunculated submucous leiomyomas are reported in order to prove that magnetic resonance imaging (MRI) is essential to choose the most appropriate treatment and to perform an adequate presurgical planning, which must be based on an overall assessment of the leiomyoma's characteristics (number, location, size and presence or absence of a stalk) and the patient's characteristics.

A randomised trial of treating fibroids with either embolisation or myomectomy to measure the effect on quality of life among women wishing to avoid hysterectomy (the FEMME study): study protocol for a randomised controlled trial.

BACKGROUND: Uterine fibroids are the most common tumour in women of reproductive age. By the time they are 50-years-old around 80% of women will have developed one. Of these, around half will experience symptoms which will impact negatively on their quality of life. Hysterectomy is the traditional treatment for women with symptomatic fibroids. For women who do not wish to undergo a hysterectomy, two invasive treatments are commonly available: myomectomy or uterine artery embolization (UAE). DESIGN: FEMME is a pragmatic, randomised, open, multi-centre trial examining the quality of life menstruating women with symptomatic fibroids experience after treatment with UAE or myomectomy. METHODS: After providing informed consent, 216 women with symptomatic fibroids from 43 NHS Hospital Trusts and Health Boards across the United Kingdom will undergo randomisation by a centralised computer system to treatment by either UAE or myomectomy. A minimisation algorithm will be used in order to balance the groups with respect to the following three parameters: the longest dimension of the largest fibroid, the number of fibroids present, and whether the woman currently desires pregnancy.Using validated questionnaires the women's quality of life will be compared between groups at six months, one year, two years and four years post-procedure, taking into account pre-procedure scores. An economic evaluation will be conducted alongside the trial to determine the cost-effectiveness of UAE compared with myomectomy.Validated diaries will also be used to compare menstrual blood loss at the same time-points. The plasma concentration of Anti-Müllerian hormone (AMH), which will act as a proxy measurement of ovarian reserve, will be recorded before the woman has her procedure and then again at six weeks, six months, and twelve months afterwards. Re-intervention rates will be recorded. DISCUSSION: The FEMME trial's primary outcome is the quality of life women with symptomatic uterine fibroids experience two years after they have been treated with either UAE or myomectomy, as measured by the disease-specific Uterine Fibroid Symptom Quality-of-Life (UFS-QoL) questionnaire. TRIAL REGISTRATION: Current Controlled Trials registration number: ISRCTN70772394, registered on 2 March 2013.

Real-time elastography for assessment of uterine disorders.

OBJECTIVES: Sonoelastography is an ultrasound-imaging technique that measures tissue strain. The aim of this study was to define, in a systematic manner, specific sonoelastographic characteristics of the myometrium, fibroids and adenomyosis, to evaluate the feasibility of sonoelastography in patients with suspected gynecological pathology and to compare the results with histology and/or magnetic resonance imaging (MRI)-based diagnoses. METHODS: We performed a prospective observational cohort study between 2009 and 2011. Two-hundred and eighteen women with suspected gynecological pathology underwent routine transvaginal ultrasound and additional real-time sonographic elastography. Sixty-nine of the 218 women underwent MRI and/or histological examination and were included in the final analysis. Acquisition of elastographic images was standardized. We analyzed the elastographic characteristics of myometrium, fibroids and adenomyosis. An independent observer, unaware of clinical, histological or MRI findings, evaluated the recorded elastographic images and cineloops. These elastographic-based diagnoses were compared with histology and/or MRI diagnoses. RESULTS: With elastography, the uterus was well delineated from the surrounding bowel. The myometrium was uniform in color in 49% of the cases, with a main color of purple or dark blue, indicating stiffer tissue. Fibroids and adenomyosis had different elastographic characteristics and different color patterns. In general, fibroids were darker and adenomyosis was brighter than adjacent myometrium. The agreement between elastography-based diagnosis of fibroids and adenomyosis with MRI-based diagnosis was excellent; with histology-based diagnosis, agreement was substantial for fibroids and adenomyosis. CONCLUSIONS: Elastography is able to identify clear discriminating characteristics of the uterus, fibroids and adenomyosis, and elastography-based diagnoses are in excellent agreement with those of MRI. Agreement between elastography-based diagnosis of adenomyosis and histology is substantial but not optimal.

The burden of uterine fibroids for African-American women: results of a national survey.

BACKGROUND: Uterine fibroids have a disproportionate impact on African-American women. There are, however, no data to compare racial differences in symptoms, quality of life, effect on employment, and information-seeking behavior for this disease. METHODS: An online survey was conducted by Harris Interactive between December 1, 2011 and January 16, 2012. Participants were U.S. women aged 29-59 with symptomatic uterine fibroids. African-American women were oversampled to allow statistical comparison of this high-risk group. Bivariate comparison of continuous and categorical measures was based on the t-test and the Chi-squared test, respectively. Multivariable adjustment of risk ratios was based on log binomial regression. RESULTS: The survey was completed by 268 African-American and 573 white women. There were no differences between groups in education, employment status, or overall health status. African-American women were significantly more likely to have severe or very severe symptoms, including heavy or prolonged menses (RR=1.51, 95% CI 1.05-2.18) and anemia (RR=2.73, 95% CI 1.47-5.09). They also more often reported that fibroids interfered with physical activities (RR=1.67, 95% CI 1.20-2.32) and relationships (RR=2.27, 95% CI 1.23-4.22) and were more likely to miss days from work (RR=1.77, 95% CI 1.20-2.61). African-American women were more likely to consult friends and family (36 vs. 22%, P=0.004) and health brochures (32 vs. 18%, P<0.001) for health information. Concerns for future fertility (RR=2.65, 95% CI 1.93-3.63) and pregnancy (RR=2.89, 95% CI 2.11-3.97) following fibroid treatments were key concerns for black women. CONCLUSIONS: African-American women have more severe symptoms, unique concerns, and different information-seeking behavior for fibroids.

Prevalence, symptoms and management of uterine fibroids: an international internet-based survey of 21,746 women.

BACKGROUND: In 2009 the Uterine Bleeding and Pain Women's Research Study (UBP-WRS) was conducted interviewing 21,479 women across 8 countries in order to gain patient-based prevalence data on uterine pain and bleeding indications and investigate uterine symptoms and women's treatment experiences. This article shows relevant results of the study for the indication uterine fibroids providing data on self-reported prevalence, symptomatology and management of uterine fibroids. METHODS: 2,500 women (USA: 4,500 women) in each country (Brazil, Canada, France, Germany, Italy, South Korea, the UK, the USA) completed an online survey. Women included were in their reproductive age (age group 15-49 years; USA: 18-49 years) and had ever experienced menstrual bleedings. Quotas were applied for age, region, level of education and household income of respondents. Variables have been analyzed descriptively and exploratory statistical tests have been performed. RESULTS: The self-reported prevalence of uterine fibroids ranged from 4.5% (UK) to 9.8% (Italy), reaching 9.4% (UK) to 17.8% (Italy) in the age group of 40-49 years. Women with a diagnosis of uterine fibroids reported significantly more often about bleeding symptoms than women without a diagnosis: heavy bleedings (59.8% vs. 37.4%), prolonged bleedings (37.3% vs. 15.6%), bleeding between periods (33.3% vs. 13.5%), frequent periods (28.4% vs. 15.2%), irregular and predictable periods (36.3% vs. 23.9%). Furthermore women with diagnosed uterine fibroids reported significantly more often about the following pain symptoms: pressure on the bladder (32.6% vs. 15.0%), chronic pelvic pain (14.5% vs. 2.9%), painful sexual intercourse (23.5% vs. 9.1%) and pain occurring mid-cycle, after and during menstrual bleeding (31.3%, 16.7%, 59.7%, vs. 17.1%, 6.4%, 52.0%). 53.7% of women reported that their symptoms had a negative impact on their life in the last 12 month, influencing their sexual life (42.9%), performance at work (27.7%) and relationship & family (27.2%). CONCLUSIONS: Uterine fibroid is a common concern in women at fertile age causing multiple bleeding and pain symptoms which can have a negative impact on different aspects in women's life.

Screening for uterine tumours.

The most prevalent uterine tumours are leiomyomas, which are benign and have a prevalence of about 50% at menopause. The incidence of endometrial cancer and uterine sarcomas is about 25 per 100,000 and 0.7 per 100,000, respectively. Reported risk factors for endometrial cancer are advanced age, unopposed oestrogen stimulation, late menopause, obesity, diabetes mellitus, nulliparity, feminising ovarian tumours, polycystic ovarian syndrome, tamoxifen and belonging to a hereditary non-polyposis colorectal cancer family. Unopposed oestrogen stimulation and tamoxifen have also been confirmed to induce uterine sarcomas. Cervical cytology, endometrial sampling and ultrasound have been proposed in the early diagnosis of endometrial cancer. No pathognomonic ultrasound, magnetic resonance imaging or computed tomography features are able to differentiate between a leiomyoma and a uterine sarcoma, and reliable serum markers for sarcomas are lacking. To date, mass screening for uterine malignancies is not feasible or effective.

O valor da doplervelocimetria na avaliação do leiomioma uterino / The role of Doppler velocimetry in the assessment of uterine leiomyoma

Os autores fizeram uma revisão de literatura acerca da análise doplervelocimétrica como ferramenta ultrassonográfica do comportamento biológico da vasculatura uterina e do leiomioma uterino, e procuraram averiguar, por meio de revisão da literatura, se o Doppler poderia diferenciar o leiomioma do leiomiossarcoma e avaliar a resposta ao tratamento clínico com agonistas do GnRH, moduladores seletivos de receptores de progesterona e procedimentos minimamente invasivos destes tumores. Outros tipos de tratamento não foram avaliados. Apesar do restrito número de estudos e da baixa casuística de cada pesquisa isoladamente, observou-se que há uma mudança no índice de resistência dos parâmetros doplervelocimétricos após o tratamento farmacológico e/ou minimamente invasivo do leiomioma uterino; as demais variáveis se comportam de forma variável. Concluiu-se, portanto, que a doplervelocimetria parece não se constituir ainda um parâmetro confiável para diferenciar o leiomioma do leiomiossarcoma e de avaliação de resposta ao tratamento clínico

The authors performed a literature review about Doppler velocimetry as the ultrasonographic tool of the biological behavior from uterine and leiomioma vascularization. They also tried to ascertain through literature review if Doppler could differ between leiomioma to leiomyossarcoma and assess response to clinical treatment with GnRH agonists, selective modulators of progesterone receptors and minimally invasive procedures of these tumors. Other types of treatment were not evaluated. Despite the restrict number of studies and low sampling of each research, there was a change on resistant index from Doppler velocimetry patterns after pharmacological and/or minimally invasive treatment of uterine leiomioma; other indices behaved diversely. Therefore, we concluded that Doppler velocimetry does not constitute a good pattern to differ uterine leiomioma from leiomyossarcoma and of response assessment to clinical treatment

Provision of a mobile uterine artery embolization service to medically underserved areas in Brazil.

PURPOSE: To determine the feasibility, efficacy, and safety of a mobile uterine artery embolization (UAE) program for patients in medically underserved, socioeconomically deprived areas. MATERIALS AND METHODS: One hundred women with symptomatic uterine leiomyomas were treated with UAE. A small truck containing a mobile c-arm and all needed supplies visited one hospital per week during a 6-month period. Four public hospitals were visited in rotation. Pre- and postprocedural magnetic resonance (MR) imaging and validated quality of life (QOL) questionnaires were obtained, and procedural details and complications were recorded. RESULTS: Technical success was achieved in 97 of 100 women. Mean procedure time was 41 minutes (range, 15-140 min) and mean fluoroscopy time was 17 minutes (range, 6-45 min). Mean hospital stay was 1.03 days (range, 1-3 d) and mean time to resumption of normal activities was 8.2 days (range, 2-20 d). At 12 weeks, 88% of patients noted symptomatic improvement and 98% stated they would recommend the procedure to other women. Complete tumor ischemia was seen on postprocedural MR imaging in 92% of women, with a mean uterine volume reduction of 36.3% (range, -4.3% to 65%) and a mean tumor volume reduction of 57.1% (range, -23.4% to 95.8%). Health-related QOL scores increased from 41.4 points before UAE to 81.2 points at 12 weeks and 85.3 points at 1 year after UAE. Complications were recorded in seven women (7%): three puncture site hematomas, three readmissions for pain control, and one case of leiomyoma passage. CONCLUSIONS: A mobile interventional radiology unit is a feasible, efficient, and safe method to provide UAE to an underserved patient community. Outcomes and complications are similar to published results from centers with conventional angiographic facilities.

Impact of periodic health examination on surgical treatment for uterine fibroids in Beijing: a case-control study.

BACKGROUND: During the past 2 decades, there has been a rapid proliferation of "health examination center (HEC)" across China. The effects of their services on public's health have not been systemically investigated. This study aimed to assess the impact of periodic health examination (PHE) at HEC on surgical treatment for uterine fibroids in Beijing residents. METHODS: We identified 224 patients with a primary diagnosis of uterine fibroids who had surgical treatment at four Level-1 general hospitals in Beijing, from June 1, 2009 to October 20, 2009. Controls were women who did not have surgery for uterine fibroids, matched (1:1 ratio) for age (within 2 years). A standard questionnaire was used to inquire about whether participants had PHE at HEC during the previous 2 years. RESULTS: PHE at HEC within 2 years were associated with surgical treatment for uterine fibroids. Odds ratios was 4.05 (95% CI, 2.61-6.29 P < 0.001), after adjustment for marital status, whether have children, annual family income, health insurance, education level and self-rated uterine fibroids-related symptom severity. CONCLUSIONS: Our study showed PHE currently provided at HEC in China were associated with significantly increased use of surgical treatment for uterine fibroids in women. Further studies are needed to assess the effects of PHE on clinical as well as on broad societal outcomes in Chinese in contemporary medical settings.

Assessment of the predictivity of preoperative serum CA 125 in the differential diagnosis of uterine leiomyoma and uterine sarcoma in the Turkish female population.

AIMS: Uterine leiomyomas are the most common benign tumors of the uterus. Unfortunately, the diagnostic imaging criteria for distinguishing leiomyosarcomas from leiomyomas remain vague. Our aim was to study the preoperative diagnostic value of CA 125 in the differential diagnosis of leiomyoma and uterine sarcoma. METHODS: The subjects of the study included a total of 2,382 patients aged between 20-71 years operated for uterine myoma between the years 2005 and 2008 at our hospital, and in the same period 26 patients diagnosed with uterine sarcoma who were assessed retrospectively. RESULTS: Assessment of the predictivity of CA 125 values in the preoperative diagnosis of uterine sarcoma showed it was not significant according to the 95% CI related to the area below the curve. The assessment of CA 125 values in the uterine sarcoma group showed that those with carcinosarcoma had higher CA 125 mean values than other sarcoma groups. The relation between staging and CA 125 in all sarcomas could not be statistically assessed. CONCLUSION: We concluded that in the differential diagnosis of myoma and uterine sarcoma, the preoperative serum CA 125 level did not have any predictivity. Additionally, there was no association between staging and CA 125 in uterine sarcomas.

MicroRNA: a new tool for biomedical risk assessment and target identification in human uterine leiomyomas.

MicroRNA (miRNA) expression is tissue specific or cell-type specific. miRNA signatures are useful tools for tumor classification and target gene identification. We and others found that uterine leiomyomas (ULMs) expressed a distinct miRNA signature. In addition, miRNA expression appears to be strongly associated with race and other biomedical factors, such as tumor sizes. Among the most highly dysregulated miRNAs, let-7 miRNAs seem to play a critical role in tumorigenesis of ULMs through negative regulation of some key target oncogenes, including high mobility group 2.

Semiquantitative assessment of MR imaging in prediction of efficacy of gonadotropin-releasing hormone agonist for volume reduction of uterine leiomyoma: initial experience.

PURPOSE: To prospectively determine if semiquantitative assessment of R2* images and T1-weighted magnetic resonance (MR) images of leiomyomas correlates with the efficacy of gonadotropin-releasing hormone (GnRH) agonist treatment for volume reduction. MATERIALS AND METHODS: Internal review board approval and informed consent were obtained for this study. Twenty women (mean age, 36.3 years) with intramyometrial leiomyomas were enrolled in this study. Single-section double-echo dynamic MR imaging was performed before GnRH agonist administration. T2-weighted images were obtained before and after two or three GnRH agonist injections (1.88 mg leuprorelin acetate). The steepest signal intensity (SI) upslope on T1-weighted images and the area under the curve (AUC) on R2* images were determined by using a 16 x 16-voxel matrix that was placed in the center of a leiomyoma. Pearson correlation analysis was performed to compare the percentage of volume reduction with SI upslope and AUC. Unpaired t test was performed to evaluate the difference between leiomyomas with AUC and SI upslope values that were less than or greater than the mean. RESULTS: Percentage of volume reduction ranged from 6.2% to 51.1%. The mean AUC and mean SI upslope were 39.2 and 9.83% per second, respectively. There was a significant correlation between the AUC and the percentage of volume reduction (r = 0.81, P < .001), although no significant correlation was observed between the SI upslope and the percentage of volume reduction. A significant difference in percentage of volume reduction was observed in leiomyomas by using mean AUC as a cutoff value (P = .003). CONCLUSION: AUC on R2* images correlates with the efficacy of GnRH agonist before initiation of treatment for volume reduction of leiomyoma.