Women seeking second opinion for symptomatic uterine leiomyoma: role of comprehensive fibroid center

Tan, Nelly; McClure, Timothy; Tarnay, Christopher M.; Johnson, Michael T.; Lu, David; Raman, Steven S.

doi:10.1186/2050-5736-2-3

Cited by 20 publications

(18 citation statements)

References 24 publications

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“…From those studies, three were performed at tertiary centres (13)(14)(15), and six at unspecified or local settings (7,(16)(17)(18)(19)(20). Six studies supported MIS as gold standard modality which offers better short-and long-term outcomes post-surgery (7,13,(15)(16)(17)(18). Two studies supported centralised care as the way forward to improve fibroid surgery outcomes, minimise cost and improve safety (15,18).…”

Section: Resultsmentioning

confidence: 99%

“…Six studies supported MIS as gold standard modality which offers better short-and long-term outcomes post-surgery (7,13,(15)(16)(17)(18). Two studies supported centralised care as the way forward to improve fibroid surgery outcomes, minimise cost and improve safety (15,18). Those studies were taken into consideration when formulating conclusions in the discussion section.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Surgical Intervention for Uterine Fibroids. Our 4-Year Experience and Literature Review: Is It Time to Centralise Care Provision Via Specialist Fibroid Centres?

Strong

Sideris

Magama

et al. 2020

In Vivo

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Background: Leiomyomas are common in women of reproductive age, for whom treatment-stratification can be challenging. We assessed factors influencing pre-operative selection of surgical intervention and compare outcomes. Patients and Methods: A literature review was performed and surgical interventions for fibroids at a London hospital (2015-2018) were retrospectively examined. Outcomes assessed were estimated blood loss, length of stay (LOS) and complications. Data were analysed using univariate non-parametric inferential statistics. Results: A total of 258 cases were identified. Estimated blood loss was statistically significantly lower for laparoscopic versus open myomectomy [200 (interquartile range; IQR)=100-200 vs. 400 (IQR=200-700 ml), p<0.001]. Length of stay was also statistically significantly lower in the laparoscopic cohort compared with open hysterectomy [1 (IQR=1-1) days vs. 2 (IQR=2-3 days)]. Similar results were noted when comparing laparoscopic versus open hysterectomy [167 (IQR=100-200) vs. 500 (IQR=100-750) ml, p<0.001]. No differences in complications were reported across groups. Patients counselled by a surgeon trained in minimally invasive surgery (MIS) opted more frequently for laparoscopy (p<0.01, rho=−0.669). Estimated blood loss during MIS was 225 ml versus 545 ml for non-MIS, and 285 ml for the overall cohort (p<0.01).The length of stay was statistically significantly lower for those treated with MIS (1.37 days) versus other surgeons (2.65 days), or overall cohort (1.63 days) (p<0.01 for all associations). Conclusion: Laparoscopic surgery offers superior short-term outcomes when performed by experienced operators. Multidisciplinary counselling and treatment stratification should be goldstandard practice. Centralisation of care provision in fibroid Centres of Excellence is required.Uterine fibroids are the most common solid benign tumours in women of reproductive age affecting over 70% of women by menopausal age (1). Associated symptoms such as menorrhagia, dysmenorrhea, pressure effects and subfertility can have an impact quality of life. One third of women with fibroids request treatment for symptom management (2), however, many of them are dissatisfied with the information received during counselling and are often unaware of the short-and long-term outcomes at the units where they receive treatment. Besides the financial and emotional burden to the individual who suffers from the effects of fibroids (3), there is also a societal burden. In the UK, surgical management of fibroids carries a significant financial burden to the United Kingdom National Health Service (NHS). Recent costs for the NHS tariff were estimated at £2,400 for uterine artery embolization, £2,609 for myomectomy and £3,275 for hysterectomy. Of the 31,624 hysterectomies performed in England in 2017 and 2018, 60% (18,974) were for fibroids, and the total in-patient cost was estimated at £103,568,600. It is also estimated that 1,600 myomectomies are performed in the UK each year (4). In the United States of America, the ...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Surgical Intervention for Uterine Fibroids. Our 4-Year Experience and Literature Review: Is It Time to Centralise Care Provision Via Specialist Fibroid Centres?

Strong

Sideris

Magama

et al. 2020

In Vivo

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“…In the subgroup of patients with additional MRI findings, UFE and MRgFUS were performed less often, whereas medical and expectant management were used more often. This is likely because UFE and MRgFUS are not as effective when adenomyosis or endometriosis are also present . In certain circumstances, partially endocavitary fibroids are better treated by hysteroscopic myomectomy, which avoids the potential risk of expulsion after UFE .…”

Section: Discussionmentioning

confidence: 99%

“…This is likely because UFE and MRgFUS are not as effective when adenomyosis or endometriosis are also present. 12,40 In certain circumstances, partially endocavitary fibroids are better treated by hysteroscopic myomectomy, which avoids the potential risk of expulsion after UFE. 15,16 Also, nonenhancing fibroids would not be expected to respond to UFE or MRgFUS.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the routine use of pelvic MRI in women presenting with symptomatic uterine fibroids: When is pelvic MRI useful?

Fast

Shaffer

et al. 2019

Magnetic Resonance Imaging

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Background Pelvic ultrasound (US) diagnosis of uterine fibroids may overlook coexisting gynecological conditions that contribute to women's symptoms. Purpose To determine the added value of pelvic MRI for women diagnosed with symptomatic fibroids by US, and to identify clinical factors associated with additional MRI findings. Study Type Retrospective observational study. Population In all, 367 consecutive women with fibroids diagnosed by US and referred to our multidisciplinary fibroid center between 2013–2017. Field Strength/Sequence All patients had both pelvic US and MRI prior to their consultations. MRIs were performed at 1.5 T or 3 T and included multiplanar T2‐weighted sequences, and precontrast and postcontrast T1‐weighted imaging. Assessment Demographics, symptoms, uterine fibroid symptom severity scores, and health‐related quality of life scores, as well as imaging findings were evaluated. Statistical Tests Patients were separated into two subgroups according to whether MRI provided additional findings to the initial US. Univariate and multivariate regression analyses were performed. Results Pelvic MRI provided additional information in 162 patients (44%; 95% confidence interval [CI] 39–49%). The most common significant findings were adenomyosis (22%), endometriosis (17%), and partially endocavitary fibroids (15%). Women with pelvic pain, health‐related quality of life scores less than 30 out of 100, or multiple fibroids visualized on US had greater odds of additional MRI findings (odds ratio [OR] 1.68, 2.26, 1.63; P = 0.02, 0.004, 0.03, respectively), while nulliparous women had reduced odds (OR 0.55, P = 0.01). Patients with additional MRI findings were treated less often with uterine fibroid embolization (14% vs. 36%, P < 0.001) or MR‐guided focused US (1% vs. 5%, P = 0.04), and more often with medical management (17% vs. 8%, P = 0.01). Data Conclusion Pelvic MRI revealed additional findings in more than 40% of women presenting with symptoms initially ascribed to fibroids by US. Further evaluation using MRI is particularly useful for parous women with pelvic pain, poor quality of life scores, and/or multiple fibroids. Level of Evidence: 4 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019.

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“…The formula was first written about in the Xian Shou Li Shang Xu Duan Mi Fang (Secret Formulas to Manage Trauma and Reconnect Fractures Received from an Immortal) approximately CE 846 [133]. Some studies show that many hysterectomies are deemed unnecessary by second opinion or when alternative treatments are offered [15,144]. Regarding menstrual difficulties, Western conventional medicine has few therapeutic options for promoting gynecological health and fewer good therapeutic options.…”

Section: Triphala and Si Wu Tangmentioning

confidence: 99%

Traditional Herbal Medicine, Pharmacognosy, and Pharmacopoeial Standards

Upton¹

2015

Evidence-Based Validation of Herbal Medicine

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Women seeking second opinion for symptomatic uterine leiomyoma: role of comprehensive fibroid center

Cited by 20 publications

References 24 publications

Surgical Intervention for Uterine Fibroids. Our 4-Year Experience and Literature Review: Is It Time to Centralise Care Provision Via Specialist Fibroid Centres?

Surgical Intervention for Uterine Fibroids. Our 4-Year Experience and Literature Review: Is It Time to Centralise Care Provision Via Specialist Fibroid Centres?

Evaluation of the routine use of pelvic MRI in women presenting with symptomatic uterine fibroids: When is pelvic MRI useful?

Traditional Herbal Medicine, Pharmacognosy, and Pharmacopoeial Standards

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