2nd opinion benefits uterine fibroid

Seeking a second opinion reduces the number of women undergoing a hysterectomy for symptomatic uterine fibroids, shows a study that indicates that multidisciplinary evaluation increases the use of less invasive treatments for this common condition.

The researchers retrospectively reviewed treatment pathways for 205 women who were consecutively evaluated at a tertiary care multidisciplinary fibroid centre at the University of California in Los Angeles between July 2008 and August 2011. Most of the women had already had uterine fibroids diagnosed and had been offered hysterectomy as treatment.

Magnetic resonance imaging (MRI) detected one or more fibroids in 87% of the women (178 of 205 women).
Contrast enhanced MRI showed that 13% of the women whose fibroids had previously been diagnosed at other centres actually had other conditions, including adenomyosis and endometrial polyps.

A gynaecologist and radiologist assessed MRI scans jointly and then discussed treatment options with the women, including conservative management, uterine preserving options, and hysterectomy.

Only eight of the 109 women who elected to transfer their care to the tertiary care centre underwent a hysterectomy—a rate of 7.3%, whereas the national figure for the United States is 70%.

A total of 76 women treated at the UCLA centre had uterine preserving procedures, most commonly magnetic resonance guided, high intensity, focused ultrasound surgery or myomectomy (surgical removal of fibroids preserving the uterus). And 24 women either had no treatment or had medical therapy.

“Our findings suggest that women desire minimally invasive therapies, and joint effort between gynaecology and radiology may be one option for institutions to improve access to most, if not all, of the therapeutic options available for symptomatic uterine fibroids,” said the researchers, led by Nelly Tan, who was clinical fellow in UCLA’s department of radiology at the time of the study.

The research group acknowledged the study’s limitations, including the fact that the women in the study wanting a second option meant that they were likely to have a preference for uterine preserving treatment. But they pointed out that growing access to information on the internet meant that more women were aware of the different treatment options for fibroids.

“With fewer barriers to medical information, patients could be the driving force for adoption of minimally invasive uterine preserving therapies,” concluded Tan.

1. Tan N, McClure TD, Tarnay C, Johnson MT, Lu DSK, Raman SS. Women seeking second opinion for symptomatic uterine leiomyoma: role of comprehensive fibroid center. J Ther Ultrasound 15 Apr 2014.

G Mohan.