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Drukker K, Medved M, Harmath CB, Giger ML, Madueke-Laveaux OS. Radiomics and quantitative multi-parametric MRI for predicting uterine fibroid growth. J Med Imaging (Bellingham) 2024; 11:054501. [PMID: 39280239 PMCID: PMC11391479 DOI: 10.1117/1.jmi.11.5.054501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 08/21/2024] [Accepted: 08/21/2024] [Indexed: 09/18/2024] Open
Abstract
Significance Uterine fibroids (UFs) can pose a serious health risk to women. UFs are benign tumors that vary in clinical presentation from asymptomatic to causing debilitating symptoms. UF management is limited by our inability to predict UF growth rate and future morbidity. Aim We aim to develop a predictive model to identify UFs with increased growth rates and possible resultant morbidity. Approach We retrospectively analyzed 44 expertly outlined UFs from 20 patients who underwent two multi-parametric MR imaging exams as part of a prospective study over an average of 16 months. We identified 44 initial features by extracting quantitative magnetic resonance imaging (MRI) features plus morphological and textural radiomics features from DCE, T2, and apparent diffusion coefficient sequences. Principal component analysis reduced dimensionality, with the smallest number of components explaining over 97.5% of the variance selected. Employing a leave-one-fibroid-out scheme, a linear discriminant analysis classifier utilized these components to output a growth risk score. Results The classifier incorporated the first three principal components and achieved an area under the receiver operating characteristic curve of 0.80 (95% confidence interval [0.69; 0.91]), effectively distinguishing UFs growing faster than the median growth rate of 0.93 cm 3 / year / fibroid from slower-growing ones within the cohort. Time-to-event analysis, dividing the cohort based on the median growth risk score, yielded a hazard ratio of 0.33 [0.15; 0.76], demonstrating potential clinical utility. Conclusion We developed a promising predictive model utilizing quantitative MRI features and principal component analysis to identify UFs with increased growth rates. Furthermore, the model's discrimination ability supports its potential clinical utility in developing tailored patient and fibroid-specific management once validated on a larger cohort.
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Affiliation(s)
- Karen Drukker
- University of Chicago, Department of Radiology, Chicago, Illinois, United States
| | - Milica Medved
- University of Chicago, Department of Radiology, Chicago, Illinois, United States
| | - Carla B Harmath
- University of Chicago, Department of Radiology, Chicago, Illinois, United States
| | - Maryellen L Giger
- University of Chicago, Department of Radiology, Chicago, Illinois, United States
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Li H, You W, Cai X, Jin X, Che X. A retrospective analysis of single-port laparoscopy in myoma management. Heliyon 2024; 10:e35821. [PMID: 39170178 PMCID: PMC11337055 DOI: 10.1016/j.heliyon.2024.e35821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 08/04/2024] [Accepted: 08/05/2024] [Indexed: 08/23/2024] Open
Abstract
Objective This study assesses the effectiveness and safety of single-port laparoscopic myomectomy (SPLM) versus conventional laparoscopic myomectomy (CLM). Methods We conducted a retrospective case-control study at a university tertiary hospital, involving 262 patients treated from July 2020 to December 2022. Participants were divided into two groups: 132 underwent SPLM and 130 underwent CLM. Results The two groups were comparable in terms of age, body mass index, parity, delivery history, preoperative anemia, number of myomas, and size of the largest myoma. The SPLM group showed a significant reduction in operation time (average 93 min) and estimated blood loss (average 50 ml) compared to the CLM group (average 118.5 min and 100 ml, respectively). Subgroup analysis based on the size, location, and number of myomas further highlighted the advantages of SPLM, particularly for patients with large (diameter ≥8 cm) or multiple myomas (number ≥4). Patient satisfaction was also notably higher in the SPLM group. Conclusions Single-port laparoscopic myomectomy offers a highly effective, safer, and patient-preferred option for the surgical management of fibroids, especially in cases of large or multiple myomas. These findings suggest that SPLM could become the preferred surgical approach for complex fibroid cases, promising less trauma and quicker recovery for patients.
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Affiliation(s)
| | | | - Xiaoji Cai
- Department of Obstetrics and Gynecology, Jiaxing University Affiliated Women and Children Hospital, Jiaxing, 314000, Zhejiang, China
| | - Xiaoying Jin
- Department of Obstetrics and Gynecology, Jiaxing University Affiliated Women and Children Hospital, Jiaxing, 314000, Zhejiang, China
| | - Xuan Che
- Department of Obstetrics and Gynecology, Jiaxing University Affiliated Women and Children Hospital, Jiaxing, 314000, Zhejiang, China
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Chandrakumar DL, Aref-Adib M, Odejinmi F. Advancing women's health: The imperative for public health screening of uterine fibroids for personalized care. Eur J Obstet Gynecol Reprod Biol 2024; 299:266-271. [PMID: 38917750 DOI: 10.1016/j.ejogrb.2024.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/02/2024] [Accepted: 06/08/2024] [Indexed: 06/27/2024]
Abstract
Uterine fibroids represent the most prevalent genital tract tumours among women, with a disproportionately higher impact on ethnic minority groups, notably black women. These hormonally dependent monoclonal tumours, characterized by excessive extracellular matrix and influenced by genetic, epigenetic, and lifestyle factors, significantly affect women's quality of life and pose substantial economic burdens on healthcare systems. Recent advances in early detection and minimally invasive treatment options have shifted management paradigms towards personalized care, yet challenges in early diagnosis, education and access to treatment persist. This review synthesizes current knowledge on uterine fibroids, highlighting the impact of fibroids on women's health, risk factors, principles of screening, diagnostic tools, and treatment modalities. It emphasizes the importance of early screening and individualized management strategies in improving patient outcomes and reducing healthcare costs. The article also discusses the socio-economic and health disparities affecting the disease burden, underscoring the need for improved patient education, clinician training, and public health strategies to enhance fibroid management. This review proposes a pathway to not only ameliorate the quality of life for women with fibroids, but also to advance global women's health equity.
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Affiliation(s)
| | | | - Funlayo Odejinmi
- Whipps Cross University Hospital, Whipps Cross Road, London E11 1NR, UK
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Wang Y, Zhao Y, Shi C, Li J, Huang X. Development and Validation of a Nomogram to Predict the Risk of Special Uterine Leiomyoma Pathological Types or Leiomyosarcoma in Postmenopausal Women: A Retrospective Study. Risk Manag Healthc Policy 2024; 17:1669-1685. [PMID: 38919406 PMCID: PMC11198023 DOI: 10.2147/rmhp.s461773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 06/10/2024] [Indexed: 06/27/2024] Open
Abstract
Purpose The aim of this study was to investigate the risk factors of postmenopausal special uterine leiomyoma pathological types or leiomyosarcoma and to develop a nomogram for clinical risk assessment, ultimately to reduce unnecessary surgical interventions and corresponding economic expenses. Methods A total of 707 patients with complete information were enrolled from 1 August 2012 to 1 August 2022. Univariate and multivariate logistic regression models were used to analyse the association between variables and special uterine leiomyoma pathological types or leiomyosarcoma in postmenopausal patients. A nomogram for special uterine leiomyoma pathological types or leiomyosarcoma in postmenopausal patients was developed and validated by bootstrap resampling. The calibration curve was used to assess the accuracy of the model and receiver operating characteristic (ROC) curve and decision curve analysis (DCA) were compared with the clinical experience model. Results The increasing trend after menopause, the diameter of the largest uterine fibroid, serum carcinoembryonic antigen 125 concentration, Serum neutrophil to lymphocyte ratio, and Serum phosphorus ion concentration were independent risk factors for special uterine leiomyoma pathological types or leiomyosarcoma in postmenopausal patients. We developed a user-friendly nomogram which showed good diagnostic performance (AUC=0.724). The model was consistent and the calibration curve of our cohort was close to the ideal diagonal line. DCA indicated that the model has potential value for clinical application. Furthermore, our model was superior to the previous clinical experience model in terms of ROC and DCA. Conclusion We have developed a prediction nomogram for special uterine leiomyoma pathological types or leiomyosarcoma in postmenopausal patients. This nomogram could serve as an important warning signal and evaluation method for special uterine leiomyoma pathological types or leiomyosarcoma in postmenopausal patients.
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Affiliation(s)
- Yaping Wang
- Zhejiang University, Womens Hospital, Sch Med, Department Obstet & Gynecol, Hangzhou, Zhejiang, People’s Republic of China
| | - Yiyi Zhao
- Zhejiang University, Womens Hospital, Sch Med, Department Obstet & Gynecol, Hangzhou, Zhejiang, People’s Republic of China
| | - Chaolu Shi
- Cixi maternity&health Care Hospital, Department Obstet & Gynecol Ningbo, Ningbo, Zhejiang, People’s Republic of China
| | - Juanqing Li
- Zhejiang University, Womens Hospital, Sch Med, Department Obstet & Gynecol, Hangzhou, Zhejiang, People’s Republic of China
- Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
- Zhejiang Provincial Key Laboratory of Precision Diagnosis and Therapy for Major Gynecological Diseases, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Xiufeng Huang
- Zhejiang University, Womens Hospital, Sch Med, Department Obstet & Gynecol, Hangzhou, Zhejiang, People’s Republic of China
- Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
- Zhejiang Provincial Key Laboratory of Precision Diagnosis and Therapy for Major Gynecological Diseases, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
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Yamaguchi T, Kyozuka H, Kochi Y, Ito F, Odajima H, Suzuki D, Nomura Y. Hydropic leiomyoma-like ovarian tumor: a case report. Fukushima J Med Sci 2024; 70:93-98. [PMID: 38494733 PMCID: PMC11140197 DOI: 10.5387/fms.2023-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 02/01/2024] [Indexed: 03/19/2024] Open
Abstract
Uterine leiomyomas, benign tumors common in reproductive-aged women, can display rare variants such as hydropic leiomyoma (HL), which exhibit unique histological features like zonal edema and increased vascularity. However, due to its rarity, comprehensive clinical knowledge about HL is limited. We report a case of a 49-year-old Japanese woman who was premenopausal and nulliparous, presenting with a two-year history of abdominal distension. An MRI scan revealed a 20 cm mass in the posterior part of the uterus, exhibiting characteristics suggestive of an ovarian tumor. During laparotomy, a cystic tumor connected with a swollen fibroid was found, and pathology confirmed HL. This case emphasizes that hydropic leiomyomas can mimic malignant tumors on ultrasonography due to their atypical features, necessitating additional evaluations using alternative imaging techniques or histopathological examinations for accurate diagnosis and appropriate management. The patient recovered uneventfully, broadening our understanding of HL's clinical presentation.
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Affiliation(s)
- Tomoko Yamaguchi
- Department of Obstetrics and Gynecology, Ohta Nisinouchi Hospital
| | - Hyo Kyozuka
- Department of Obstetrics and Gynecology, Ohta Nisinouchi Hospital
| | - Yoshihiro Kochi
- Department of Obstetrics and Gynecology, Ohta Nisinouchi Hospital
| | - Fumihiro Ito
- Department of Obstetrics and Gynecology, Ohta Nisinouchi Hospital
| | | | - Daisuke Suzuki
- Department of Obstetrics and Gynecology, Ohta Nisinouchi Hospital
| | - Yasuhisa Nomura
- Department of Obstetrics and Gynecology, Ohta Nisinouchi Hospital
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Vilos GA, Vilos AG, Burbank F. Bipedalism and the dawn of uterine fibroids. Hum Reprod 2024; 39:454-463. [PMID: 38300232 DOI: 10.1093/humrep/deae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 01/03/2024] [Indexed: 02/02/2024] Open
Abstract
The high prevalence and burden of uterine fibroids in women raises questions about the origin of these benign growths. Here, we propose that fibroids should be understood in the context of human evolution, specifically the advent of bipedal locomotion in the hominin lineage. Over the ≥7 million years since our arboreal ancestors left their trees, skeletal adaptations ensued, affecting the pelvis, limbs, hands, and feet. By 3.2 million years ago, our ancestors were fully bipedal. A key evolutionary advantage of bipedalism was the freedom to use hands to carry and prepare food and create and use tools which, in turn, led to further evolutionary changes such as brain enlargement (encephalization), including a dramatic increase in the size of the neocortex. Pelvic realignment resulted in narrowing and transformation of the birth canal from a simple cylinder to a convoluted structure with misaligned pelvic inlet, mid-pelvis, and pelvic outlet planes. Neonatal head circumference has increased, greatly complicating parturition in early and modern humans, up to and including our own species. To overcome the so-called obstetric dilemma provoked by bipedal locomotion and encephalization, various compensatory adaptations have occurred affecting human neonatal development. These include adaptations limiting neonatal size, namely altricial birth (delivery of infants at an early neurodevelopmental stage, relative to other primates) and mid-gestation skeletal growth deceleration. Another key adaptation was hyperplasia of the myometrium, specifically the neomyometrium (the outer two-thirds of the myometrium, corresponding to 90% of the uterine musculature), allowing the uterus to more forcefully push the baby through the pelvis during a lengthy parturition. We propose that this hyperplasia of smooth muscle tissue set the stage for highly prevalent uterine fibroids. These fibroids are therefore a consequence of the obstetric dilemma and, ultimately, of the evolution of bipedalism in our hominin ancestors.
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Affiliation(s)
- George A Vilos
- Department of Obstetrics and Gynecology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Angelos G Vilos
- Department of Obstetrics and Gynecology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Fred Burbank
- Salt Creek International Women's Health Foundation, San Clemente, CA, USA
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Lombardi A, Arezzo F, Di Sciascio E, Ardito C, Mongelli M, Di Lillo N, Fascilla FD, Silvestris E, Kardhashi A, Putino C, Cazzolla A, Loizzi V, Cazzato G, Cormio G, Di Noia T. A human-interpretable machine learning pipeline based on ultrasound to support leiomyosarcoma diagnosis. Artif Intell Med 2023; 146:102697. [PMID: 38042596 DOI: 10.1016/j.artmed.2023.102697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 10/08/2023] [Accepted: 10/29/2023] [Indexed: 12/04/2023]
Abstract
The preoperative evaluation of myometrial tumors is essential to avoid delayed treatment and to establish the appropriate surgical approach. Specifically, the differential diagnosis of leiomyosarcoma (LMS) is particularly challenging due to the overlapping of clinical, laboratory and ultrasound features between fibroids and LMS. In this work, we present a human-interpretable machine learning (ML) pipeline to support the preoperative differential diagnosis of LMS from leiomyomas, based on both clinical data and gynecological ultrasound assessment of 68 patients (8 with LMS diagnosis). The pipeline provides the following novel contributions: (i) end-users have been involved both in the definition of the ML tasks and in the evaluation of the overall approach; (ii) clinical specialists get a full understanding of both the decision-making mechanisms of the ML algorithms and the impact of the features on each automatic decision. Moreover, the proposed pipeline addresses some of the problems concerning both the imbalance of the two classes by analyzing and selecting the best combination of the synthetic oversampling strategy of the minority class and the classification algorithm among different choices, and the explainability of the features at global and local levels. The results show very high performance of the best strategy (AUC = 0.99, F1 = 0.87) and the strong and stable impact of two ultrasound-based features (i.e., tumor borders and consistency of the lesions). Furthermore, the SHAP algorithm was exploited to quantify the impact of the features at the local level and a specific module was developed to provide a template-based natural language (NL) translation of the explanations for enhancing their interpretability and fostering the use of ML in the clinical setting.
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Affiliation(s)
- Angela Lombardi
- Department of Electrical and Information Engineering (DEI), Politecnico di Bari, Bari, Italy.
| | - Francesca Arezzo
- Gynecologic Oncology Unit, Interdisciplinar Department of Medicine, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Eugenio Di Sciascio
- Department of Electrical and Information Engineering (DEI), Politecnico di Bari, Bari, Italy
| | - Carmelo Ardito
- Department of Engineering, LUM "Giuseppe Degennaro" University, Casamassima, Bari, Italy
| | - Michele Mongelli
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Nicola Di Lillo
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | | | - Erica Silvestris
- Gynecologic Oncology Unit, Interdisciplinar Department of Medicine, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Anila Kardhashi
- Gynecologic Oncology Unit, Interdisciplinar Department of Medicine, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Carmela Putino
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Ambrogio Cazzolla
- Gynecologic Oncology Unit, Interdisciplinar Department of Medicine, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Vera Loizzi
- Gynecologic Oncology Unit, Interdisciplinar Department of Medicine, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy; Interdisciplinar Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Gerardo Cazzato
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari "Aldo Moro", Bari, Italy
| | - Gennaro Cormio
- Gynecologic Oncology Unit, Interdisciplinar Department of Medicine, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy; Interdisciplinar Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Tommaso Di Noia
- Department of Electrical and Information Engineering (DEI), Politecnico di Bari, Bari, Italy
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8
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Elagib H, Alshammari SS, Alsadoon WK, Zahra A. Assessment of the Attitudes, Beliefs, and Potential Effects of Nutritional Phytoestrogenic Plant Consumption on Women's Health in Saudi Arabia. Cureus 2023; 15:e40918. [PMID: 37496541 PMCID: PMC10367118 DOI: 10.7759/cureus.40918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Phytoestrogens are plant-derived endocrine-disrupting chemicals known as estrogen-like compounds with health and preventive benefits. This study aimed to assess Saudi Arabian women's beliefs and attitudes toward phytoestrogen-rich plant consumption and its association with hormone-sensitive tumors and diseases. METHODS A cross-sectional study was carried out between November 2022 and May 2023 in Saudi Arabia using an online self-administered questionnaire created via Google Forms (Appendix). The collected data were extracted, coded, and analyzed using the IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp. RESULTS The study included 702 females aged 18 years and older. 61.6% (n=432) of the participants consumed Trigonella foenum-graecum (fenugreek) and Foeniculum vulgare (fennel), whereas 45.7% (n=321) consumed soy products and flaxseeds. In addition, 44.7% (n=191) were diagnosed with breast tumors and other breast diseases. The association between the occurrence of breast conditions and the consumption of all the different types of phytoestrogen-rich plants in this study was significant, with a p-value of <0.001. (41.7%, n=187) diagnosed with uterine and ovarian-related conditions, the association with the consumption of fenugreek and fennel was significant with a p-value of <0.001, but for soy products and flaxseed consumption, the association was not significant with a p-value of 0.368. Regarding the consumer's attitudes and duration of consumption, most of them (41.0%, n=288) consume phytoestrogen-rich herbs and plants about every month during menstruation, and 55% (n=386) consumed phytoestrogen-rich plants a long time ago (for many years). About the purpose of consumption, 62.1% (n=436) answered to reduce pain and symptoms associated with menstruation. The majority of the participants (36.3%, n=255) have poor knowledge and don't know about the high estrogen levels' impact on their health. CONCLUSION The study showed that there is a possible association between the consumption of some types of phytoestrogen-rich plants and the occurrence of several hormone-related tumors and diseases. Further studies are needed to evaluate the possible effects in consideration of the co-founding factors.
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Affiliation(s)
- Halima Elagib
- Pharmacology, Faculty of Pharmacy, Omdurman Islamic University, Omdurman, SDN
- Pharmacology, College of Medicine, University of Hail College of Medicine, Hail, SAU
| | | | - Wefaq K Alsadoon
- Medicine and Surgery, University of Hail College of Medicine, Hail, SAU
| | - Aqeela Zahra
- Community and Family Medicine, Leicester Medical School, University of Leicester, Leicester, GBR
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Seidel V, Wernecke KD, Bellingkrodt AL, Armbrust R, David M. Sonographic Monitoring of Growth of Uterine Myomas in Untreated Women and Respective Influence Factors. Geburtshilfe Frauenheilkd 2023; 83:446-452. [PMID: 37034415 PMCID: PMC10076097 DOI: 10.1055/a-1996-2980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/01/2022] [Indexed: 04/11/2023] Open
Abstract
Research Question What are the growth patterns of uterine myomas in untreated premenopausal women? Which factors influence the growth rate of uterine myomas in premenopausal women? Method All premenopausal women who presented to the outpatient myoma consultation clinic between January 2005 and March 2022 at least twice were screened. Exclusion criteria were hormonal therapy, pregnancy, and postmenopausal status. Results A total of 189 patients were included in our study which focused on the respective largest uterine myoma of each woman. An ideal linear growth over time was assumed. Most myomas (82%) increased in size. The mean annual growth of these myomas was 68.42 cm 3 . The most important prognostic factor for growth was the initial size of the myoma. The absolute annual growth of myomas measuring > 50 cm 3 at first presentation was higher compared to smaller myomas (p < 0.001). The relative annual growth rate was highest for myomas measuring between 20 and 50 cm 3 at the initial presentation (p = 0.003). The relative annual growth rate in women older than 40 years was significantly lower than that in women below the age of 40 years (p = 0.003). Conclusion Overall, it is difficult to make an individual prognosis about the growth pattern of a uterine myoma in a specific patient. It should be noted especially in asymptomatic patients that spontaneous regression of myoma size can also occur in premenopausal women.
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Affiliation(s)
- Vera Seidel
- Obstetrics, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Klinik für Gynäkologie, Charité Campus Virchow-Klinikum, Berlin, Germany
| | - Klaus Dieter Wernecke
- Institut für Biometrie und Klinische Epidemiologie, Charité Universitätsmedizin Berlin, Berlin, Germany
- SOSTANA GmbH, Berlin, Germany
| | | | - Robert Armbrust
- Klinik für Gynäkologie, Charité Campus Virchow-Klinikum, Berlin, Germany
| | - Matthias David
- Klinik für Gynäkologie, Charité Campus Virchow-Klinikum, Berlin, Germany
- Correspondence/Korrespondenzadresse Prof. Matthias David Charité Campus Virchow-KlinikumKlinik für GynäkologieAugustenburger
Platz 113353 BerlinGermany
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10
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Arezzo F, Cormio G, Putino C, Di Lillo N, Silvestris E, Kardhashi A, Cazzolla A, Lombardi C, Mongelli M, Cazzato G, Loizzi V. Overlap of Suspicious and Non-Suspicious Features in the Ultrasound Evaluations of Leiomyosarcoma: A Single-Center Experience. Diagnostics (Basel) 2023; 13:diagnostics13030543. [PMID: 36766648 PMCID: PMC9914677 DOI: 10.3390/diagnostics13030543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/21/2023] [Accepted: 01/28/2023] [Indexed: 02/05/2023] Open
Abstract
Leiomyosarcoma (LMS) is a rare type of mesenchymal tumor. Suspecting LMS before surgery is crucial for proper patient management. Ultrasound is the primary method for assessing myometrial lesions. The overlapping of clinical, laboratory, as well as ultrasound features between fibroids and LMS makes differential diagnosis difficult. We report our single-center experience in ultrasound imaging assessment of LMS patients, highlighting that misleading findings such as shadowing and absent or minimal vascularization may also occur in LMS. To avoid mistakes, a comprehensive evaluation of potentially overlapping ultrasound features is necessary in preoperative ultrasound evaluations of all myometrial tumors.
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Affiliation(s)
- Francesca Arezzo
- Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy
- Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy
- Correspondence: ; Tel.: +39-3274961788
| | - Gennaro Cormio
- Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy
- Interdisciplinar Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Carmela Putino
- Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Nicola Di Lillo
- Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Erica Silvestris
- Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy
| | - Anila Kardhashi
- Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy
| | - Ambrogio Cazzolla
- Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy
| | - Claudio Lombardi
- Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Michele Mongelli
- Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Gerardo Cazzato
- Section of Molecular Pathology, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Vera Loizzi
- Interdisciplinar Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy
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Sefah N, Ndebele S, Prince L, Korasare E, Agbleke M, Nkansah A, Thompson H, Al-Hendy A, Agbleke AA. Uterine fibroids - Causes, impact, treatment, and lens to the African perspective. Front Pharmacol 2023; 13:1045783. [PMID: 36703761 PMCID: PMC9871264 DOI: 10.3389/fphar.2022.1045783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/12/2022] [Indexed: 01/12/2023] Open
Abstract
Leiomyomas, or uterine fibroids as they are commonly known, are mostly seen in women of reproductive age. However, they can go undetected in most women, and approximately 25% of women show clinical symptoms. Although fibroids are a global burden impacting 80% of premenopausal women, they are more prevalent among Black women than among women of other races. Based on clinical diagnosis, the estimated cumulative incidence of fibroids in women ≤50 years old is significantly higher for black (>80%) versus white women (∼70%). The cause of leiomyomas is not clearly known, but studies have shown evidence of factors that drive the development or exacerbation of the disease. Evidence has linked risk factors such as lifestyle, age, environment, family history of uterine fibroids, and vitamin D deficiencies to an increased risk of uterine fibroids, which impact women of African descent at higher rates. Treatments may be invasive, such as hysterectomy and myomectomy, or non-invasive, such as hormonal or non-hormonal therapies. These treatments are costly and tend to burden women who have the disease. Sub-Saharan Africa is known to have the largest population of black women, yet the majority of uterine fibroid studies do not include populations from the continent. Furthermore, the prevalence of the disease on the continent is not well determined. To effectively treat the disease, its drivers need to be understood, especially with regard to racial preferences. This paper aims to review the existing literature and build a case for conducting future research on African women.
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Inácio Â, Aguiar L, Carrilho R, Pires P, Ferreira J, Coelho L, Mascarenhas MR, Sardinha L, Bilhim T, Pisco J, Bicho M, Bicho MC. Genetic Contribution of the Adrenergic, Cholinergic, and Serotonergic Systems to Leiomyoma Development and Treatment. INTERNATIONAL JOURNAL OF MOLECULAR AND CELLULAR MEDICINE 2023; 12:320-334. [PMID: 39006196 PMCID: PMC11240054 DOI: 10.22088/ijmcm.bums.12.4.320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 07/16/2024]
Abstract
The link between the autonomic nervous system and tumor biology is being unfold. We aim to study the contribution of genes of the adrenergic (ADBR2 - rs1042713, NM_000024.6:c.46G>A, NP_000015.2:p. Gly16Arg), cholinergic (CHRNA5 - rs16969968, NM_000745.3:c.1192G>A, NP_000736.2:p.Asp398Asn), and serotonergic systems (SLC6A4 - 5-HTTVNTR-intron2, HTR2A - rs6313, NM_000621.5:c.102C>T, NP_ 001365853 .1: p. Ser 34=) to gynecological tumorigenesis and their treatment by embolization. A total of 517 DNA samples from women were analyzed. Samples were genotyped by PCR, PCR-RFLP and EndPoint genotyping. Results show a statistically significant association between the AA genotype of the ADBR2 gene and GG genotype of the CHRNA5 gene with leiomyoma (OR = 2.311; p = 0.003 and OR = 2.165; p = 0.001, respectively), and the epistatic interaction between genotypes increases the risk (OR = 2.458; p= 0.043). The GG genotype (CHRNA5) shows a lower reduction of the volume of the main leiomyoma after treatment (p=0.015). Combination of the genotypes 12/12-AA (SLC6A4 - ADBR2) increases the risk to leiomyoma (OR = 2.540, p= 0.030). TT genotype of HTR2A gene in combination with any of the two risk genotypes (of ADBR2 or CHRNA5) increases substantially the risk (OR = 5.266, p = 0.006; OR = 6.364, p=0.007, respectively). We conclude that ADBR2 and CHRNA5 genes have a relevant role that is enhanced by the epistatic relationship with the genes HTR2A and SLC6A4. CHRNA5 gene may also be a modulator of the success of embolization. We confirm the contribution of the genetics of Autonomous Nervous System to tumor biology.
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Affiliation(s)
- Ângel Inácio
- Instituto de Investigação Científica Bento da Rocha Cabral, Calçada Bento Rocha Cabral, 14, 1257-047 Lisboa, Portugal
- Laboratório de Genética, Faculdade de Medicina da Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
- Instituto de Saúde Ambiental, Laboratório Associado TERRA, Faculdade de Medicina da Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
| | - Laura Aguiar
- Instituto de Investigação Científica Bento da Rocha Cabral, Calçada Bento Rocha Cabral, 14, 1257-047 Lisboa, Portugal
- Laboratório de Genética, Faculdade de Medicina da Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
- Instituto de Saúde Ambiental, Laboratório Associado TERRA, Faculdade de Medicina da Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
| | - Raquel Carrilho
- Instituto de Investigação Científica Bento da Rocha Cabral, Calçada Bento Rocha Cabral, 14, 1257-047 Lisboa, Portugal
- Laboratório de Genética, Faculdade de Medicina da Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
| | - Patrícia Pires
- Instituto de Investigação Científica Bento da Rocha Cabral, Calçada Bento Rocha Cabral, 14, 1257-047 Lisboa, Portugal
- Laboratório de Genética, Faculdade de Medicina da Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
| | - Joana Ferreira
- Instituto de Investigação Científica Bento da Rocha Cabral, Calçada Bento Rocha Cabral, 14, 1257-047 Lisboa, Portugal
- Laboratório de Genética, Faculdade de Medicina da Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
- Instituto de Saúde Ambiental, Laboratório Associado TERRA, Faculdade de Medicina da Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
| | - Luís Coelho
- Instituto de Investigação Científica Bento da Rocha Cabral, Calçada Bento Rocha Cabral, 14, 1257-047 Lisboa, Portugal
- Laboratório de Genética, Faculdade de Medicina da Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
| | - Mário Rui Mascarenhas
- Instituto de Saúde Ambiental, Laboratório Associado TERRA, Faculdade de Medicina da Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
- Clínica de Endocrinologia, Diabetes e Metabolismo de Lisboa, Avenida António Augusto Aguiar 56-r/c-D, 1050-017, Lisboa, Portugal
| | - Luís Sardinha
- Centro Interdisciplinar de Estudo da Performance Humana, Faculdade de Motricidade Humana da Universidade de Lisboa, Estrada da Costa 1499-002 Cruz Quebrada, Oeiras, Portugal
| | - Tiago Bilhim
- Serviço de Radiologia de Intervenção do Hospital Saint Louis, R. Luz Soriano 182, 1200-249 Lisboa, Portugal
- Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - João Pisco
- Serviço de Radiologia de Intervenção do Hospital Saint Louis, R. Luz Soriano 182, 1200-249 Lisboa, Portugal
| | - Manuel Bicho
- Instituto de Investigação Científica Bento da Rocha Cabral, Calçada Bento Rocha Cabral, 14, 1257-047 Lisboa, Portugal
- Laboratório de Genética, Faculdade de Medicina da Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
- Instituto de Saúde Ambiental, Laboratório Associado TERRA, Faculdade de Medicina da Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
| | - Maria Clara Bicho
- Instituto de Saúde Ambiental, Laboratório Associado TERRA, Faculdade de Medicina da Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
- Instituto de Medicina Preventiva e Saúde Publica, Faculdade de Medicina da Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
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Edzie EKM, Dzefi-Tettey K, Brakohiapa EK, Abdulai AB, Kekessie KK, Aidoo E, Amoah S, Boadi E, Kpobi JM, Quarshie F, Edzie RA, Kusodzi H, Asemah AR. Assessment of the Clinical Presentations and Ultrasonographic Features of Uterine Fibroids in Adult Africans: A Retrospective Study. Oman Med J 2023; 38:e459. [PMID: 36908828 PMCID: PMC9996686 DOI: 10.5001/omj.2023.36] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/17/2022] [Indexed: 11/03/2022] Open
Abstract
Objectives We sought to determine the clinical presentations and ultrasonographic features of uterine fibroids in adult Ghanaians. Methods Between 1 January 2018 and 31 December 2021, 4279 ultrasound-confirmed cases of uterine fibroids were retrieved. The data obtained, which included age, clinical presentations, and sonographic features were analyzed. A chi-squared test was done to assess for possible associations between the clinical indications, age distribution, and ultrasonographic features of uterine fibroids. Results The mean age of the patients diagnosed with uterine fibroids was 37.1±11.5 years (range = 16-69 years). Routine checkup (n = 1310, 28.1%), menorrhagia (n = 1104, 23.7%), and lower abdominal mass (n = 801, 17.2%) were the leading clinical indications. Dysmenorrhea, amenorrhea, menorrhagia, and routine checkup were significantly noted in the younger patients (p ≤ 0.001). The majority of the fibroid nodules had smooth regular outline (n = 4125, 96.4%) and were mostly heterogeneous (n = 3282, 76.7%). The echo pattern of the nodules was predominantly hypoechoic (n = 3358, 51.1%) followed by hyperechoic nodules (n = 2554, 38.9%). Degenerative changes accounted for less than one-third of the total fibroid nodules, with the least recorded degenerative change being nodules with cystic areas (n = 55, 5.4%) and the most observed degenerative feature being nodules with rim of calcification and areas of calcified degeneration (n = 965, 94.6%). Almost all the sonographic features were significantly seen in the 30-44 years age category. Conclusions Sonographically, uterine fibroids were mostly hypoechoic heterogeneous nodules with a smooth regular outline with a predominant occurrence within women in the fourth to fifth decade of life.
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Affiliation(s)
- Emmanuel Kobina Mesi Edzie
- Department of Medical Imaging, University of Cape Coast, Cape Coast, Ghana.,Department of Radiology, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | | | | | | | - Kafui Kossi Kekessie
- Department of Medical Imaging, University of Health and Allied Sciences, Ho, Ghana
| | - Eric Aidoo
- Department of Anatomy and Cell Biology, University of Cape Coast, Cape Coast, Ghana
| | - Stephen Amoah
- Department of Anatomy and Cell Biology, University of Cape Coast, Cape Coast, Ghana
| | - Evans Boadi
- Department of Radiology, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | | | - Frank Quarshie
- Department of Mathematical Sciences, African Institute for Mathematical Sciences, Accra, Ghana
| | - Richard Ato Edzie
- Department of Medical Imaging, University of Cape Coast, Cape Coast, Ghana
| | - Henry Kusodzi
- Department of Medical Imaging, University of Cape Coast, Cape Coast, Ghana
| | - Abdul Raman Asemah
- Department of Medical Imaging, University of Cape Coast, Cape Coast, Ghana
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Selter JH, Price TM, Harris BS. Fibroids in pregnancy: a growing or shrinking issue? Fertil Steril 2022; 118:666-667. [PMID: 36064663 DOI: 10.1016/j.fertnstert.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 01/13/2023]
Affiliation(s)
- Jessica H Selter
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke Fertility Center, Morrisville, North Carolina
| | - Thomas M Price
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke Fertility Center, Morrisville, North Carolina
| | - Benjamin S Harris
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke Fertility Center, Morrisville, North Carolina
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Yuk JS, Kim JM. Uterine fibroids increase the risk of thyroid goiter and thyroid nodules. Sci Rep 2022; 12:6620. [PMID: 35459918 PMCID: PMC9033769 DOI: 10.1038/s41598-022-10625-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 04/11/2022] [Indexed: 12/26/2022] Open
Abstract
Uterine fibroid and benign thyroid disease are both common diseases in women. This study aimed to evaluate whether these diseases are related. We established the uterine fibroid group according to diagnosis and surgery codes using the Korea National Health Insurance data from 2009 to 2020. All women from 20 to 50 years old who underwent uterine myomectomy from 2009 to 2020 were identified. We selected the control group by performing a 1:1 propensity score matching on age at 5-year intervals, socioeconomic status (SES), region, Charlson comorbidity index (CCI), menopause, and year among women who visited a medical institution for a health check-up. Thyroid disease cases were selected using the thyroid disease diagnosis code and thyroid-associated laboratory tests. A total of 181,419 patients were included in the uterine fibroid and control groups. The median age of each group was 40 (range, 35 ~ 44) and 40 (range, 35 ~ 45) years old, respectively. Benign thyroid disease affected 1162 (0.6%) in the uterine fibroid group and 1137 (0.6%) in the control group. Among the benign thyroid diseases, hypothyroidism was the most common in both groups, followed by a nontoxic single thyroid nodule. The uterine fibroid group had a higher risk of thyroid goiter (hazard ratio (HR) 1.169, 95% confidence interval (CI) 1.022-1.338), nontoxic single thyroid nodule (HR 1.268, 95% CI 1.182-1.361), and total thyroid disease (HR 1.078, 95% CI 1.036-1.121) in stratified Cox regression analysis adjusted for age, SES, region, CCI, parity, menopause, hypertension, diabetes, dyslipidemia, systemic lupus erythematosus, irritable bowel syndrome, Crohn's disease, and endometriosis than the control group. The results suggest that women with uterine fibroids have an increased risk of thyroid goiters and thyroid nodules. Although the mechanism is not well known, estrogen and iodide might be a link between uterine fibroids and thyroid goiters and nodules. Future studies that prospectively follow women with uterine fibroids across a lifetime are needed.
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Affiliation(s)
- Jin-Sung Yuk
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Jung Min Kim
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea.
- Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea.
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Preoperative Differentiation of Uterine Leiomyomas and Leiomyosarcomas: Current Possibilities and Future Directions. Cancers (Basel) 2022; 14:cancers14081966. [PMID: 35454875 PMCID: PMC9029111 DOI: 10.3390/cancers14081966] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/11/2022] [Accepted: 04/11/2022] [Indexed: 01/03/2023] Open
Abstract
The distinguishing of uterine leiomyosarcomas (ULMS) and uterine leiomyomas (ULM) before the operation and histopathological evaluation of tissue is one of the current challenges for clinicians and researchers. Recently, a few new and innovative methods have been developed. However, researchers are trying to create different scales analyzing available parameters and to combine them with imaging methods with the aim of ULMs and ULM preoperative differentiation ULMs and ULM. Moreover, it has been observed that the technology, meaning machine learning models and artificial intelligence (AI), is entering the world of medicine, including gynecology. Therefore, we can predict the diagnosis not only through symptoms, laboratory tests or imaging methods, but also, we can base it on AI. What is the best option to differentiate ULM and ULMS preoperatively? In our review, we focus on the possible methods to diagnose uterine lesions effectively, including clinical signs and symptoms, laboratory tests, imaging methods, molecular aspects, available scales, and AI. In addition, considering costs and availability, we list the most promising methods to be implemented and investigated on a larger scale.
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17
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Rumph JT, Stephens VR, Martin JL, Brown LK, Thomas PL, Cooley A, Osteen KG, Bruner-Tran KL. Uncovering Evidence: Associations between Environmental Contaminants and Disparities in Women's Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031257. [PMID: 35162279 PMCID: PMC8835285 DOI: 10.3390/ijerph19031257] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/29/2021] [Accepted: 01/20/2022] [Indexed: 11/16/2022]
Abstract
Over the years, industrial accidents and military actions have led to unintentional, large-scale, high-dose human exposure to environmental contaminants with endocrine-disrupting action. These historical events, in addition to laboratory studies, suggest that exposure to toxicants such as dioxins and polychlorinated biphenyls negatively impact the reproductive system and likely influence the development of gynecologic diseases. Although high-level exposure to a single toxicant is rare, humans living in industrialized countries are continuously exposed to a complex mixture of manmade and naturally produced endocrine disruptors, including persistent organic pollutants and heavy metals. Since minorities are more likely to live in areas with known environmental contamination; herein, we conducted a literature review to identify potential associations between toxicant exposure and racial disparities in women's health. Evidence within the literature suggests that the body burden of environmental contaminants, especially in combination with inherent genetic variations, likely contributes to previously observed racial disparities in women's health conditions such as breast cancer, endometriosis, polycystic ovarian syndrome, uterine fibroids, and premature birth.
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Affiliation(s)
- Jelonia T. Rumph
- Department of Microbiology, Immunology and Physiology, Meharry Medical College, Nashville, TN 37208, USA; (J.T.R.); (J.L.M.); (L.K.B.); (P.L.T.); (A.C.)
- Women’s Reproductive Health Research Center, Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA; (V.R.S.); (K.G.O.)
- Department of Pharmacology, Vanderbilt University, Nashville, TN 37232, USA
| | - Victoria R. Stephens
- Women’s Reproductive Health Research Center, Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA; (V.R.S.); (K.G.O.)
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Joanie L. Martin
- Department of Microbiology, Immunology and Physiology, Meharry Medical College, Nashville, TN 37208, USA; (J.T.R.); (J.L.M.); (L.K.B.); (P.L.T.); (A.C.)
| | - LaKendria K. Brown
- Department of Microbiology, Immunology and Physiology, Meharry Medical College, Nashville, TN 37208, USA; (J.T.R.); (J.L.M.); (L.K.B.); (P.L.T.); (A.C.)
| | - Portia L. Thomas
- Department of Microbiology, Immunology and Physiology, Meharry Medical College, Nashville, TN 37208, USA; (J.T.R.); (J.L.M.); (L.K.B.); (P.L.T.); (A.C.)
| | - Ayorinde Cooley
- Department of Microbiology, Immunology and Physiology, Meharry Medical College, Nashville, TN 37208, USA; (J.T.R.); (J.L.M.); (L.K.B.); (P.L.T.); (A.C.)
| | - Kevin G. Osteen
- Women’s Reproductive Health Research Center, Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA; (V.R.S.); (K.G.O.)
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
- VA Tennessee Valley Healthcare System, Nashville, TN 37208, USA
| | - Kaylon L. Bruner-Tran
- Women’s Reproductive Health Research Center, Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA; (V.R.S.); (K.G.O.)
- Correspondence:
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Wesselink AK, Weuve J, Fruh V, Bethea TN, Claus Henn B, Harmon QE, Hauser R, Williams PL, Calafat AM, McClean M, Baird DD, Wise LA. Urinary concentrations of phenols, parabens, and triclocarban in relation to uterine leiomyomata incidence and growth. Fertil Steril 2021; 116:1590-1600. [PMID: 34366109 PMCID: PMC8627427 DOI: 10.1016/j.fertnstert.2021.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/02/2021] [Accepted: 07/06/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To examine the association of urinary concentrations of phenols, parabens, and triclocarban with incidence and growth of uterine leiomyomata (UL; fibroids). DESIGN Case-cohort study, nested within the Study of Environment, Lifestyle, and Fibroids, a prospective cohort study. SETTING Clinic visits at baseline and every 20 months for 60 months. PATIENT(S) 754 Black women aged 23-35 years residing in the Detroit, Michigan area (enrolled during 2010-2012). INTERVENTION None. MAIN OUTCOME MEASURE(S) At each study visit, women underwent transvaginal ultrasound for measurement of UL incidence and growth and provided urine specimens in which we quantified concentrations of seven phenols, four parabens, and triclocarban. We used Cox proportional hazards regression to estimate hazard ratios and 95% confidence intervals (CIs) characterizing the relation of urinary biomarker concentrations with UL incidence during the 60 months of follow-up. In a subset of UL detected and measured at multiple time points, we used linear regression to assess the associations between biomarker concentrations and UL growth. RESULT(S) Urinary biomarker concentrations were generally inversely associated with UL incidence, but the associations were weak and nonmonotonic. For example, hazard ratios comparing concentrations ≥90th with <50th percentile were 0.77 (95% CI: 0.46, 1.27) for bisphenol A, 0.72 (95% CI: 0.40, 1.28) for bisphenol S, and 0.76 (95% CI: 0.43, 1.33) for methylparaben. Biomarker concentrations were not strongly associated with UL growth. CONCLUSION(S) In this study of reproductive-aged Black women, urinary phenols, parabens, and triclocarban biomarkers were neither strongly nor consistently associated with UL incidence and growth.
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Affiliation(s)
- Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts.
| | - Jennifer Weuve
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Victoria Fruh
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
| | - Traci N Bethea
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, D.C
| | - Birgit Claus Henn
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
| | - Quaker E Harmon
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, North Carolina
| | - Russ Hauser
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Paige L Williams
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Antonia M Calafat
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael McClean
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
| | - Donna D Baird
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, North Carolina
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
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Sasamori Y, Takehara K, Terashima T, Onodera T, Yatsuki K, Nakagawa I, Takahashi Y, Nishida H, Ichinose T, Hiraike H, Nagasaka K. A case of adenomyosis with leiomyoma that was effectively treated with relugolix and kamishoyosan add-on therapy. BMC Womens Health 2021; 21:306. [PMID: 34412607 PMCID: PMC8375059 DOI: 10.1186/s12905-021-01442-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/02/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Recently, relugolix, an oral gonadotropin-releasing hormone receptor antagonist, has been considered an effective therapy for leiomyoma based on a phase 3 study in Japanese women. Leiomyoma combined with severe adenomyosis occasionally occurs in perimenopausal women; however, little information on the effectiveness of relugolix against severe adenomyosis exists. CASE PRESENTATION A 49-year-old woman was referred to our hospital with acute lower abdominal pain and abnormal uterine bleeding. Magnetic resonance imaging revealed multiple leiomyomas with diffuse adenomyosis. Left hydrosalpinx was also observed. The patient refused surgical treatment and preferred oral relugolix. Since she experienced a hot flush and headache induced by relugolix, a traditional Japanese Kampo, kamishoyosan, was added to improve the side effects of relugolix. The patient was asymptomatic at the time of this report and experienced a significant shrinkage in uterine volume. Ultimately, she avoided hysterectomy as desired. CONCLUSIONS To our knowledge, this is the first report of co-occurring adenomyosis and leiomyoma, which was effectively treated with relugolix. Although the management of adverse side effects, including hot flush and headache by relugolix, has recently attracted attention and controversy, relugolix add-on therapy with kamishoyosan may help treat menopausal symptoms.
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Affiliation(s)
- Yukifumi Sasamori
- Department of Obstetrics and Gynecology, Teikyo University School of Medicine, Tokyo , Japan
| | - Kohei Takehara
- Department of Obstetrics and Gynecology, Teikyo University School of Medicine, Tokyo , Japan
| | - Tsuyoshi Terashima
- Department of Obstetrics and Gynecology, Teikyo University School of Medicine, Tokyo , Japan
| | - Takako Onodera
- Department of Obstetrics and Gynecology, Teikyo University School of Medicine, Tokyo , Japan
| | - Keita Yatsuki
- Department of Obstetrics and Gynecology, Teikyo University School of Medicine, Tokyo , Japan
| | - Ippei Nakagawa
- Department of Obstetrics and Gynecology, Teikyo University School of Medicine, Tokyo , Japan
| | - Yuko Takahashi
- Department of Obstetrics and Gynecology, Teikyo University School of Medicine, Tokyo , Japan
| | - Haruka Nishida
- Department of Obstetrics and Gynecology, Teikyo University School of Medicine, Tokyo , Japan
| | - Takayuki Ichinose
- Department of Obstetrics and Gynecology, Teikyo University School of Medicine, Tokyo , Japan
| | - Haruko Hiraike
- Department of Obstetrics and Gynecology, Teikyo University School of Medicine, Tokyo , Japan
| | - Kazunori Nagasaka
- Department of Obstetrics and Gynecology, Teikyo University School of Medicine, Tokyo , Japan.
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Coutinho LM, Assis WA, Spagnuolo-Souza A, Reis FM. Uterine Fibroids and Pregnancy: How Do They Affect Each Other? Reprod Sci 2021; 29:2145-2151. [PMID: 34142343 DOI: 10.1007/s43032-021-00656-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/09/2021] [Indexed: 01/20/2023]
Abstract
The present narrative review is aimed to rekindle discussion regarding whether and how uterine leiomyoma and pregnancy may impact each other. Although fibroids are hormone-dependent lesions, their growth during pregnancy seems to have a nonlinear trend. Besides placental estrogens and progesterone, an array of endocrine and paracrine factors affect fibroid blood supply, growth rate, and risk of degeneration along the gestational and puerperal periods. According to current evidence, the presence of leiomyomas might increase the risk of some adverse pregnancy outcomes. Although a causative relation between fibroids and spontaneous abortion is questionable, the presence of multiple submucosal lesions in certain populations, such as infertile women, may increase the risk of pregnancy loss. Slightly increased risks of placenta previa, placental abruption and fetal malpresentation may occur, mainly due to the mechanical influence of multiple and large fibroids. Cesarean section and preterm birth rates are also probably increased in the presence of fibroids. The risk associations are based on meta-analyses of cohort studies (level of evidence 2a), retrospective cohort studies (2b), case-control (3a), and cross-sectional studies (3b), but with a predominantly low risk of bias. For evaluating the growth pattern of leiomyomas and their real influence on obstetric outcomes, future studies should enroll women with fibroids diagnosed prior to pregnancy and follow them prospectively throughout the gestation and puerperium.
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Affiliation(s)
- Larissa M Coutinho
- Department of Maternal and Child Health, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil.,Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Wiviane A Assis
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ananda Spagnuolo-Souza
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Fernando M Reis
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil. .,Division of Human Reproduction, Department of Ob/Gyn, Hospital das Clínicas, UFMG, Av. Alfredo Balena, 110, 9° andar, Belo Horizonte, MG, 30130-100, Brazil.
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Abstract
Uterine fibroids (UFs) are benign tumors that arise from a single genetically altered mesenchymal stem cell under the influence of gonadal hormones. UFs are the most common benign gynecologic tumors in premenopausal women worldwide. It is estimated that nearly 70% to 80% of women will develop UFs at some point during their lifetime. UFs often present with abnormal uterine bleeding (AUB), pelvic fullness, and may have deleterious effects on fertility. The natural regression of UFs begins in menopause. This is, however, a generality as this pathology may still be present in this age group. Many clinicians are concerned about hormone therapy (HT) because of UFs regrowth; nevertheless, research of this subject remains inconclusive. If UFs are present in perimenopause or menopause, they typically manifest as AUB, which represents up to 70% of all gynecological consultations in perimenopausal and postmenopausal women. As AUB is a broad symptom and may not be specific to UFs, a thorough evaluation is required for correct diagnosis and proper treatment accordingly. Understanding the unique characteristics of the available treatment modalities is crucial in deciding the appropriate treatment approach. Decision on treatment modality should be made based on selection of the least morbidity and lowest risk for each patient. Multiple modalities are available; however, surgery remains the method of choice, with the best cure rates. Various attempts to create an inexpensive, safe, and effective drug for the treatments of UFs are still in the early stages of the clinical trials with some showing great promise. Treatment options include tibolone, aromatase inhibitors, selective estrogen receptor modulators, uterine artery embolization, and selective progesterone receptor modulators.
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Baird DD, Patchel SA, Saldana TM, Umbach DM, Cooper T, Wegienka G, Harmon QE. Uterine fibroid incidence and growth in an ultrasound-based, prospective study of young African Americans. Am J Obstet Gynecol 2020; 223:402.e1-402.e18. [PMID: 32105679 DOI: 10.1016/j.ajog.2020.02.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 01/09/2020] [Accepted: 02/17/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Uterine fibroids are common. Symptoms are debilitating for many, leading to high medical and societal costs. Indirect data suggest that compared with white women, African Americans develop fibroids at least 10 years earlier on average, and their higher health burden has been well documented. OBJECTIVE The objective of the study was to directly measure fibroid incidence and growth in a large, community-based cohort of young African-American women. STUDY DESIGN This observational, community-based, prospective study enrolled 1693 African-American women, aged 23-35 years with no prior diagnosis of fibroids. Standardized transvaginal ultrasound examinations at enrollment and after approximately 18 months were conducted to identify and measure fibroids ≥0.5 cm in diameter. Fibroid growth (change in natural log volume per 18 months) was analyzed with mixed-model regression (n = 344 fibroids from 251 women whose baseline ultrasound revealed already existing fibroids). RESULTS Among the 1123 fibroid-free women with follow-up data (88% were followed up), incidence was 9.4% (95% confidence interval, 7.7-11.2) and increased with age (Ptrend < .0001), from 6% (confidence interval, 3-9) for 23-25 year olds to 13% (confidence interval, 9-17) for 32-35 year olds. The chance of any new fibroid development was greater than twice as high for women with existing fibroids compared with women who were fibroid free at baseline (age-adjusted relative risk = 2.3 (confidence interval, 1.7-3.0). The uterine position of most incident fibroids (60%) was intramural corpus. Average fibroid growth was 89% per 18 months (confidence interval, 74-104%) but varied by baseline fibroid size (P < .0001). Fibroids ≥2 cm in diameter had average growth rates well under 100%. In contrast, small fibroids (<1 cm diameter) had an average growth rate of nearly 200% (188%, confidence interval, 145-238%). However, these small fibroids also had a high estimated rate of disappearance (23%). CONCLUSION This is the first study to directly measure age-specific fibroid incidence with a standardized ultrasound protocol and to measure fibroid growth in a large community-based sample. Findings indicate that very small fibroids are very dynamic in their growth, with rapid growth, but a high chance of loss. Larger fibroids grow more slowly. For example, a 2-cm fibroid is likely to take 4-5 years to double its diameter. Detailed data on fibroid incidence confirm an early onset in African-American women.
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Brioso Rubio X, Beal SG, Ross JA, Kresak J. Educational Case: Smooth Muscle Tumors of the Uterus. Acad Pathol 2020; 7:2374289520932285. [PMID: 32613077 PMCID: PMC7307400 DOI: 10.1177/2374289520932285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 02/17/2020] [Accepted: 05/10/2020] [Indexed: 11/21/2022] Open
Abstract
The following fictional case is intended as a learning tool within the
Pathology Competencies for Medical Education (PCME), a set of national
standards for teaching pathology. These are divided into three basic
competencies: Disease Mechanisms and Processes, Organ System Pathology, and
Diagnostic Medicine and Therapeutic Pathology. For additional information,
and a full list of learning objectives for all three competencies,
seehttp://journals.sagepub.com/doi/10.1177/2374289517715040.
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Affiliation(s)
- Xiomara Brioso Rubio
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Stacy G Beal
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Julia A Ross
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Jesse Kresak
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
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Abstract
RATIONALE Fibroids are common, hormone-dependent, benign uterine tumors. It is estimated that they occur in 20% to 40% of women during their reproductive years. The prevalence of fibroids among pregnant women is 10.7%. Most fibroids do not increase in size during pregnancy. Pregnancy has a variable and unpredictable effect on fibroid growth. The influence of pregnancy on uterine fibroid size still remains unclear. Researchers evaluating fibroids have reported an inverse association between parity and fibroids, suggestive of a protective effect. Pregnancies that occur while fibroids are small would be protective; whereas pregnancies occurring before fibroid development or after the tumors reach some critical size would not be protective. Herein, the case of a woman with a large uterine fibroid that was spontaneously regressed after a second successful vaginal delivery is reported. To our knowledge, the complete regression of a large fibroid after delivery has not yet been reported. PATIENT CONCERNS A 35-year-old gravida 1 para 0 woman was referred from a private clinic with a history of pelvic mass, adnexal mass and 19 weeks of amenorrhea. DIAGNOSIS Ultrasonographic examination indicated a solid mass at the uterine fundus (12.1 × 8.3 cm) suggestive of a uterine fibroid and complex echogenic mass at the right adnexa (7.7 × 6.0 cm). INTERVENTIONS Usually, cesarean sections are performed after myomectomy due to the risk for rupture when attempting vaginal delivery. So, the patient decided against the myomectomy, because she did not have any myoma-related symptoms after the first vaginal delivery and wanted to have more children via vaginal birth. OUTCOMES Six months postpartum she becomes pregnant again. The patient had another vaginal birth. Four years after second delivery, the large myoma completely regressed. LESSONS Fibroids can regress with postpartum involution. Even though fibroid-related pregnancy complication is 10% to 30%, prophylactic myomectomy is not recommended. In addition, given the protective effect of parity, conception and delivery are reasonable option and could allow treatment to be deferred in women planning a pregnancy.
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