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Aimagambetova G, Bapayeva G, Ukybassova T, Zemlyanskiy V, Gusmanov A, Terzic M. The role of VEGF and TGF-β blood levels for fibroid shrinkage, menorrhagia score, and quality of life improvement after uterine artery embolization for uterine fibroids: a study protocol. Front Med (Lausanne) 2024; 11:1382822. [PMID: 39165371 PMCID: PMC11334076 DOI: 10.3389/fmed.2024.1382822] [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: 02/06/2024] [Accepted: 06/12/2024] [Indexed: 08/22/2024] Open
Abstract
Uterine leiomyoma is a common condition affecting women that occurs in more than 70% of females. Women with leiomyomas overall have lower quality of life and deficiency in many specific spheres of life including work-related productivity, sexuality, relationships, social-emotional health, and physical well-being that might be present even in pre-and extended throughout early postmenopausal life. Choices for symptomatic fibroid management include medical, interventional radiology procedures, surgical, and expectant management. The uterine artery embolization (UAE) procedure has gained justified popularity for myoma management. Growth factors, vascular endothelial growth factor (VEGF) and tumor growth factor β (TGF-β), hold an important role in leiomyoma progression. However, blood levels of VEGF and TGF-β in patients before and after UAE are not fully investigated and the possible relationship with myoma shrinkage has not been evaluated. Therefore, this study aims to assess menorrhagia score and quality of life improvement after UAE for uterine fibroids and compare blood levels of VEGF and TGF-β in patients with uterine leiomyoma before and after UAE. This cross-sectional study will be performed at the University Medical Center, Astana, Kazakhstan. Women undergoing the UAE procedure for uterine leiomyoma will be involved in the study following the precisely defined inclusion/exclusion criteria. Uterine leiomyoma nodules' structural changes after UAE will be assessed along with the blood levels of growth factors (VEGF and TGF-β), menorrhagia score, and quality of life. An important outcome of this project will be an investigation of the blood levels of growth factors (VEGF and TGF-β) before and after the procedure and their association with leiomyoma shrinkage in correlation with the menorrhagia score and quality of life alterations among patients undergoing UAE.
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Affiliation(s)
| | - Gauri Bapayeva
- Clinical Academic Department of Women’s Health, CF “University Medical Center”, Astana, Kazakhstan
| | - Talshyn Ukybassova
- Clinical Academic Department of Women’s Health, CF “University Medical Center”, Astana, Kazakhstan
| | - Viktor Zemlyanskiy
- Clinical Academic Department of Radiology and Nuclear Medicine, CF “University Medical Center”, Astana, Kazakhstan
| | - Arnur Gusmanov
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | - Milan Terzic
- Department of Surgery, School of Medicine, Nazarbayev University, Astana, Kazakhstan
- Clinical Academic Department of Women’s Health, CF “University Medical Center”, Astana, Kazakhstan
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Micić J, Macura M, Andjić M, Ivanović K, Dotlić J, Micić DD, Arsenijević V, Stojnić J, Bila J, Babić S, Šljivančanin U, Stanišić DM, Dokić M. Currently Available Treatment Modalities for Uterine Fibroids. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:868. [PMID: 38929485 PMCID: PMC11205795 DOI: 10.3390/medicina60060868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 05/04/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024]
Abstract
Uterine fibroids (leiomyomas and myomas) are the most common benign gynecological condition in patients presenting with abnormal uterine bleeding, pelvic masses causing pressure or pain, infertility and obstetric complications. Almost a third of women with fibroids need treatment due to symptoms. OBJECTIVES In this review we present all currently available treatment modalities for uterine fibroids. METHODS An extensive search for the available data regarding surgical, medical and other treatment options for uterine fibroids was conducted. REVIEW Nowadays, treatment for fibroids is intended to control symptoms while preserving future fertility. The choice of treatment depends on the patient's age and fertility and the number, size and location of the fibroids. Current management strategies mainly involve surgical interventions (hysterectomy and myomectomy hysteroscopy, laparoscopy or laparotomy). Other surgical and non-surgical minimally invasive techniques include interventions performed under radiologic or ultrasound guidance (uterine artery embolization and occlusion, myolysis, magnetic resonance-guided focused ultrasound surgery, radiofrequency ablation of fibroids and endometrial ablation). Medical treatment options for fibroids are still restricted and available medications (progestogens, combined oral contraceptives andgonadotropin-releasing hormone agonists and antagonists) are generally used for short-term treatment of fibroid-induced bleeding. Recently, it was shown that SPRMs could be administered intermittently long-term with good results on bleeding and fibroid size reduction. Novel medical treatments are still under investigation but with promising results. CONCLUSIONS Treatment of fibroids must be individualized based on the presence and severity of symptoms and the patient's desire for definitive treatment or fertility preservation.
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Affiliation(s)
- Jelena Micić
- Clinic of Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.M.); (M.M.); (M.A.); (K.I.); (J.D.); (J.S.); (J.B.); (S.B.); (U.Š.); (D.M.S.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.D.M.); (V.A.)
| | - Maja Macura
- Clinic of Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.M.); (M.M.); (M.A.); (K.I.); (J.D.); (J.S.); (J.B.); (S.B.); (U.Š.); (D.M.S.)
| | - Mladen Andjić
- Clinic of Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.M.); (M.M.); (M.A.); (K.I.); (J.D.); (J.S.); (J.B.); (S.B.); (U.Š.); (D.M.S.)
| | - Katarina Ivanović
- Clinic of Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.M.); (M.M.); (M.A.); (K.I.); (J.D.); (J.S.); (J.B.); (S.B.); (U.Š.); (D.M.S.)
| | - Jelena Dotlić
- Clinic of Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.M.); (M.M.); (M.A.); (K.I.); (J.D.); (J.S.); (J.B.); (S.B.); (U.Š.); (D.M.S.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.D.M.); (V.A.)
| | - Dušan D. Micić
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.D.M.); (V.A.)
- Clinic of Emergency Surgery, Emergency Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Vladimir Arsenijević
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.D.M.); (V.A.)
- Clinic of Emergency Surgery, Emergency Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Jelena Stojnić
- Clinic of Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.M.); (M.M.); (M.A.); (K.I.); (J.D.); (J.S.); (J.B.); (S.B.); (U.Š.); (D.M.S.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.D.M.); (V.A.)
| | - Jovan Bila
- Clinic of Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.M.); (M.M.); (M.A.); (K.I.); (J.D.); (J.S.); (J.B.); (S.B.); (U.Š.); (D.M.S.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.D.M.); (V.A.)
| | - Sandra Babić
- Clinic of Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.M.); (M.M.); (M.A.); (K.I.); (J.D.); (J.S.); (J.B.); (S.B.); (U.Š.); (D.M.S.)
| | - Una Šljivančanin
- Clinic of Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.M.); (M.M.); (M.A.); (K.I.); (J.D.); (J.S.); (J.B.); (S.B.); (U.Š.); (D.M.S.)
| | - Danka Mostić Stanišić
- Clinic of Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.M.); (M.M.); (M.A.); (K.I.); (J.D.); (J.S.); (J.B.); (S.B.); (U.Š.); (D.M.S.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.D.M.); (V.A.)
| | - Milan Dokić
- Clinic of Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.M.); (M.M.); (M.A.); (K.I.); (J.D.); (J.S.); (J.B.); (S.B.); (U.Š.); (D.M.S.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.D.M.); (V.A.)
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Akhatova A, Aimagambetova G, Bapayeva G, Laganà AS, Chiantera V, Oppelt P, Sarria-Santamera A, Terzic M. Reproductive and Obstetric Outcomes after UAE, HIFU, and TFA of Uterine Fibroids: Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20054480. [PMID: 36901489 PMCID: PMC10001943 DOI: 10.3390/ijerph20054480] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/24/2023] [Accepted: 03/01/2023] [Indexed: 06/07/2023]
Abstract
Novel treatment options for uterine fibroids, such as uterine artery embolization (UAE), ultrasound-guided and magnetic resonance-guided high-intensity focused ultrasound (USgHIFU and MRgHIFU), and transcervical radiofrequency ablation (TFA) methods, are widely used in clinical practice. This systematic review and meta-analysis (CRD42022297312) aims to assess and compare reproductive and obstetric outcomes in women who underwent these minimally invasive approaches for uterine fibroids. The search was performed in PubMed, Google Scholar, ScienceDirect, Cochrane Library, Scopus, Web of Science and Embase. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) and Cochrane guidelines. The articles were selected to meet the following eligibility criteria: (1) research article, (2) human subject research, and (3) the study of pregnancy outcomes after the treatment of uterine fibroids by either one of three methods-UAE, HIFU, and TFA. The analysis of 25 eligible original articles shows a similar rate of live births for UAE, USgHIFU, MRgHIFU, and TFA (70.8%, 73.5%, 70%, and 75%, respectively). The number of pregnancies varied considerably among these studies, as well as the mean age of pregnant women. However, the results of pregnancy outcomes for TFA are insufficient to draw firm conclusions, since only 24 women became pregnant in these studies, resulting in three live births. The miscarriage rate was highest in the UAE group (19.2%). USgHIFU was associated with a higher rate of placental abnormalities compared to UAE (2.8% vs. 1.6%). The pooled estimate of pregnancies was 17.31% to 44.52% after UAE, 18.69% to 78.53% after HIFU, and 2.09% to 7.63% after TFA. The available evidence confirmed that these minimally invasive uterine-sparing treatment options for uterine fibroids are a good approach for patients wishing to preserve their fertility, with comparable reproductive and obstetric outcomes among the different techniques.
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Affiliation(s)
- Ayazhan Akhatova
- School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street 5/1, Astana 010000, Kazakhstan
| | - Gulzhanat Aimagambetova
- Department of Surgery, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street 5/1, Astana 010000, Kazakhstan
| | - Gauri Bapayeva
- Clinical Academic Department of Women’s Health, CF “University Medical Center”, Turan Ave. 32, Astana 010000, Kazakhstan
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS “Civico–Di Cristina–Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS “Civico–Di Cristina–Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Peter Oppelt
- Department of Gynecology, Obstetrics and Gynecologic Endocrinology, Kepler University Hospital, Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
| | - Antonio Sarria-Santamera
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street 5/1, Astana 010000, Kazakhstan
| | - Milan Terzic
- Department of Surgery, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street 5/1, Astana 010000, Kazakhstan
- Clinical Academic Department of Women’s Health, CF “University Medical Center”, Turan Ave. 32, Astana 010000, Kazakhstan
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, 300 Halket Street, Pittsburgh, PA 15213, USA
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Yerezhepbayeva M, Terzic M, Aimagambetova G, Crape B. Comparison of two invasive non-surgical treatment options for uterine myomas: uterine artery embolization and magnetic resonance guided high intensity focused ultrasound-systematic review. BMC Womens Health 2022; 22:55. [PMID: 35241063 PMCID: PMC8896369 DOI: 10.1186/s12905-022-01627-y] [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: 07/12/2021] [Accepted: 02/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Uterine Artery Embolization (UAE) and Magnetic Resonance guided High Intensity Focused Ultrasound (MRgHIFU) are two noninvasive treatments for uterine leiomyoma. METHODS This systematic review, following PRISMA guidelines, analyzed the effectiveness of two treatments by comparing percent fibroid volume shrinkage immediately after the procedure and after 3, 6, 12 and 24 months of follow-up and also assessed and compared common complications following treatment. The search utilized Science Direct, PubMed, MEDLINE, Google Scholar and BioMed Central databases, selecting manuscripts published during the period 2000 and 2020. Studies with premenopausal patients with previous treatments for uterine leiomyoma and/or with other pelvic diseases were excluded. RESULTS Twenty-nine papers satisfied inclusion and exclusion criteria. Results were pooled and stratified by treatment and follow-up time. Weighted fibroid volume percent shrinkage after UAE was statistically significantly greater than MRgHIFU at 6, 12, and 24 months follow-up times. However, UAE had statistically significantly more complications, such as pain, nausea and vomiting. However, this study cannot conclude that UAE is more effective than MRgHIFU due to confounding factors.
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Affiliation(s)
- Madina Yerezhepbayeva
- Department of Medicine, School of Medicine, Nazarbayev University, Kabanbay Batyr Avenue 53, Nur-Sultan, Kazakhstan
| | - Milan Terzic
- Department of Medicine, School of Medicine, Nazarbayev University, Kabanbay Batyr Avenue 53, Nur-Sultan, Kazakhstan.,Clinical Academic Department of Women's Health, Corporate Fund "University Medical Center", Turan Ave. 32, Nur-Sultan, Kazakhstan.,Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA, 15213, USA
| | - Gulzhanat Aimagambetova
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Kabanbay Batyr Avenue 53, Nur-Sultan, Kazakhstan.
| | - Byron Crape
- Department of Medicine, School of Medicine, Nazarbayev University, Kabanbay Batyr Avenue 53, Nur-Sultan, Kazakhstan
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Clinical outcomes of uterine artery embolization and experience of postoperative transvaginal fibroid expulsion: a retrospective analysis. Arch Gynecol Obstet 2022; 306:829-840. [PMID: 35122498 DOI: 10.1007/s00404-022-06407-5] [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: 10/29/2021] [Accepted: 01/07/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To explore the efficacy of uterine artery embolization (UAE) in the treatment of uterine fibroid and share the experience of transvaginal fibroid expulsion (FE) after UAE. METHODS We retrospectively analyzed the changes in uterine and fibroid volume in 152 patients with symptomatic uterine fibroid after UAE at Fujian Provincial Hospital and Fujian Longyan People Hospital from March 2014 to March 2020. After a 12-month follow-up, the improvement in postoperative clinical symptoms and the incidence of complications were evaluated. We also shared the clinical features and imaging findings of four patients with FE after UAE. RESULTS All 152 patients successfully underwent UAE. After a 12-month follow-up, the postoperative volumes of the uterus and fibroid at 3, 6, and 12 months were significantly reduced or disappeared compared to those before surgery (P < 0.05). Clinical symptoms, such as menorrhagia, dysmenorrhea, prolonged menstrual period, anemia, increased leucorrhea, pelvic discomfort, and urinary tract compression, were significantly improved after UAE. Among the 152 patients, the incidences of postoperative fever, nausea, vomiting, lower abdominal pain, and increased vaginal secretion were 7.89%, 7.24%, 3.95%, 19.08%, and 4.61%, respectively. Additionally, there were six cases of FE, with an incidence of 3.95%. Three cases of fibroid specimens and pathological images of fibroid biopsy, which were expelled through the vagina, were also provided. CONCLUSION UAE is a satisfactory alternative surgical method for symptomatic uterine fibroid with definitive efficacy and high safety. However, it is necessary to guard against the occurrence of postoperative complications such as FE.
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Liao P, Jiang J, Zeng YH, Chen Y, Yong M, Qu DC, Zhou HG. Comparison of outcomes of hysteroscopic myomectomy of type 2 submucous fibroids greater than 4 cm in diameter via pretreatment with HIFU or GnRH-a. Int J Hyperthermia 2021; 38:183-188. [PMID: 33573453 DOI: 10.1080/02656736.2021.1874546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To compare the efficacy and safety of high-intensity focused ultrasound (HIFU) and gonadotropin-releasing analogues (GnRH-a) as pretreatments for the hysteroscopic transcervical resection of myoma (TCRM) for type 2 submucosal fibroids greater than 4 centimeters in diameter. MATERIALS AND METHODS Seventy-nine patients were assigned into two groups according patient preference: 42 in HIFU and 37 in GnRHa. TCRM was performed after 3 months of pretreatment with HIFU or GnRHa. RESULTS Following pretreatment with HIFU or GnRHa, uterine-fibroid symptom (UFS) scores and hemoglobin levels (HGB) showed improvement. The fibroid maximum diameter, size of fibroids, and volume of the uterus were decreased. Following HIFU pretreatment, one case reported complete vaginal fibroid expulsion, and four reported partial fibroid expulsion. No similar cases were found in the GnRHa group. Eighteen patients were lost to follow-up prior to TCRM. Among the 31 patients in HIFU, the fibroids were downgraded to type 0 in 10 cases and type 1 in 5 cases. Of the 30 patients in GnRHa, the treated fibroids were downgraded to type 1 in 9 cases. The mean operation time and intraoperative blood loss of the HIFU group were significantly lower than those in the GnRHa group. No significant differences were observed in the incidence of intraoperative complications and the one-time resection rate of fibroids between the two groups (p>.05). CONCLUSIONS HIFU seems to be superior to GnRHa as a pretreatment method prior to TCRM for type 2 submucosal fibroids greater than 4 centimeters in diameter.
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Affiliation(s)
- Ping Liao
- Department of Obstetrics and Gynecology, The Affifiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Jing Jiang
- Department of Obstetrics and Gynecology, The Affifiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yu-Hua Zeng
- Department of Obstetrics and Gynecology, The Affifiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yan Chen
- Department of Obstetrics and Gynecology, The Affifiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Min Yong
- Department of Obstetrics and Gynecology, The Affifiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Da-Cheng Qu
- Department of Obstetrics and Gynecology, The Affifiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Hong-Gui Zhou
- Department of Obstetrics and Gynecology, The Affifiliated Hospital of North Sichuan Medical College, Nanchong, China
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Wong WSF, Lee MHM, Wong PH. A Journey from Learning a Noninvasive High-intensity Focused Ultrasound Surgical Treatment for Gynecological Diseases to Providing High-intensity Focused Ultrasound Services in Hong Kong. Gynecol Minim Invasive Ther 2021; 10:71-74. [PMID: 34040964 PMCID: PMC8140538 DOI: 10.4103/gmit.gmit_23_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/09/2021] [Accepted: 03/08/2021] [Indexed: 11/04/2022] Open
Abstract
This paper reflects a Hong Kong doctors group's journey to learn the high-intensity focused ultrasound (HIFU) ablation treatment for gynecological diseases in China. The procedures of HIFU ablation for fibroids, adenomyosis, and other gynecological diseases are described. After completing our training, the authors applied the HIFU ablation techniques they have learned to establish an outpatient HIFU clinic and provided HIFU ablation treatment in Hong Kong. This paper describes their early experience in providing HIFU services.
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Affiliation(s)
- Wu Shun Felix Wong
- Department of Obstetrics and Gynaecology, School of Women's and Children's Health, The University of New South Wales, Sydney, NSW, Australia
| | | | - Peng Hao Wong
- Medical Clinic, HK Pacific Centre, Kowloon, Hong Kong
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Contegiacomo A, Cina A, Di Stasi C, Barone M, Scrofani AR, Barbieri P, Punzi E, Manfredi R. Uterine Myomas: Endovascular Treatment. Semin Ultrasound CT MR 2021; 42:13-24. [PMID: 33541585 DOI: 10.1053/j.sult.2020.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Uterine fibroids embolization is a safe and effective organ sparing treatment for fibroid-related symptoms based on a broad range of published evidence including randomized-controlled trials. Indication to treatment is usually the presence of symptomatic uterine fibroids. In this review, a systematic search of journal articles relevant to the treatment of symptomatic uterine fibroids was conducted, with a special focus on the indication to treatment, technique, procedural outcomes and pain control. All clinical trials published in English language, representing original research, and reporting clinical outcomes associated with interventions for the management of symptomatic uterine fibroids were considered.
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Affiliation(s)
- Andrea Contegiacomo
- Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Alessandro Cina
- Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carmine Di Stasi
- UOC Radiodiagnostica Ospedale SS. Annunziata, Presidio Ospedaliero Centrale ASL Taranto, Taranto, Italy
| | - Michele Barone
- Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome - Università Cattolica del Sacro Cuore - Rome, Italy
| | - Anna Rita Scrofani
- Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome - Università Cattolica del Sacro Cuore - Rome, Italy
| | - Pierluigi Barbieri
- Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome - Università Cattolica del Sacro Cuore - Rome, Italy
| | - Ernesto Punzi
- Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome - Università Cattolica del Sacro Cuore - Rome, Italy
| | - Riccardo Manfredi
- Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome - Università Cattolica del Sacro Cuore - Rome, Italy
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Khan KN, Fujishita A, Koshiba A, Ogawa K, Mori T, Ogi H, Itoh K, Teramukai S, Kitawaki J. Expression profiles of E/P receptors and fibrosis in GnRHa-treated and -untreated women with different uterine leiomyomas. PLoS One 2020; 15:e0242246. [PMID: 33186388 PMCID: PMC7665806 DOI: 10.1371/journal.pone.0242246] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/30/2020] [Indexed: 02/07/2023] Open
Abstract
Differential expressions of estrogen/progesterone receptors (ER/PR) and individual component of extracellular matrices derived from fibroid are reported. Information on the pattern of change in ER/PR expression and amount of tissue fibrosis after hormonal treatment is unclear. We investigated pattern of change in ER/PR expression and percentage of tissue fibrosis in different uterine leiomyomas after gonadotropin-releasing hormone agonist (GnRHa) treatment. Biopsy specimens from fibroids and adjacent myometria were collected after surgery from women with submucosal myoma (SMM, n = 18), intramural myoma (IMM, n = 16) and subserosal myoma (SSM, n = 17). A proportion of women in each group of fibroid underwent treatment with GnRHa for a variable period of 3-6 months. Tissue expression of ER and PR was analyzed by immunohistochemistry. In vitro cell proliferation effect of GnRHa on human umbilical vein endothelial cells (HUVECs) was examined. Distribution of tissue fibrosis was examined by Masson's trichrome staining with computer-captured image analysis of fibrosis derived from different types of fibroid. PR content was significantly higher than ER in tissues derived from GnRHa-untreated women with SMM and SSM (p = 0.04 for both). Comparing to untreated group, GnRHa-treatment significantly decreased either ER or PR expression in different fibroids. Exogenous treatment with GnRHa dose-dependently decreased proliferation of HUVECs. No significant difference was observed in the percentage of fibrosis in tissues collected from GnRHa-treated and -untreated women with fibroids. The distribution of fibrosis in myoma/myometria and occurrence of fibrosis in perivascular area showed an increasing trend with higher age of the women and with larger size of fibroids. Our findings suggest that despite estrogen dependency, higher PR content in GnRHa-untreated group may indicate a potential role of progesterone in leiomyoma growth. Although GnRHa therapy may shrink fibroids and reduce risk of bleeding during surgery, the occurrence of diffuse tissue fibrosis may impair effective reduction of fibroid size after hormonal treatment.
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Affiliation(s)
- Khaleque N. Khan
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Akira Fujishita
- Department of Gynecology, Saiseikai Nagasaki Hospital, Nagasaki, Japan
| | - Akemi Koshiba
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kanae Ogawa
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Taisuke Mori
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroshi Ogi
- Department of Pathology and Applied Neurobiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kyoko Itoh
- Department of Pathology and Applied Neurobiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Teramukai
- Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Jo Kitawaki
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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