Leiomyomas Diagnosis
Classification
- Based on location, fibroids can be:
- Submucosal (protruding into the uterine cavity)
- Intramural (found within the myometrium)
- Subserosal (protruding outside the uterus)
- Fibroid classification may use the European Society for Gynecological Endoscopy (ESGE) or the International Federation of Gynecology and Obstetrics (FIGO) classification wherein the degree of uterine cavity distortion and/or intramural extension are taken into account
Physical Examination
- Pelvic exam may reveal a palpable enlarged, firm, and irregular uterus
- A pelvic mass that moves with the uterus is suggestive of fibroids
- Myomatous uterus’ size is reported in menstrual week as is a pregnant uterus
- Size of >12 to 20 weeks may be palpated on abdominal exam
- Diagnosis can be difficult in obese women
Laboratory Tests
- A CBC to evaluate hemoglobin (Hb) will detect iron-deficiency anemia in patients with heavy menstrual bleeding
Imaging
- Transvaginal ultrasound (TVS): Helpful in assessing the adnexae and growth of myoma
- Transvaginal sonohysterography (TVSH): Should be considered if submucosal fibroids and polyps are suspected
- TVSH may avoid the need for diagnostic hysteroscopy in approximately 47% of women who can then proceed to planned operative hysteroscopy
- Magnetic resonance imaging (MRI): May be considered in women in whom the location and nature of the fibroids remain unclear after TVS and TVSH
- May also be used in those who wish to avoid discomfort of TVSH
- MRI predictors of malignancy include age >45 years, menopausal status, thickening of the endometrium, presence of intratumoral hemorrhage, nonmyometrial origin, and T2-weighted signal heterogeneity