Learn more about the latest innovative advancements in gynecological ultrasound with Professor Wolter Froyman, physician and PhD. At the ISUOG World Congress 2023 GE Symposium in Seoul, Prof Froyman discussed the FibroidMapping tool found on the Voluson™ system and how this tool has led to improved ultrasound fibroids assessment and treatment planning.
This article gives a summary of Prof Froyman's session. The entire session can be watched HERE.
Current Challenges in Fibroid Detection and Diagnosis
Fibroids are present in more than 50% of women and, though common, present unique challenges in detection and treatment planning. Fibroids develop from the uterus's smooth muscle tissue layer (the myometrium). These tumors grow in ways that displace normal myometrial tissue and tend to migrate outward or inward along the path of least resistance. Inward growing fibroids that extend into the endometrium are classified as submucosal and outward growing fibroids that extend beyond the serosa surface are subserosa fibroids. Those that remain within the myometrium are called intramural fibroids.
The location of a fibroid will affect the symptoms experienced by the patient and presents unique challenges for treatment and removal. Some fibroids can cause or contribute to symptoms that include:
- Infertility
- Recurrent pregnancy loss
- Dysmenorrhea
- Menorrhagia
- Pelvic pain
Surgical treatment of a myomectomy may be necessary to relieve symptoms in these cases. Fibroids can vary significantly in size, location, number, and characteristics. Healthcare providers must be able to confidently assess for and document these variables in order to provide the appropriate management for patients.
Ultrasound is the imaging modality used most extensively for uterine fibroids diagnosis, which requires careful assessment, identification, and documentation. However, ultrasound can be limited by many factors, such as operator variability, the identification of very small tumors, multiple compressed fibroids, and submucosal fibroids. These limitations can lead to challenges with reproducibility in follow-up imaging and determining optimal treatment methods.
Enhance Fibroid Identification with Innovative FibroidMapping
The ultrasound advancement of Fibroid Mapping revolutionizes how healthcare providers assess, analyze, understand, and diagnose uterine fibroids. This innovative tool offers a three-dimensional context, improving ultrasound fibroids identification and transforming diagnostic confidence and treatment strategies for these uterine abnormalities.
Fibroid shown using Voluson™ Fibroid Mapping tool
Fibroid Mapping Tool - Voluson Expert 22, RIC10 probe, UltraHD
Fibroid Mapping Tool segments endometrium and uterus.
At the heart of Fibroid Mapping lies its unparalleled ability to display the location and size of uterine fibroids in relation to the endometrium and the uterine serosa. The use of 3D ultrasound in fibroid assessment provides a more comprehensive visualization than 2D ultrasound alone. This technology enables a more thorough understanding of fibroid distribution and their effects on surrounding uterine tissue and structures.
Benefits of 3D Visualization in Fibroid Mapping
There are many advantages to using the Voluson™ Fibroid Mapping with ultrasound for diagnosing and managing uterine fibroids.
Improve Fibroid Assessment and Classification
Management of fibroids can include surgical removal (myomectomy), but this treatment path will depend on a number of factors. Two types of fibroid classification systems are utilized to evaluate a fibroid for surgical removal, which is crucial in determining the probability of a successful myomectomy procedure. These classification systems are the Lasmar/STEP-W system and the FIGO system.
The Lasmar/STEP-W classification system evaluates five fibroid variables: location, size, lateral wall involvement, myometrium penetration, and extension of the base in relation to the uterine wall. Each of the five variables is given a score, which is totalled and used to classify patients into one of three levels of surgical difficulty. A 2012 study has shown that it is possible to obtain a presurgical LASMAR score for myomectomy by 3D ultrasound. When performed in the luteal phase of the patient's menstrual cycle, it provides results similar to hysteroscopy.
The FIGO classification system is a full spectrum system for ultrasound fibroids classification developed by the International Federation of Gynecology and Obstetrics. FIGO classifies fibroids into 9 different types:
- Type 0. Pedunculated, intracavitary
- Type 1. Submucosal, <50% intramural
- Type 2. Submucosal, ≥50% intramural
- Type 3. Endometrium contact, 100% intramural
- Type 4. Intramural
- Type 5. Subserosal, ≥50% intramural
- Type 6. Subserosal, <50% intramural
- Type 7. Subserosal, pedunculated
- Type 8. Other presentations, such as parasitic or cervical origin
A fibroid can be scored with two numbers. The first number refers to the relationship with the endometrium, and the second number refers to the relationship with the serosa. This classification system provides a precise description of a fibroid location, which is very useful when determining the probability of successful fibroid resection. However, it does not provide information on the number and size of fibroids, nor the uterine wall location, which will need to be included along with the FIGO data. The Fibroid Mapping tool includes the FIGO classifications.
The incorporation of Fibroid Mapping with 3D ultrasound translates into improved accuracy during assessment and for treatment planning. Fibroid Mapping with 3D ultrasound uses sagittal and transverse sweeps through the uterus to identify and outline the outer serosa surface of the uterus as well as the endometrium. When a fibroid is seen on the sweep, the FibroidMapping tool will outline the full volume of the tumor and map it onto both the coronal view of the uterus, as well as the 3D reconstruction of the entire uterine body. Not only is a visual representation provided for clinicians, but there is also a clear depiction of each fibroid's position in relation to the uterus.
Clinicians can perform 3D visualization for single or multiple fibroids to accurately reconstruct the uterus with all present fibroids and their relation to both the endometrium and outer serosal wall. This precise ultrasound fibroids mapping technique enables a better understanding of fibroid behavior, growth patterns, and their current and potential impact on surrounding structures. Healthcare providers can use this crucial information for informed decision-making.
Enhance the Accuracy and Consistency of Diagnoses
Fibroid Mapping streamlines the fibroid assessment and identification process for uterine fibroids. The variability of imaging data that can be found between different sonography operators can be minimized by using a Fibroid Mapping tool for primary assessment and follow-up exams.
This improves accuracy and reproducibility and ensures consistency in diagnoses and treatment strategies across healthcare settings. This is essential for patient management and determination of the best treatment options, as both conservative and surgical fibroid treatments rely on precise diagnostic imaging information. Accurate assessments can shorten the time to diagnosis and allow clinicians to determine the most effective treatment method more quickly.
Increase Workflow Efficiency
Fibroid Mapping also contributes to workflow efficiency. By expediting the diagnostic process, this tool allows healthcare providers to make informed decisions swiftly. Enhanced efficiency lets healthcare professionals dedicate more time to patient care and personalized treatment strategies, which improves the quality of care delivered to patients.
In conclusion, FibroidMapping marks a paradigm shift in ultrasound fibroids by significantly advancing uterine fibroid diagnosis, analysis, and treatment planning. Its three-dimensional precision, standardization of examinations, and contribution to workflow efficiency elevate the quality of care and improve patient confidence in their clinician. With its ability to classify fibroids and provide detailed visualizations, Fibroid Mapping empowers healthcare providers with a comprehensive understanding, heralding a new era in fibroid management.
