Small fibroids located just beneath the lining of the uterus (submucosal) are more likely to move to the endometrial cavity after uterine artery embolization (UAE) but usually don't cause major complications, according to a new study.
The study included 49 patients with 140 fibroids who underwent an MRI examination before and after UAE. The study found that 39 of these were submucosal. Of these, 33% migrated to the endometrial cavity after UAE, said Sachit Verma, MD, lead author of the study. "At the beginning of our study, we suspected that all submucosal fibroids became endocavitary following UAE irrespective of their area of contact with the endometrium (ID ratio)," said Dr. Verma. "By further analyzing our results we realized that submucosal fibroids with an ID ratio greater than 0.55 at pre-procedural MRI have a higher risk of becoming endocavitary following UAE," he said
The majority of these fibroids are expelled spontaneously without significant symptoms, Dr. Verma said. However it is good to know if patients are at higher risk of this situation occurring so they can be better counseled regarding risk of post procedural complications and symptoms such as menorrhagia, acute pelvic pain or persistent vaginal discharge, he said. Patients may also choose an alternative treatment option, such as hysteroscopic resection and/or myomectomy, said Dr. Verma.
In a recent commentary written in conjunction with the study, by Fred Burbank, MD adds patients contemplating UAE should anticipate that fibroids bordering on or inside the uterine cavity may require cervical dilatation or hysteroscopic resection for removal. The addition of either of these gynecology procedures shouldn't necessarily be regarded as a UAE complication or treatment failure, he says.
Both the study and commentary appear in the May issue of the American Journal of Roentgenology.