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FIGO 5—subserosal fibroid with less than 50% subserosal component and more than 50% intramural component. a Longitudinal view on transvaginal ultrasound demonstrating FIGO 5 leiomyoma (white arrow). In addition, note that a FIGO 2 submucosal leiomyoma with < 50% submucosal component (yellow arrow). b Illustration depicting FIGO 5 leiomyoma
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Uterine leiomyomas are the most common gynecological and pelvic neoplasm, reported in up to 80 percent of women by age 50. While the majority are asymptomatic, uterine leiomyomas, depending on size, number, and location can result in bulk symptoms, abnormal uterine bleeding (AUB), infertility or recurrent pregnancy loss. Ultrasonography (USG) remai...
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Background: Abnormal uterine bleeding (AUB) is defined as bleeding from the uterine corpus endometrium to be precise, the bleeding is abnormal in regularity, volume, frequency, or duration. The international federation of gynecology and obstetrics (FIGO) categorized AUB based on structured medical history, laboratory tests, ultrasound, and or hyste...
Citations
... Classically, on TVUS, typical leiomyomas appear as solid, well-defined, homogeneous hypoechoic masses that may show posterior acoustic shadowing. However, due to the frequent differences in the composition of the extracellular matrix and fibroblasts or due to the presence of calcification and necrosis, leiomyomas may have different echogenicity [51]. MRI provides greater detail, aiding in the assessment of leiomyomas' characteristics, location, and their impact on adjacent structures, which is particularly valuable in treatment planning. ...
Abnormal uterine bleeding (AUB) poses a multifaceted challenge in women’s health, necessitating an integrated approach that addresses its diverse etiologies and clinical presentations. The International Federation of Gynecology and Obstetrics PALM-COEIN classification system provides a systematic approach to the diagnosis of AUB in non-pregnant women, based on clinical and imaging-based categorization of causes into structural (Polyps, Adenomyosis, Leiomyomas and Malignancy; PALM), and non-structural causes (Coagulopathies, Ovulatory disorders, primary Endometrial disorders, Iatrogenic and Not otherwise classified; COEIN). On the other hand, placental disorders, uterine rupture, ectopic pregnancy and retained products of conceptions are the main causes of uterine bleeding during pregnancy and in the peripartum period. Ultrasound is usually the first-line imaging technique for the differential diagnosis of causes of AUB. Computed Tomography may be useful if ultrasound findings are unclear, especially in emergency settings. Magnetic resonance imaging, when indicated, is an excellent second-line diagnostic tool for a better non-invasive characterization of the underlying cause of AUB. This pictorial review aims to illustrate the main causes of AUB from the point of view of diagnostic imaging and to show not-so-common cases that can be treated by means of interventional radiology.
... UL are idiopathic benign fibromuscular tumors in women characterized by the presence of the female genitalia. The International Federation of Gynecology and Obstetrics made a secondary, and tertiary subclassification system for leiomyoma according to their number, size and location, and PL is involved in the category 8, with all the extrauterine leiomyomas and unusual extrauterine variants of leiomyomas [4]. Parasitic fibroma has no connection with the uterus and obtains its blood supplies from the nearby organs and tissues. ...
Parasitic leiomyomas (PL), also known as free leiomyomas, which occur outside the uterus and rarely happen in clinical practice. They are usually reported in women of reproductive age who underwent hysterectomy or myomectomy and frequently present with symptoms such as abdominal pain and distention. In fact, it is hard to determine the nature of the mass according to the imaging examination and clinical manifestation. At present, the most common treatment involves an abdominal or laparoscopic surgery in order to remove the mass and perform the next step of treatment based on the histological diagnosis. In this case report, we describe a 35-year-old woman with a 12.4 × 9.3 × 9.8 cm3 PL with blood supply from the greater omentum. Considering the prolonged menstruation of the patient, she underwent the hysteroscopic and laparotomy exploration. The mass was confirmed as smooth leiomyoma with necrosis by the immunohistochemical examination. The patient had a good recovery and being discharged seven days after the surgery. The patient is still in the follow-up.
... The clinical symptoms of PCOS include hyperandrogenism, disrupted ovulation, polycystic ovaries, and metabolic irregularities such as insulin resistance and dyslipidemia [2]. Recent research findings suggest a plausible correlation between autoimmune mechanisms and the development of PCOS [3]. Moreover, according to a study, there may be a correlation between PCOS and the development of autoimmune mechanisms, sparking a growing interest in investigating the potential involvement of autoimmunity in the pathogenesis of PCOS [4]. ...
Polycystic ovary syndrome (PCOS) is a prevalent endocrinopathy that affects 5-10% of women
during their reproductive age. Recent research suggests a potential link between autoantibodies
and PCOS development. The current study aimed to investigate the relationship between
autoantibodies and PCOS. One hundred and fifty female patients suffered from PCOS aged
between 20 and 35 years participated in this study as matched with healthy control. The result
showed a significantly higher concentrations of anti-thyroid peroxidase (TPO) and antithyroglobulin (TG) autoantibodies in the patients compared to the healthy control group.
Moreover, the concentrations of IgM and IgG for anti-cardiolipin (ACL) were significantly
higher in the patients than in the control group. These increments in ACL antibodies in patients
suggested a risk factor for PCOS. Conversely, no significant correlation was found in case of β-
2 glycoprotein I (β2GPI) antibodies and lupus in patients. Serum amyloid A (SAA) and highsensitivity C-reactive protein (hs-CRP) were significantly higher in patients. Procalcitonin
(PCT) was also highly significant in patients compared to the controls. Lastly, the concentration
of total IgG antibodies was significantly higher in patients than in controls. In conclusion, high
concentrations of autoantibodies in patients suggest a risk factor and positive associations with
PCOS in females.
... However, depending on the level of calcification and/or the amount of fibrous tissue present, UFs may exhibit different echogenicity, usually being hyperechogenic or isoechogenic. 25 Leisure sedentary behaviour assessment Sedentary behaviour refers to awake behaviour characterised by energy consumption≤1.5 metabolic equivalent task (MET) when sedentary, reclining or lying down. Screen time and sedentary time are usually the two main indicators used to quantify sedentary behaviour time. ...
Objective
Sedentary behaviour is associated with a variety of adverse health outcomes, including obesity, oestrogen metabolism and chronic inflammation, all of which are related to the pathogenesis of uterine fibroids (UFs). This study aimed to explore the relationship between leisure sedentary time (LST) and UFs.
Design
Cross-sectional.
Setting
We conducted a cross-sectional analysis of data from patients from the Yunnan region in the China Multi-Ethnic Cohort Study.
Participants
A total of 6623 non-menopausal women aged 30–55 years old were recruited. Menstrual status was self-reported. Participants who lacked a unique national identity card, suffered from serious mental illness, did not have a clear diagnosis of UFs, or provided incomplete information were excluded.
Primary and secondary outcome
UFs were diagnosed by abdominal B-ultrasound. Leisure sedentary behaviour was assessed by using a face-to-face questionnaire interview. Logistic regression and restricted cubic spline were employed to explore the relationship between LST and UFs.
Results
A total of 562 participants had UFs, with a prevalence rate of 8.5% (7.8%, 9.2%). Multivariate adjusted logistic regression analysis showed that the risk of UFs in women with LST≥6 hour/day was 2.008 times that in women with LST<2 hour/day (95% CI 1.230 to 3.279). The restricted cubic spline results showed that there was a linear dose‒response relationship between LST and UFs (p for non-linearity>0.05). According to the results of the stratified analysis for menstrual status and body mass index (BMI), there was a correlation between LST and the prevalence of UFs only in women with a BMI<24 kg/m ² or perimenopause.
Conclusion
LST was independently associated with the prevalence of UFs, and a linear dose‒response relationship was observed. Our study provides evidence on the factors influencing UFs, and further research is needed to propose feasible measures for UFs prevention.
... Its ability to analyse medical images in real-time, accurately identify infections, and improve healthcare accessibility makes it a valuable asset for chest infection diagnosis. With further advancements and refinement, the YOLO v8 algorithm can potentially enhance patient outcomes and contribute to more effective and efficient healthcare practices in the future [50]. ...
... On the other hand, the comparison of the different algorithms is shown in Table are the classifications of the chest X-ray image dataset explained in Table 2. (Supplem tary Materials S2, Table S1). Good for high-dimensional data [50] Complex and may overfit noi data [12] Figure 3. The different types of lung infections and the percentages of patients with each type of infection [10]. ...
... Deep residual neural network with 50 layers [51] Excellent for complex features [24] Prone to overfitting and sensitive to small changes in the data [1] Inception V3 Dense CNN with dense connectivity [32] Good for high-dimensional data [50] Complex and may overfit noisy data [12] Mobile Net A lightweight CNN designed for mobile devices [25] Strong feature reuse, fewer parameters, and memory-efficient [28] Computationally expensive as may require powerful hardware [51] EfficientNet Scalable and efficient CNN architecture [3] State-of-the-art performance that balances accuracy and efficiency [52] Computationally expensive at higher-scale levels, such as EfficientNet-B7 [32] The method was designed to identify unique features and patterns in chest X-rays that could indicate abnormalities associated with chronic diseases [17]. By utilising the boundaries within the X-ray data, the method was trained to recognise and pinpoint the exact locations of these deviations [3]. ...
Our research focused on creating an advanced machine-learning algorithm that accurately detects anomalies in chest X-ray images to provide healthcare professionals with a reliable tool for diagnosing various lung conditions. To achieve this, we analysed a vast collection of X-ray images and utilised sophisticated visual analysis techniques; such as deep learning (DL) algorithms, object recognition, and categorisation models. To create our model, we used a large training dataset of chest X-rays, which provided valuable information for visualising and categorising abnormalities. We also utilised various data augmentation methods; such as scaling, rotation, and imitation; to increase the diversity of images used for training. We adopted the widely used You Only Look Once (YOLO) v8 algorithm, an object recognition paradigm that has demonstrated positive outcomes in computer vision applications, and modified it to classify X-ray images into distinct categories; such as respiratory infections, tuberculosis (TB), and lung nodules. It was particularly effective in identifying unique and crucial outcomes that may, otherwise, be difficult to detect using traditional diagnostic methods. Our findings demonstrate that healthcare practitioners can reliably use machine learning (ML) algorithms to diagnose various lung disorders with greater accuracy and efficiency.
... Thus, uterine fi broids are classifi ed as submucosal, intramural, or subserosal (16) . With advances in diagnostic modalities, the need arose for a detailed, universally accepted classifi cation system as a guide for choosing the most appropriate treatment (17) . Therefore, in 2011, the FIGO classifi cation system for causes of abnormal uterine bleeding was developed (17,18) . ...
... With advances in diagnostic modalities, the need arose for a detailed, universally accepted classifi cation system as a guide for choosing the most appropriate treatment (17) . Therefore, in 2011, the FIGO classifi cation system for causes of abnormal uterine bleeding was developed (17,18) . Currently, the FIGO classifi cation includes a total of nine types of fi broids (8) -types 0 through 8-as presented in Table 1 and Figure 1. ...
Uterine fibroids are the most common benign gynecologic tumors in women of reproductive age, and ultrasound is the first-line imaging modality for their diagnosis and characterization. The International Federation of Gynecology and Obstetrics developed a system for describing and classifying uterine fibroids uniformly and consistently. An accurate description of fibroids in the ultrasound report is essential for planning surgical treatment and preventing complications. In this article, we review the ultrasound findings of fibroids, detailing the main points to be reported for preoperative evaluation. In addition, we propose a structured, illustrated report template to describe fibroids, based on the critical points for surgical planning.
... Myomas may grow asymptomatically. When symptoms occur, abnormal uterine bleeding, urinary or bowel dysfunction, infertility, and abdominal pain are mainly reported (8)(9)(10). Thus, women with this disease have high risks of developing physical and emotional distress, which can strongly impact their life (11). ...
Introduction
As a new minimally invasive surgery, transvaginal natural orifice transluminal endoscopic surgery (vNOTES) has been proved to be suitable for the treatment of a variety of gynecological benign diseases. However, compared with other minimally invasive surgeries that have been widely used, such as conventional multiport laparoscopy and transumbilical laparoendoscopic single-site surgery (LESS), their advantages and disadvantages and how to choose are still unknown. The purpose of our study is to compare the advantages and disadvantages of the three minimally invasive surgeries in myomectomy and to provide theoretical basis for the wider development of vNOTES surgery.
Material and methods
This retrospective study included 282 patients at our hospital who underwent laparoscopic myomectomy from May 2021 to March 2022. Based on the surgical approach, patients were classified into multiport, transumbilical LESS, and vNOTES groups. The patients’ demographic characteristics and follow-up data were collected during the perioperative period and at 1 month postoperatively.
Results
Among the three procedures, vNOTES had the shortest anal exhaust time but also the highest postoperative infection rate. Multiple linear regression analysis showed that the operative time increased by 3.5 min for each 1 cm increase in myoma, and intraoperative bleeding increased by approximately 12 ml. The average duration of single pores increased by 25 min compared to that of multiports, and the operative duration increased by 10.48 min for each degree of adhesion.
Conclusions
For gynecologists who have mastered vNOTES, this procedure has the same efficacy and safety as the two existing minimally invasive surgeries in myomectomy, but it shows obvious advantages in postoperative recovery.
... Since the revision of the FIGO classification of AUB in 2018, reports on the incidence of each causative disease in PALM-COEIN 1,8,9,[12][13][14] and the relationship with ultrasound findings and pathology results in PALM-COEIN have mainly been reported using system 2. [15][16][17][18] In addition, some reviews explored biomarkers that may be useful in the diagnosis of AUB for each causative disease of AUB, 19 and most of the reports have discussed how to accurately diagnose the causative disease of AUB using PALM-COEIN. However, to the best of our knowledge, there have been no reports on the symptoms of AUB using system 1 or on the relationship between system 1 and system 2. Therefore, we expounded on the relationship between the symptoms of AUB and AUB causative diseases by analyzing AUB system 1 and PALM-COEIN using correspondence analysis. ...
Aim:
To investigate the status of abnormal uterine bleeding (AUB) in Japan using the International Federation of Gynecology and Obstetrics (FIGO) classification (AUB system 1 and 2; PALM-COEIN) and to clarify the relationship between AUB symptoms and the diseases causing AUB.
Methods:
In a nationwide study, we enrolled first-time patients who visited target facilities during two consecutive weeks from December 1, 2019 to January 31, 2020. The FIGO classification was used to investigate patients with symptoms and causative diseases of AUB. Based on the proportion of patients in the nationwide study, 373 cases were included in the detailed survey. Survey items included symptoms of AUB according to AUB system 1, examination details, and causative diseases according to the PALM-COEIN classification.
Results:
Within the study period, we encountered 61 740 first-time patients, of which 8081 (13.1%) were diagnosed with AUB. Among them, 39.9% had abnormal menstrual cycles and 56.9% had abnormal menstrual bleeding. In the survey, PALM had the highest percentage of AUB-L and COEIN had the highest percentage of AUB-O. Correspondence analysis showed that COEIN was strongly associated with abnormal menstrual cycles and PALM with abnormal menstrual bleeding.
Conclusion:
We conducted the first nationwide survey of AUB in Japan. The FIGO classification was a useful tool for the diagnosis of AUB, with a strong correlation between symptoms of AUB by AUB system 1 and the causative disease of AUB by PALM-COEIN. Conversely, a high percentage of AUB-N and AUB-E suggests that AUB system 1 and PALM-COEIN are ambiguous as diagnostic tools.
