fibroid imaging and treatment options

fibroid imaging and treatment options

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  FIBROIDS
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  Uterine Fibroid
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  Uterine Fibroid Uterine fibroids(also called myomas) are non-cancerous growths that originate from the uterus. Up to 70% of women will have fibroids by age 50, and 25% of these women will have significant symptoms. They can occur as single or multiple focal fibroids or can be diffuse.Symptoms of uterine fibroids can include heavy menstrual bleeding, prolonged periods, pelvic pain, pressure on other organs. Symptoms often depend on the size and location of the fibroids in the uterus. Why do fibroids cause bleeding ? Current evidence suggests that it is not compression of the vessels but local action of vasoactive growth factor that accounts for vascular abnormalities. Due to fibroid ,ectasia (dilation or distention of a tubular structure)of venules - most likely to burst and normal clotting mechanism overwhelmed by increased diameter of the vessels leading to bleeding. Due to fibroid defects in arterioles, veins, and the extracellular matrix is high, leading to bleeding. Prolonged & Painful Menstruation Infertility Severe Abdominal Pain
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  Incidence & Prevalence Uterinefibroids are most common in women who are in their 40s and early 50s, although some women may develop fibroids at a younger age. At least 25% of women have uterine fibroids which can cause problems(1 in 4 women). Worldwide about 20-40% women will be diagnosed with fibroid and the incidence is twice more common in black women than white. The prevalence of UFs varied widely across the studies, from 4.5% to 68.6%. Economic impact ● 2-17$ billion health care dollars in US ● 238$ million to 7.7 billion in infertility & OBG complication cost. ● $9500 direct health care cost to patient the year following diagnosis. ● Indirect cost over control $300-4800 [direct costs (drug costs, procedure costs, and medical service costs) Treatment delay ● 1/3rd of women will seek treatment due to symptoms or infertility ● Most women attempt home remedies prior to seeking care of physician. ● 3.3 year delay for caucasian women ● 4.3 years delay for black women.
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  Confidential – Donot copy or distribute Literature Review Uterine fibroids affect a wide cross-section of the population, with prevalence, symptom severity, and overall disease burden generally higher among black women, likely due to both genetic and environmental factors. Race and age factor : From a study it was found that the incidence of UFs among Hispanic, Asian and white women was similar, but the incidence in black women was approximately three times higher than in the other population. Further the study found that the prevalence of fibroid was high (21.9%) in the age group of 45-49 compared to other age group. Geography wise: Another internet survey study notes the self-reported prevalence of uterine fibroids from 8 countries .Prevalence of uterine fibroids ranged from a low of 4.5% in UK and 4.6% in France to a high of 9.8% in Italy and 9.0% in Korea. Self-reported prevalence in the age group of 40 years and older rose to 14.1% across all countries
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  Existing Solution- Hysterectomy-Removal Of Uterus Hysterectomy is the traditional treatment for relief of fibroid symptoms. Over 600,000 hysterectomies are performed every year in the US, many of them to relieve symptoms of fibroids. A hysterectomy is a standard surgical procedure that involves the complete or partial removal of a person’s uterus. Types of hysterectomy: A supracervical or subtotal hysterectomy removes only the upper part of the uterus, keeping the cervix in place. A total hysterectomy removes the whole uterus and cervix. A radical hysterectomy removes the whole uterus, tissue on the sides of the uterus, the cervix, and the top part of the vagina. Advantages : Disadvantages: Permanent relief from pain. No longer be able to bear children. Symptoms Relief Significant recovery Morbidities associated: Risk for heart disease. Ostheroposis .
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  Existing Solution- Surgical-Myomectomy – Selected Fibroid Removal Myomectomy:is a surgical procedure to remove uterine fibroids.The surgeon's goal during myomectomy is to take out symptom-causing fibroids and reconstruct the uterus. 65,000 myomectomy procedures are performed every year in the U.S. Types : Abdominal myomectomy (laparotomy), an open abdominal incision is made to access the uterus and remove fibroids. Laparoscopic myomectomy, accesses and removes fibroids through several small abdominal incisions. Hysteroscopic myomectomy With this procedure, fibroids are removed using an instrument called a hysteroscopic resectoscope, which is passed up into the uterine cavity through the vagina and cervical canal. Standard resection uses an electrosurgical wire loop to surgically remove the fibroid. Advantages Disadvantages: Symptom relief Recurrence of fibroid Fertility improvement. Blood loss
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  Existing Solution- MinimalInvasive- Uterine Artery Embolisation UAE is conducted under a moving X-ray (fluoroscopy) by an experienced interventional radiologist. It is a procedure where a tiny tube called catheter is inserted through an incision in the groin area into the femoral artery and then threaded to the uterine arteries. Some tiny sand-like gelatinous particles will be injected into the uterine arteries through the catheter in order to block the blood supply to the fibroids. The blockage or embolization will eventually result in the degeneration of the fibroids Challenges faced using this technology Requiring a interventional radiologist. Recurrence of the fibroid Disadvantages Embolization may cause damage to the uterus Deep vein thrombosis Limitations of these treatment : Patient selection
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  Existing Solution- MinimalInvasive-Magnetic Guided Focused Ultrasound MRgFUS is a noninvasive thermo ablative technique that combines the anatomic detail and thermal monitoring capabilities of MRI . MRgFUS is to treat as much of the fibroid as possible. This outpatient procedure allows interventional radiologists to target fibroids with high doses of focused ultrasound waves to shrink or destroy the fibroids without damaging surrounding tissue. MRI is used to locate fibroids and establish the proper ultrasound pathway, keeping healthy tissue safe from the ultrasound waves used to attack fibroid tissue. Challenges faced using this technology Requiring a interventional radiologist. Well set up lab Disadvantages Prolonged duration Limited eligibility Difficulty with insurance coverage Limitations of this treatment : Patient selection
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  Exploration Of Ablationtechnology Ablation:destroying the tumor (by means of energy) right through the skin, without open surgery. There are main types of ablation i.e. Microwave, Laser, Cryo and Radiofrequency.Radiofrequency and Microwave ablation were most common techniques used for soft tumor ablation. Principle of ablation During ablation, electrical current from the generator oscillates between electrodes through ion channels present in most biologic tissues. In this way, the ablation setup can be thought of as a simple electrical circuit wherein the current loop comprises a generator, cabling, electrodes, and tissue as the resistive element. Tissues are imperfect conductors of electricity (they have electrical impedance), so current flow leads to frictional agitation at the ionic level and heat generation. Heating occurs most rapidly in areas of high current density: Tissues nearest to an electrode are heated most effectively, while more peripheral areas receive heat by thermal conduction Advantages of ablation:Irreversible :Permanent damage to tissue Current Area of ablation used: Radiofrequency ablation has been used for thermal ablation in bone, liver, kidney, heart and other various organs.
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  Fibroid Imaging Visualization offibroid-type 6,7, can be visualized in laparoscopic camera, this is done by advancement of instrument into the abdominal region, before the advancement of the instrument , the CO2 gas will be passed for insufflation of the abdominal cavity to provide better visibility of the surgical area. The clinicians can subjectively feel the intramural type 2-5 by moving or piercing the instrument into the uterus based on ultrasound images ,which will be done prior to laparoscopic procedure . Visualization of fibroid type (0-2) can be visualised through the hysteroscopic camera. in order to visualised the fibroid before introducing the hysteroscopy instrument , a fluid will be passed into the uttering cavity , for distening the cavity and for better visibility of the surgical area and fibroid. Ultrasound imaging techniques, both transabdominal and transvaginal, are the most accurate and widely used imaging modalities in the detection and characterization of fibroids . With the help of trans abdominal and travgainall all types of fibroids can be mapped. Magnetic resonance imaging provides accurate imaging information, but its cost and lack of significant superiority over ultrasound have hitherto limited its use. Computerized tomography, plain X-ray, and hysterosalpingography have little to offer in the assessment of fibroids.