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Incidence and changes in endometrial–leiomyoma fistula following uterine artery embolization: a single-center retrospective analysis

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Abstract

Objectives

To investigate whether the number and size of endometrial–leiomyoma fistulas (ELFs) change following uterine artery embolization (UAE) for leiomyoma and the correlation between ELFs and vaginal discharge (VD).

Materials & Methods

This study was a retrospective analysis of 100 patients who underwent UAE at a single institution between May 2016 and March 2021. They all underwent MRI at baseline, 4 months, and 1 year after UAE. The number and size of the ELFs were compared with the MRI images each time. The ELF tumor characteristics and the correlation between the ELFs and VD were assessed. Additional gynecologic interventions due to VD associated with ELFs were evaluated.

Results

No ELF was observed at baseline. Ten ELFs were noted in nine patients at 4 months, and 35 ELFs were noted in 32 patients 1 year after UAE. The ELFs significantly increased over time (p = 0.004, baseline vs. 4 months; p < 0.001, 4 months vs. 1 year). The ELF size did not significantly change over time (p = 0.941). The tumors developing ELFs after UAE were mainly located at the submucosal or intramural area contacting the endometrium at baseline, with a mean size of 7.1 (2.6) cm. Nineteen patients (19%) had VD 1 year after UAE. There was no significant correlation between VD and the number of ELFs (p = 0.80). No patients underwent additional gynecologic interventions due to VD associated with ELFs.

Conclusion

ELFs increased in number and did not disappear over time after UAE in most tumors.

Clinical relevance statement

Despite the MR imaging findings, within the limited data of this study, ELFs were not seemingly associated with clinical symptoms, including VD.

Key Points

• Endometrial–leiomyoma fistula (ELF) is a complication of uterine artery embolization (UAE).

• ELFs increased in number over time after UAE and did not disappear in most tumors.

• Most tumors developing ELFs after UAE were located near/contacted the endometrium and were larger.

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Abbreviations

CE-MRI:

Contrast-enhanced MRI

ELF:

Endometrial–leiomyoma fistula

ICC:

Intraclass correlation coefficients

UAE:

Uterine artery embolization

VD:

Vaginal discharge

References

  1. Dariushnia SR, Nikolic B, Stokes LS, Spies JB, Society of Interventional Radiology Standards of Practice C (2014) Quality improvement guidelines for uterine artery embolization for symptomatic leiomyomata. J Vasc Interv Radiol 25:1737-1747

  2. Gupta JK, Sinha A, Lumsden MA, Hickey M (2014) Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD005073.pub4:CD005073

    Article  PubMed  PubMed Central  Google Scholar 

  3. van Overhagen H, Reekers JA (2015) Uterine artery embolization for symptomatic leiomyomata. Cardiovasc Intervent Radiol 38:536–542

    Article  PubMed  Google Scholar 

  4. de Bruijn AM, Ankum WM, Reekers JA et al (2016) Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 10-year outcomes from the randomized EMMY trial. Am J Obstet Gynecol 215:745.e1-e12

    Article  PubMed  Google Scholar 

  5. Silberzweig JE, Powell DK, Matsumoto AH, Spies JB (2016) Management of uterine fibroids: a focus on uterine-sparing interventional techniques. Radiology 280:675–692

    Article  PubMed  Google Scholar 

  6. Daniels J, Middleton LJ, Cheed V et al (2022) Uterine artery embolisation versus myomectomy for premenopausal women with uterine fibroids wishing to avoid hysterectomy: the FEMME RCT. Health Technol Assess 26:1–74

    PubMed  PubMed Central  Google Scholar 

  7. Walker WJ, Carpenter TT, Kent AS (2004) Persistent vaginal discharge after uterine artery embolization for fibroid tumors: cause of the condition, magnetic resonance imaging appearance, and surgical treatment. Am J Obstet Gynecol 190:1230–1233

    Article  PubMed  Google Scholar 

  8. Fischer JH, Gimpelevich AD, Abesada-Aguet J, Zurawin RK (2009) Endometrial-myoma fistula following uterine artery embolization. J Minim Invasive Gynecol 16:S59

    Article  Google Scholar 

  9. Peivandi S, Batzer FR, Fossum GT (2011) Uterine cavity-myoma fistula after hysteroscopic myomectomy mimicking uterine perforation at hysterosalpingography: case report. J Minim Invasive Gynecol 18:534–537

    Article  PubMed  Google Scholar 

  10. Morris DV, Shekhani H, Peters G (2018) Chronic vaginal discharge after uterine fibroid embolization. J Vasc Interv Radiol 29:1319–1321

    Article  PubMed  Google Scholar 

  11. Hajati A (2021) Endometrial cavity-myoma fistula after uterine artery embolization diagnosed by pelvic MRI: case report. Radiol Case Rep 16:2916–2919

    Article  PubMed  PubMed Central  Google Scholar 

  12. Pereira N, Fenster T (2018) Definitive management of persistent vaginal discharge caused by leiomyoma-endometrial fistulas after uterine artery embolization. J Minim Invasive Gynecol 25:944–945

    Article  PubMed  Google Scholar 

  13. Ogliari KS, Mohallem SV, Barrozo P, Viscomi F (2005) A uterine cavity-myoma communication after uterine artery embolization: two case reports. Fertil Steril 83:220–222

    Article  PubMed  Google Scholar 

  14. Mara M, Horak P, Kubinova K, Dundr P, Belsan T, Kuzel D (2012) Hysteroscopy after uterine fibroid embolization: evaluation of intrauterine findings in 127 patients. J Obstet Gynaecol Res 38:823–831

    Article  PubMed  Google Scholar 

  15. Spies JB, Benenati JF, Worthington-Kirsch RL, Pelage JP (2001) Initial experience with use of tris-acryl gelatin microspheres for uterine artery embolization for leiomyomata. J Vasc Interv Radiol 12:1059–1063

    Article  CAS  PubMed  Google Scholar 

  16. Pelage JP, Le Dref O, Beregi JP et al (2003) Limited uterine artery embolization with tris-acryl gelatin microspheres for uterine fibroids. J Vasc Interv Radiol 14:15–20

    Article  PubMed  Google Scholar 

  17. Goodwin SC, Bonilla SM, Sacks D et al (2001) Reporting standards for uterine artery embolization for the treatment of uterine leiomyomata. J Vasc Interv Radiol 12:1011–1020

    Article  CAS  PubMed  Google Scholar 

  18. Munro MG, Critchley HO, Broder MS, Fraser IS, Disorders FWGoM (2011) FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet 113:3-13

  19. Thrippleton MJ, Munro KI, McKillop G et al (2015) Unbiased and efficient estimation of the volume of the fibroid uterus using the Cavalieri method and magnetic resonance imaging. Reprod Sci 22:15–22

    Article  PubMed  PubMed Central  Google Scholar 

  20. Kroencke TJ, Scheurig C, Poellinger A, Gronewold M, Hamm B (2010) Uterine artery embolization for leiomyomas: percentage of infarction predicts clinical outcome. Radiology 255:834–841

    Article  PubMed  Google Scholar 

  21. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

  22. Spies JB, Coyne K, Guaou Guano NG, Boyle D, Skyrnarz-Murphy K, Gonzalves SM (2002) The UFS-QOL, a new disease-specific symptom and health-related quality of life questionnaire for leiomyomata. Obstet Gynecol 99:290–300

    PubMed  Google Scholar 

  23. Hehenkamp WJ, Volkers NA, Donderwinkel PF et al (2005) Uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids (EMMY trial): peri- and postprocedural results from a randomized controlled trial. Am J Obstet Gynecol 193:1618–1629

    Article  PubMed  Google Scholar 

  24. Walker WJ, Pelage JP (2002) Uterine artery embolisation for symptomatic fibroids: clinical results in 400 women with imaging follow up. BJOG 109:1262–1272

    Article  CAS  PubMed  Google Scholar 

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 602-8566, Kyoto, Japan

    Yasuteru Sasakura, Tatsuya Yoshikawa, Akiko Takahata & Kei Yamada

  2. Department of Radiology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto, Shiga, 520-3046, Japan

    Tetsuya Katsumori, Kaori Nishizawa & Tomoaki Nishimura

Authors
  1. Yasuteru Sasakura
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  2. Tetsuya Katsumori
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  3. Kaori Nishizawa
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  4. Tomoaki Nishimura
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  5. Tatsuya Yoshikawa
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  6. Akiko Takahata
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  7. Kei Yamada
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Corresponding author

Correspondence to Yasuteru Sasakura.

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Guarantor

The scientific guarantor of this publication is Tetsuya Katsumori.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Tetsuya Katsumori has received payment for lectures and writing articles from Nippon Kayaku. The other authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this study.

Informed consent

Written informed consent for the procedure and opt-out consent for the retrospective use of data were obtained from all patients in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• observational

• performed at one institution

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Sasakura, Y., Katsumori, T., Nishizawa, K. et al. Incidence and changes in endometrial–leiomyoma fistula following uterine artery embolization: a single-center retrospective analysis. Eur Radiol 33, 8157–8164 (2023). https://doi.org/10.1007/s00330-023-09794-8

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  • DOI: https://doi.org/10.1007/s00330-023-09794-8

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