Department of Obstetrics and Gynecology, Hospital Clínic of Barcelona, Spain, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain.
Department of Obstetrics and Gynecology, Hospital Clínic of Barcelona, Spain, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain.
Fertil Steril. 2024 Jul;122(1):12-19. doi: 10.1016/j.fertnstert.2024.05.003. Epub 2024 May 9.
The aim of this review was to provide an updated assessment of the present diagnostic tools and clinical symptoms and signs to evaluate uterine fibroids (UFs) on the basis of current guidelines, recent scientific evidence, and a PubMed and Google Scholar search for peer-reviewed original and review articles related to clinical signs and diagnosis of UFs. Approximately 50%-75% of UFs are considered nonclinically relevant. When present, the most common symptoms are abnormal uterine bleeding, pelvic pain and/or bulk symptoms, and reproductive failure. Transvaginal ultrasound is recommended as the initial diagnostic modality because of its accessibility and high sensitivity, although magnetic resonance imaging appears to be the most accurate diagnostic tool to date in certain cases. Other emerging techniques, such as saline infusion sonohysterography, elastography, and contrast-enhanced ultrasonography, may contribute to improving diagnostic accuracy in selected cases. Moreover, artificial intelligence has begun to demonstrate its ability as a complementary tool to improve the efficiency of UF diagnosis. Therefore, it is critical to standardize descriptions of transvaginal ultrasound images according to updated classifications and to individualize the use of the different complementary diagnostic tools available to achieve precise uterine mapping that can lead to targeted therapeutic approaches according to the clinical context of each patient.
本次综述的目的在于根据现有指南、最新科学证据，以及对与子宫肌瘤（UFs）的临床体征和诊断相关的同行评审原始文章和综述文章的 PubMed 和 Google Scholar 搜索，对目前评估 UFs 的诊断工具和临床症状及体征进行最新评估。大约 50%-75%的 UFs 被认为与临床无关。UFs 出现时，最常见的症状是异常子宫出血、盆腔疼痛和/或肿块症状以及生殖失败。由于其可及性和高灵敏度，推荐经阴道超声作为初始诊断方式，尽管在某些情况下磁共振成像似乎是迄今为止最准确的诊断工具。其他新兴技术，如盐水灌注超声造影、弹性成像和对比增强超声，可能有助于提高某些情况下的诊断准确性。此外，人工智能已开始展示其作为辅助工具来提高 UF 诊断效率的能力。因此，根据最新分类标准规范经阴道超声图像的描述，并根据可用的不同补充诊断工具进行个体化使用，以实现精确的子宫定位至关重要，这可以根据每位患者的临床情况进行靶向治疗。
