title: Feasibility of a new system of classification of submucous myomas: a multicenter study.
abstract: OBJECTIVE
  To evaluate the performance of the STEPW (size, topography, extension, penetration, wall) classification system in predicting partial or complete fibroid removal on hysteroscopic myomectomy.
  
  
  METHODS
  Multicenter, prospective study (Canadian Task Force classification II-2).
  
  
  METHODS
  Four hysteroscopy centers in Brazil, China, Italy, and the United States.
  
  
  METHODS
  Four hundred forty-nine women who underwent hysteroscopic resection of 465 submucous fibroids.
  
  
  METHODS
  Resection of the submucous fibroids (hysteroscopic myomectomy). Fibroids were scored according to the European Society for Gynaecological Endoscopy (ESGE) and STEPW classifications. The validation of the two classifications was assessed using sensitivity and specificity of each classification, with their best cutoff point. A test of equality of the two areas under the receiver operating characteristic curves was performed for correlated samples.
  
  
  METHODS
  Correlation of ESGE and STEPW classifications with complete or incomplete removal of submucous fibroid.
  
  
  RESULTS
  Removal of the myoma was complete in 432 (92.9%) of 465 myomectomies and incomplete in 33 (7.1%). All 320 fibroids (100%) with a score≤4 in the STEPW classification were completely removed, and 112 of 145 fibroids (77.2%) with a score>4 were removed. All 33 cases of incomplete hysteroscopic myomectomy (100%) had a STEPW score>4. Using the ESGE classification, 85 of 86 cases (98.9%) of type 0 fibroids, 278 of 298 (93.3%) of type 1, and 69 of 81 (85.2%) of type 2 were completely resected.
  
  
  CONCLUSIONS
  Classifying submucous fibroids using the STEPW classification permits greater correlation with complete or incomplete removal of the myoma by hysteroscopic myomectomy.
authors.affiliation: Department of Gynecology and Obstetrics, Federal Fluminense University, Rio de Janeiro, Brazil. Ricardo@lasmar.com.br
authors.forename: Ricardo Bassil
authors.initials: RB
authors.lastname: Lasmar
authors.forename: Zhang
authors.initials: Z
authors.lastname: Xinmei
authors.forename: Paul D
authors.initials: PD
authors.lastname: Indman
authors.forename: Roger Keller
authors.initials: RK
authors.lastname: Celeste
authors.forename: Attilio
authors.initials: A
authors.lastname: Di Spiezio Sardo
mesh_terms: D000328:Adult; D000368:Aged; D003944:Diagnostic Techniques, Obstetrical and Gynecological; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000473:pathology / Q000601:surgery; D007889:Leiomyoma / Q000145:classification* / Q000150:complications / Q000175:diagnosis / Q000473:pathology; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014594:Uterine Neoplasms / Q000145:classification* / Q000150:complications / Q000175:diagnosis / Q000473:pathology; D055815:Young Adult