title: A new system to classify submucous myomas: a Brazilian multicenter study.
abstract: OBJECTIVE
  To evaluate 2 different predicting scores of submucous myoma removal, fluid balance, and operative time in woman undergoing hysteroscopic myomectomy.
  
  
  METHODS
  A multicenter and prospective study (Canadian Task Force classification II-2).
  
  
  METHODS
  Six hysteroscopy centers in Brazil.
  
  
  METHODS
  A total of 191 women who underwent hysteroscopic resection of 205 submucous myomas.
  
  
  METHODS
  Resection of submucous myomas (hysteroscopic myomectomy). Myomas were scored according to the European Society for Gynaecological Endoscopy (ESGE) and STEPW (size, topography, extension, penetration, and wall) classifications. The validation of the 2 classifications was assessed with sensitivity and specificity of each classification, with their best cutoff point.
  
  
  METHODS
  To correlate ESGE and STEPW classifications with complete or incomplete removal of submucous myoma, length of surgery, surgical complications, and fluid balance.
  
  
  RESULTS
  Removal of the myoma was complete in 190 (92.7%) of 205 myomectomies, and incomplete in 15 (7.3%). All 140 (100%) of 140 myomas with a score ≤ 4 in the STEPW classification were completely removed, and 50 (76.9%) of 65 myomas with a score >4 were removed. All 15 (100%) cases of incomplete hysteroscopic myomectomy had a STEPW score >4. With the ESGE classification, 156/164 (95.1%) cases of type 0 and type 1 myomas, and 34/41 (82.9%) of type 2 were completely resected. STEPW scores >4 were statistically associated with longer duration of surgery, surgical complications, higher levels of fluid balance, and use of gonadotropin releasing hormone analogue if compared with lower scores. The ESGE scores were not associated with any of these variables.
  
  
  CONCLUSIONS
  Classifying submucous myomas with the STEPW classification allows better prediction of myoma removal, fluid balance, length of surgery and surgical complications in hysteroscopic myomectomy than ESGE classification.
authors: Department of Gynecology and Obstetrics, Universidade Federal Fluminense, Rio de Janeiro, Brazil. Ricardo@lasmar.com.br
authors: Ricardo Bassil
authors: RB
authors: Lasmar
authors: Bernardo Portugal
authors: BP
authors: Lasmar
authors: Roger Keller
authors: RK
authors: Celeste
authors: Daniela Baltar
authors: DB
authors: da Rosa
authors: Daniella de Batista
authors: Dde B
authors: Depes
authors: Reginaldo Guedes Coelho
authors: RG
authors: Lopes
mesh_terms: D000328:Adult; D000368:Aged; D001938:Brazil; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D007889:Leiomyoma / Q000145:classification* / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology / Q000601:surgery; D061646:Operative Time; D011183:Postoperative Complications; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000145:classification* / Q000473:pathology / Q000601:surgery; D014882:Water-Electrolyte Balance