title: Women seeking second opinion for symptomatic uterine leiomyoma: role of comprehensive fibroid center.
abstract: OBJECTIVE
  The objective of the study was to describe our early experience with a comprehensive uterine fibroid center and report our results in women seeking a second opinion for management of symptomatic uterine leiomyoma.
  
  
  METHODS
  We performed a HIPAA-complaint, IRB-approved retrospective study of women seeking second opinion for management of uterine fibroids at our multidisciplinary fibroid treatment center in a tertiary care facility from July 2008 to August 2011. After a review of patients' history, physical examination, and magnetic resonance imaging (MRI) findings, treatment options were discussed which included conservative management, uterine-preserving options, and hysterectomy. We performed Fisher's exact test for categorical variables between the cohort that did or did not undergo a uterine-preserving treatment. Differences were considered significant at p < 0.05.
  
  
  RESULTS
  The mean age of the 205 patient study cohort was 43.8 years (SD 7.5). One hundred sixty-two (79.0%) patients had no prior therapy. Based on MRI, one or more fibroids were detected in 178/205 (86.8%), adenomyosis in 8/205 (3.9%), and a combination of fibroid and nonfibroid condition (i.e., adenomyosis, endometrial polyp) in 18/205 (8.8%). In those who desired to transition their care to our institution (n = 109), 85 patients underwent 90 interventions: 39 MRgFUS (magnetic resonance-guided high-intensity focused ultrasound surgery), 14 UAE (uterine artery embolization), 25 myomectomies, 8 hysterectomies, 3 polypectomies, and 1 endometrial ablation. Five patients had two procedures. Intramural and subserosal fibroids were most commonly treated with MRgFUS followed by myomectomy and then UAE; in contrast, pedunculated fibroids were frequently managed with myomectomy.
  
  
  CONCLUSIONS
  Multidisciplinary fibroid evaluation may facilitate the increase use of less invasive options over hysterectomy for symptomatic fibroid treatment.
authors.affiliation: Department of Radiology, University of California, 757 Westwood Blvd, Los Angeles, CA 90095, USA.
authors.forename: Nelly
authors.initials: N
authors.lastname: Tan
authors.affiliation: Department of Radiology, University of California, 757 Westwood Blvd, Los Angeles, CA 90095, USA.
authors.forename: Timothy D
authors.initials: TD
authors.lastname: McClure
authors.affiliation: Department of Obstetrics and Gynecology, University of California, 757 Westwood Blvd, Los Angeles, CA 90095, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Tarnay
authors.affiliation: Department of Obstetrics and Gynecology, University of California, 757 Westwood Blvd, Los Angeles, CA 90095, USA.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Johnson
authors.affiliation: Department of Radiology, University of California, 757 Westwood Blvd, Los Angeles, CA 90095, USA.
authors.forename: David Sk
authors.initials: DS
authors.lastname: Lu
authors.affiliation: Department of Radiology, University of California, 757 Westwood Blvd, Los Angeles, CA 90095, USA.
authors.forename: Steven S
authors.initials: SS
authors.lastname: Raman
keywords: Fibroid center; Fibroids; MRgFUS; Multidisciplinary