Incidence and changes in endometrial–leiomyoma fistula following uterine artery embolization: a single-center retrospective analysis
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...
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| Veröffentlicht in: | European radiology 2023-11, Vol.33 (11), p.8157-8164 |
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| creator | Sasakura, Yasuteru Katsumori, Tetsuya Nishizawa, Kaori Nishimura, Tomoaki Yoshikawa, Tatsuya Takahata, Akiko Yamada, Kei |
| description | 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
|
| doi_str_mv | 10.1007/s00330-023-09794-8 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2823498578</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2823498578</sourcerecordid><originalsourceid>FETCH-LOGICAL-c326t-7143675f4ac790a90e666bfad7c11b1681d6cd4f81b7ad37a71b029ef48c59a03</originalsourceid><addsrcrecordid>eNp9kctu1TAQhi0Eohd4gS6QJTbdhI5jJ3a6QxW9SJW6gbXlOJPWlWOf2gnVYdVVX4A35EnqwykXsWA1I83nbzz6CTlg8IEByKMMwDlUUPMKOtmJSr0gu0zwumKgxMu_-h2yl_MtAHRMyNdkh8taCdU2u-TxIlg3YLBITRiovTHhGjN1gWIY4oRzcsb_ePju0cVpHSdDR5fnxZcavY_3LlzTZcbkQhGk0qwpTn307puZXQzH1NBcGI-VxVDGNBVlzCu0s_u62Wn8Orv8hrwajc_49rnuky-nnz6fnFeXV2cXJx8vK8vrdq5kuaiVzSiMlR2YDrBt2340g7SM9axVbGjtIEbFemkGLo1kPdQdjkLZpjPA98nh1rtK8W7BPOvJZYvem4BxybpWNRedaqQq6Pt_0Nu4pPLfDaUYNJzzplD1lrLlqpxw1KvkJpPWmoHepKS3KemSkv6Zkt6o3z2rl37C4feTX7EUgG-BXEYlkPRn93-0T_WKoPw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2881053335</pqid></control><display><type>article</type><title>Incidence and changes in endometrial–leiomyoma fistula following uterine artery embolization: a single-center retrospective analysis</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Sasakura, Yasuteru ; Katsumori, Tetsuya ; Nishizawa, Kaori ; Nishimura, Tomoaki ; Yoshikawa, Tatsuya ; Takahata, Akiko ; Yamada, Kei</creator><creatorcontrib>Sasakura, Yasuteru ; Katsumori, Tetsuya ; Nishizawa, Kaori ; Nishimura, Tomoaki ; Yoshikawa, Tatsuya ; Takahata, Akiko ; Yamada, Kei</creatorcontrib><description>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.</description><identifier>ISSN: 1432-1084</identifier><identifier>ISSN: 0938-7994</identifier><identifier>EISSN: 1432-1084</identifier><identifier>DOI: 10.1007/s00330-023-09794-8</identifier><identifier>PMID: 37284865</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Correlation ; Diagnostic Radiology ; Embolization ; Embolization, Therapeutic ; Endometrium ; Endometrium - pathology ; Female ; Fibroids ; Fistula ; Fistulae ; Humans ; Imaging ; Incidence ; Internal Medicine ; Interventional Radiology ; Leiomyoma - pathology ; Leiomyoma - therapy ; Magnetic resonance imaging ; Medicine ; Medicine & Public Health ; Neuroradiology ; Radiology ; Retrospective Studies ; Treatment Outcome ; Tumors ; Ultrasound ; Urogenital ; Uterine Artery Embolization ; Uterine Neoplasms - pathology ; Uterine Neoplasms - therapy ; Uterus</subject><ispartof>European radiology, 2023-11, Vol.33 (11), p.8157-8164</ispartof><rights>The Author(s), under exclusive licence to European Society of Radiology 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. The Author(s), under exclusive licence to European Society of Radiology.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c326t-7143675f4ac790a90e666bfad7c11b1681d6cd4f81b7ad37a71b029ef48c59a03</cites><orcidid>0000-0001-9316-9398</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00330-023-09794-8$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00330-023-09794-8$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27923,27924,41487,42556,51318</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37284865$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sasakura, Yasuteru</creatorcontrib><creatorcontrib>Katsumori, Tetsuya</creatorcontrib><creatorcontrib>Nishizawa, Kaori</creatorcontrib><creatorcontrib>Nishimura, Tomoaki</creatorcontrib><creatorcontrib>Yoshikawa, Tatsuya</creatorcontrib><creatorcontrib>Takahata, Akiko</creatorcontrib><creatorcontrib>Yamada, Kei</creatorcontrib><title>Incidence and changes in endometrial–leiomyoma fistula following uterine artery embolization: a single-center retrospective analysis</title><title>European radiology</title><addtitle>Eur Radiol</addtitle><addtitle>Eur Radiol</addtitle><description>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.</description><subject>Correlation</subject><subject>Diagnostic Radiology</subject><subject>Embolization</subject><subject>Embolization, Therapeutic</subject><subject>Endometrium</subject><subject>Endometrium - pathology</subject><subject>Female</subject><subject>Fibroids</subject><subject>Fistula</subject><subject>Fistulae</subject><subject>Humans</subject><subject>Imaging</subject><subject>Incidence</subject><subject>Internal Medicine</subject><subject>Interventional Radiology</subject><subject>Leiomyoma - pathology</subject><subject>Leiomyoma - therapy</subject><subject>Magnetic resonance imaging</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Neuroradiology</subject><subject>Radiology</subject><subject>Retrospective Studies</subject><subject>Treatment Outcome</subject><subject>Tumors</subject><subject>Ultrasound</subject><subject>Urogenital</subject><subject>Uterine Artery Embolization</subject><subject>Uterine Neoplasms - pathology</subject><subject>Uterine Neoplasms - therapy</subject><subject>Uterus</subject><issn>1432-1084</issn><issn>0938-7994</issn><issn>1432-1084</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNp9kctu1TAQhi0Eohd4gS6QJTbdhI5jJ3a6QxW9SJW6gbXlOJPWlWOf2gnVYdVVX4A35EnqwykXsWA1I83nbzz6CTlg8IEByKMMwDlUUPMKOtmJSr0gu0zwumKgxMu_-h2yl_MtAHRMyNdkh8taCdU2u-TxIlg3YLBITRiovTHhGjN1gWIY4oRzcsb_ePju0cVpHSdDR5fnxZcavY_3LlzTZcbkQhGk0qwpTn307puZXQzH1NBcGI-VxVDGNBVlzCu0s_u62Wn8Orv8hrwajc_49rnuky-nnz6fnFeXV2cXJx8vK8vrdq5kuaiVzSiMlR2YDrBt2340g7SM9axVbGjtIEbFemkGLo1kPdQdjkLZpjPA98nh1rtK8W7BPOvJZYvem4BxybpWNRedaqQq6Pt_0Nu4pPLfDaUYNJzzplD1lrLlqpxw1KvkJpPWmoHepKS3KemSkv6Zkt6o3z2rl37C4feTX7EUgG-BXEYlkPRn93-0T_WKoPw</recordid><startdate>20231101</startdate><enddate>20231101</enddate><creator>Sasakura, Yasuteru</creator><creator>Katsumori, Tetsuya</creator><creator>Nishizawa, Kaori</creator><creator>Nishimura, Tomoaki</creator><creator>Yoshikawa, Tatsuya</creator><creator>Takahata, Akiko</creator><creator>Yamada, Kei</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7P</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-9316-9398</orcidid></search><sort><creationdate>20231101</creationdate><title>Incidence and changes in endometrial–leiomyoma fistula following uterine artery embolization: a single-center retrospective analysis</title><author>Sasakura, Yasuteru ; Katsumori, Tetsuya ; Nishizawa, Kaori ; Nishimura, Tomoaki ; Yoshikawa, Tatsuya ; Takahata, Akiko ; Yamada, Kei</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c326t-7143675f4ac790a90e666bfad7c11b1681d6cd4f81b7ad37a71b029ef48c59a03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Correlation</topic><topic>Diagnostic Radiology</topic><topic>Embolization</topic><topic>Embolization, Therapeutic</topic><topic>Endometrium</topic><topic>Endometrium - pathology</topic><topic>Female</topic><topic>Fibroids</topic><topic>Fistula</topic><topic>Fistulae</topic><topic>Humans</topic><topic>Imaging</topic><topic>Incidence</topic><topic>Internal Medicine</topic><topic>Interventional Radiology</topic><topic>Leiomyoma - pathology</topic><topic>Leiomyoma - therapy</topic><topic>Magnetic resonance imaging</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Neuroradiology</topic><topic>Radiology</topic><topic>Retrospective Studies</topic><topic>Treatment Outcome</topic><topic>Tumors</topic><topic>Ultrasound</topic><topic>Urogenital</topic><topic>Uterine Artery Embolization</topic><topic>Uterine Neoplasms - pathology</topic><topic>Uterine Neoplasms - therapy</topic><topic>Uterus</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sasakura, Yasuteru</creatorcontrib><creatorcontrib>Katsumori, Tetsuya</creatorcontrib><creatorcontrib>Nishizawa, Kaori</creatorcontrib><creatorcontrib>Nishimura, Tomoaki</creatorcontrib><creatorcontrib>Yoshikawa, Tatsuya</creatorcontrib><creatorcontrib>Takahata, Akiko</creatorcontrib><creatorcontrib>Yamada, Kei</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection (ProQuest)</collection><collection>Natural Science Collection (ProQuest)</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biological Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>European radiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sasakura, Yasuteru</au><au>Katsumori, Tetsuya</au><au>Nishizawa, Kaori</au><au>Nishimura, Tomoaki</au><au>Yoshikawa, Tatsuya</au><au>Takahata, Akiko</au><au>Yamada, Kei</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Incidence and changes in endometrial–leiomyoma fistula following uterine artery embolization: a single-center retrospective analysis</atitle><jtitle>European radiology</jtitle><stitle>Eur Radiol</stitle><addtitle>Eur Radiol</addtitle><date>2023-11-01</date><risdate>2023</risdate><volume>33</volume><issue>11</issue><spage>8157</spage><epage>8164</epage><pages>8157-8164</pages><issn>1432-1084</issn><issn>0938-7994</issn><eissn>1432-1084</eissn><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.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>37284865</pmid><doi>10.1007/s00330-023-09794-8</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0001-9316-9398</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1432-1084 |
| ispartof | European radiology, 2023-11, Vol.33 (11), p.8157-8164 |
| issn | 1432-1084 0938-7994 1432-1084 |
| language | eng |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Correlation Diagnostic Radiology Embolization Embolization, Therapeutic Endometrium Endometrium - pathology Female Fibroids Fistula Fistulae Humans Imaging Incidence Internal Medicine Interventional Radiology Leiomyoma - pathology Leiomyoma - therapy Magnetic resonance imaging Medicine Medicine & Public Health Neuroradiology Radiology Retrospective Studies Treatment Outcome Tumors Ultrasound Urogenital Uterine Artery Embolization Uterine Neoplasms - pathology Uterine Neoplasms - therapy Uterus |
| title | Incidence and changes in endometrial–leiomyoma fistula following uterine artery embolization: a single-center retrospective analysis |
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