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. 2017 Nov;139(2):143-148.
doi: 10.1002/ijgo.12266. Epub 2017 Aug 14.

Clinical limitations of the International Federation of Gynecology and Obstetrics (FIGO) classification of uterine fibroids

Shannon K Laughlin-Tommaso  1   2 , Gina K Hesley  3 , Matthew R Hopkins  1   2 , Kathleen R Brandt  3 , Yunxiao Zhu  4 , Elizabeth A Stewart  2   5
Affiliations

Clinical limitations of the International Federation of Gynecology and Obstetrics (FIGO) classification of uterine fibroids

Shannon K Laughlin-Tommaso et al. Int J Gynaecol Obstet. 2017 Nov.

Abstract

Objective: To determine the reproducibility of classifying uterine fibroids using the 2011 International Federation of Gynecology and Obstetrics (FIGO) staging system.

Methods: The present retrospective cohort study included patients presenting for the treatment of symptomatic uterine fibroids at the Gynecology Fibroid Clinic at Mayo Clinic, Rochester, USA, between April 1, 2013 and April 1, 2014. Magnetic resonance imaging of fibroid uteri was performed and the images were independently reviewed by two academic gynecologists and two radiologists specializing in fibroid care. Fibroid classifications assigned by each physician were compared and the significance of the variations was graded by whether they would affect surgical planning.

Results: There were 42 fibroids from 23 patients; only 6 (14%) fibroids had unanimous classification agreement. The majority (36 [86%]) had at least two unique answers and 4 (10%) fibroids had four unique classifications. Variations in classification were not associated with physician specialty. More than one-third of the classification discrepancies would have impacted surgical planning.

Conclusion: FIGO fibroid classification was not consistent among four fibroid specialists. The variation was clinically significant for 36% of the fibroids. Additional validation of the FIGO fibroid classification system is needed.

Keywords: FIGO; Abnormal uterine bleeding; Fibroids; Leiomyoma; Myoma; Staging.

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Conflict of interest statement

Conflicts of interest

SKL-T has received research funding, paid to the Mayo Clinic, from Truven Health Analytics Inc, and InSightec Ltd (Israel). She is on the data safety monitoring board for the Uterine Leiomyoma (fibroid) Treatment with Radiofrequency Ablation trial (ULTRA trial; Halt Medical, Inc) and has received royalties for UpToDate. GKH has received research funding from InSightec Ltd (Israel). EAS is a consultant for AbbVie, Allergan, Astellas Pharma, Bayer Health Care, Gynesonics, and Viteava, and has received royalties from UpToDate and the Massachusetts Medical Society. The authors have no other conflicts of interest.

Figures

Figure 1
Figure 1
In fibroid 12A, a typical T2 dark fibroid arising from the posterior uterine wall extends into the uterine cavity inferiorly, distorting the serosa. Fibroid 12A was classified as type 2, type 4, and type 3–6.
Figure 2
Figure 2
In fibroid 6A, a fibroid arising from the posterior wall impacts the uterine cavity. It is almost exactly 50% intramural from a sagittal view (A). It appears to be <50% intramural using a coronal view (B). With an axial view, it appears to be >50% intramural (C).
Figure 2
Figure 2
In fibroid 6A, a fibroid arising from the posterior wall impacts the uterine cavity. It is almost exactly 50% intramural from a sagittal view (A). It appears to be <50% intramural using a coronal view (B). With an axial view, it appears to be >50% intramural (C).
Figure 2
Figure 2
In fibroid 6A, a fibroid arising from the posterior wall impacts the uterine cavity. It is almost exactly 50% intramural from a sagittal view (A). It appears to be <50% intramural using a coronal view (B). With an axial view, it appears to be >50% intramural (C).
Figure 3
Figure 3
Fibroid 11A is the larger fibroid arising from the posterior uterine wall compressing the uterine cavity and extending to the serosa; it was classified as type 3, type 4, type 3–5, and type 4–5. 11B is the smaller T2 dark subserosal fibroid with possible extension into the myometrium; it was classified as type 6 and type 7.
Figure 4
Figure 4
Box plot of fibroid volume stratified by the number of unique FIGO fibroid classifications recorded by the four readers. Abbreviation: FIGO, International Federation of Gynecology and Obstetrics.
Figure 5
Figure 5
Fibroid 7A shows a typical T2 dark fibroid arising in the cervix that was classified as type 0, type 2–5, and type 8.
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References

    1. Day Baird D, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003;188(1):100–107. - PubMed
    1. Munro MG, Critchley HO, Fraser IS. The flexible FIGO classification concept for underlying causes of abnormal uterine bleeding. Semin Reprod Med. 2011;29(5):391–399. - PubMed
    1. Munro MG, Critchley HO, Fraser IS. The FIGO classification of causes of abnormal uterine bleeding in the reproductive years. Fertility and Sterility. 2011;95(7):2204–2208. 2208 e2201–2203. - PubMed
    1. Critchley HO, Munro MG, Broder M, Fraser IS. A five-year international review process concerning terminologies, definitions, and related issues around abnormal uterine bleeding. Semin Reprod Med. 2011;29(5):377–382. - PubMed
    1. Wamsteker K, Emanuel MH, de Kruif JH. Transcervical hysteroscopic resection of submucous fibroids for abnormal uterine bleeding: results regarding the degree of intramural extension. Obstet Gynecol. 1993;82(5):736–740. - PubMed

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