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A new system to classify submucous myomas: a Brazilian multicenter study.
Ricardo Bassil Lasmar1, Bernardo Portugal Lasmar, Roger Keller Celeste
1Department of Gynecology and Obstetrics, Universidade Federal Fluminense, Rio de Janeiro, Brazil. Ricardo@lasmar.com.br
Journal of Minimally Invasive Gynecology
|July 24, 2012
Summary
The STEPW classification better predicts outcomes for hysteroscopic myomectomy, including myoma removal success and surgical complications, compared to the ESGE classification. This aids in planning and managing submucous myoma resections.
Area of Science:
- Gynecology
- Minimally Invasive Surgery
- Surgical Outcomes
Background:
- Submucous myomas are common uterine fibroids requiring surgical intervention.
- Hysteroscopic myomectomy is a standard treatment, but predicting outcomes can be challenging.
- Accurate preoperative assessment is crucial for surgical planning and patient management.
Purpose of the Study:
- To compare the predictive accuracy of the European Society for Gynaecological Endoscopy (ESGE) and STEPW (size, topography, extension, penetration, and wall) classifications.
- To evaluate the ability of these classifications to predict submucous myoma removal, operative time, fluid balance, and surgical complications during hysteroscopic myomectomy.
Main Methods:
- A prospective, multicenter study involving 191 women undergoing hysteroscopic myomectomy at six centers in Brazil.
- Myomas were classified using both ESGE and STEPW systems.
- Sensitivity and specificity of each classification were assessed to determine the best cutoff points for predicting outcomes.
Main Results:
- The STEPW classification demonstrated superior predictive value. All myomas with STEPW scores ≤4 were completely removed (100%), while 76.9% of those with scores >4 were removed.
- STEPW scores >4 were significantly associated with longer surgery, complications, and greater fluid imbalance.
- The ESGE classification showed less predictive power for these outcomes.
Conclusions:
- The STEPW classification is a more effective tool than the ESGE classification for predicting submucous myoma removal, operative time, fluid balance, and surgical complications in hysteroscopic myomectomy.
- Utilizing the STEPW classification can enhance surgical planning and improve patient outcomes in hysteroscopic myomectomy procedures.
