Fibromes : tests and screening

Clinical examinationPap smear2D uterine ultrasound examination3D uterine ultrasound examinationHystero-sonographyMRIObsolete tests

Fibroid center.

Pap smear

1. Clinical examination

During a consultation, when your doctor perform a pelvic examination (bimanual exam) he will feel a firm mass, sometimes quite a bit elastic, fixed to the uterus.

2. Pap smear

Pap smear is realised in consultation by your gynecologist.
The goal is to search for abnormalities in cervical cells, these abnormalities can sometimes cause bleeding.
Your gynecologist push a small brush into the cervix place the cells on a slide, it is examined under a microscope by a specialist.

3. Two dimensions uterine ultrasound examination

Ultrasound examination should be performed under certain technical conditions and using two probes, abdominal and vaginales :

• The abdominal probe is essential for the study of fibroids growing towards the navel.
• Endovaginal probe allows the identification of fibroids located down in the pelvic cavity and also examining other parts of the female reproductive organs: endometrium and ovaries.
  

During the ultrasound the following parameters must be specified :

• Size (volume) in order to monitor fibroids evolution and predict the extent of surgery.
• Precise location: in order to know the impact on fertility, treatment option (laparotomy, coelioscopy or hysteroscopy) and predict operative difficulties.
• Intratumoral vascularization.
• Aspects: necrobiosis, delivery by the cervix.

Fibroid and uterus

Fibroid and uterus

Fibroid and uterus : vascularization

The use of Doppler ultrasound is necessary to map the vessels supplying the fibroid and predict the growth potential.

Indeed, Doppler analysis provides information on the number of vessels and the extent of blood flow. The greater the flow is, the more the risk of fibroid growth is important.

4. Three dimensions uterine ultrasound examination

The 3D ECHO allows organs studied in three dimensions. A specific computer, integrated into the ultrasound machine, integrates images acquired in different planes and rebuilt an electronic synthetic image in three dimensions.

3D ECHO can be useful for the differential diagnosis :

• Between fibroids and adenomyosis.
• When poor conditions cause problems for achieving exam (obesity, previous abdominal surgery).

2D fibroid

3D fibroid

5. Hystero-sonography

The endometrial cavity is virtual, this means that its walls are joined one to another, which reduces the quality of the ultrasound vision.

Injection of sterile saline solution into the uterine cavity (saline infusion sonography = sis) can expand the wall and allows a better visualization of the shape, contours and internal structures. The endometrium can then be viewed in its entirety.

Normal echography

Echography after HySo

6. Magnetic Resonance Imaging

MRI provides the best contrast between fibroids and regular uterine tissue. MRI is at this time the first choice for fibroids imaging.

7. Obsolete tests : CT scanner and hysterography

These two tests have no indication at this time.