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ACR Appropriateness Criteria® Management of Uterine Fibroids: 2023 Update

适宜性标准 子宫肌瘤 医学 妇科 放射科
作者
Martin A. Makary,Kylie Zane,Gloria L. Hwang,Charles Kim,Osman Ahmed,Erica M. Knavel Koepsel,Eric J. Monroe,Matthew J. Scheidt,Amanda R. Smolock,Elizabeth A. Stewart,Ashish P. Wasnik,Jason W. Pinchot
出处
期刊:Journal of The American College of Radiology [Elsevier]
卷期号:21 (6): S203-S218
标识
DOI:10.1016/j.jacr.2024.02.022
摘要

Uterine fibroids are the most common benign tumor in women of reproductive age and can present with symptoms including bleeding, bulk related symptoms, and infertility. Several treatment options are available for the management of uterine fibroids, including medical management, minimally invasive therapies such as uterine artery embolization and MR-guided focused ultrasound ablation, and surgical interventions ranging from laparoscopic myomectomy to open hysterectomy. Given this wide range of therapeutic interventions, it is important to understand the data supporting these interventions and to be able to apply it in different clinical settings. This document provides a summary of recent trials supporting various therapies for uterine fibroids, including recent evidence for MR-guided focused ultrasound ablation and a detailed discussion of fertility outcomes in myomectomy and uterine fibroid embolization. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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