To evaluate the accuracy of pre-operative imaging in detecting submucosal fibroids to ascertain the necessity of hysteroscopic cavity assessment for all patients undergoing Laparoscopic Myomectomy (LM).

Design:

A retrospective analysis of electronic patient records (EPR) from July 2014 to September 2023. Follow-up duration varied based on the timing of LM procedures within this timeframe.

Setting:

The study was conducted within a single institution, with patients positioned and managed according to standard protocols for laparoscopic procedures.

Patients or Participants:

A total of 144 patients who underwent LM during the specified timeframe were included in the study. Among them, 73 (51%) underwent hysteroscopic assessment either concurrently with myomectomy or within the preceding six months.

Interventions:

The study primarily involved the retrospective analysis of electronic patient records to assess the accuracy of pre-operative imaging, particularly MRI and transvaginal ultrasound scan (TVUS), in detecting submucosal fibroids. No direct interventions were performed on patients as part of the study protocol.

Measurements and Main Results:

The analysis revealed that MRI demonstrated 100% accuracy in predicting the presence of submucous fibroids when compared to hysteroscopic observations. In contrast, TVUS showed a discrepancy rate of 32% when compared to hysteroscopic findings, with false positives (43%) and false negatives (57%) identified. This discrepancy was not significantly influenced by the expertise of the sonographer. These findings highlight the superior accuracy of MRI over TVUS in identifying submucous fibroids prior to LM.

Conclusion:

The study concludes that MRI is superior to TVUS in detecting submucosal fibroids before LM. Despite higher cost, MRI offers more accurate counselling and may potentially eliminate the need for pre-operative hysteroscopy. These results support the clinical utility of MRI in pre-operative assessments for patients undergoing LM with suspected submucosal fibroids. Further research may be warranted to validate these findings and explore additional factors influencing the choice of pre-operative imaging modalities.