Is it possible to obtain a presurgical Lasmar score for hysteroscopic myomectomy by ultrasound alone?

Abstract

Objective: To determine whether a Lasmar score obtained entirely by the use of two-dimensional (2D) and three-dimensional (3D) ultrasound provides results similar to those obtained using the original hysteroscopic technique.

Methods: This was a prospective study performed on a series of patients presenting with symptomatic submucous fibroids and scheduled for hysteroscopic myomectomy. Ultrasound Lasmar scores were obtained by a single physician, a specialist in ultrasonography, in the luteal phase of the menstrual cycle. 3D images were evaluated by offline examination using multiplanar analysis. Classical Lasmar scores were obtained by a different physician, a specialist in hysteroscopy, during the follicular phase of the subsequent cycle. Surgery was performed by a third physician in the follicular phase who also reported a Lasmar score, which we considered as the gold standard. The concordance between group classifications (I-III, relating to difficulty of hysteroscopic resection) according to the three methods used to obtain the Lasmar score (ultrasound, classical and surgery) was calculated using Cohen's κ statistic.

Results: Thirty-four women, with a mean age of 43 ± 4.9 years, were enrolled in the study. Thirty-six submucous fibroids were identified by both ultrasound and diagnostic hysteroscopy. The mean diameter of fibroids evaluated was 28 ± 13.2 mm. The concordance between the three methods of classifying patients according to Lasmar score was high: classical vs. surgery, κ = 0.88; ultrasound vs. surgery, κ = 0.93; and classical vs. ultrasound, κ = 0.77.

Conclusion: The Lasmar score can be obtained solely by ultrasound examination performed in the luteal phase of the menstrual cycle, avoiding office hysteroscopy without a loss of diagnostic accuracy.