ABSTRACT
Fibroids (leiomyomas) of the uterus are the most common benign lesions of the myometrium. A routine pelvic ultrasonography in daily clinical practice is of utmost importance to detect every detail of the fibroids, in either symptomatic or asymptomatic patients. To standardize the sonographic assessment of fibroids in the uterus, the machine settings need to be optimized before performing a two-dimensional and three-dimensional examination. Once the diagnosis of a fibroid and exclusion of an adenomyoma are certain, these fibroids are classified on the basis of their proximity to the endometrial cavity as per the FIGO (International Federation of Gynecology and Obstetrics) classification and graded from 0 to 8. Submucous myomas are further scored using the STEPW (size, topography, extension, penetration, wall) classification to assess the complexity of their nature before surgery and plan the modality of the myomectomy. Fibroids usually increase in size over a period of time and require evaluation regularly. When a preoperative assessment of the symptomatic fibroids by ultrasound is performed within 3 months of the planned surgery, it can help in re-confirming or re-planning the surgical method and give a preview of the expected complications. In cases of multiple large fibroids, owing to the large size of the uterus, an ultrasonographic evaluation may be inadequate and a magnetic resonance imaging examination is required.
