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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 3  |  Issue : 2  |  Page : 50-56

Prevalence and sonographic patterns of uterine fibroid among women of reproductive age in Jos, Plateau state, Nigeria


1 Department of Radiology, Al Nairyal General Hospital, Dammam, Saudi Arabia
2 Department of Radiology, Ahmadu Bello University Teaching Hopital, Zaria, Nigeria
3 Department of Radiology, King Khalid Hospital, Najran, Saudi Arabia
4 Department of Radiology, Gurayat General Hospital, Yurayat, Saudi Arabia
5 Department of Radiology, Dalhatu Araf Specialist Hospital, Lafia, Nigeria
6 Department of Radiology, Jos University Teaching Hospital, Jos, Nigeria

Date of Submission10-Mar-2021
Date of Decision10-Aug-2021
Date of Acceptance22-Apr-2022
Date of Web Publication17-Dec-2022

Correspondence Address:
Chigoze Blessed Ukaonu
Department of Radiology, Al Nairyal General Hospital, Dammam
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jrmt.jrmt_6_21

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  Abstract 


Background: Uterine leiomyoma represents a major public health problem and is regarded as the most common benign gynecologic tumors affecting premenopausal women. It is associated with considerable morbidity and hospitalization. Objectives: This research was carried out to establish the prevalence and sonographic characteristics of uterine leiomyoma as well as the histological diagnosis of the tumor among Nigerian women of reproductive age living in Jos, Plateau State. Materials and Methods: It was a prospective cross-sectional hospital-based study, in which 295 women of the age between 20 years and 50 years were recruited randomly after obtaining informed consent from each woman. Abdominopelvic ultrasound scan was performed on each participant using a GE Logic 5 machine fitted with 3.5-MHz probe with emphasis on the location, number, and characterization of uterine leiomyoma(s); thereafter, transvaginal ultrasound scan using 7.5-MHz frequency probe was done for the subjects that have uterine fibroid for better delineation and location of the mass(es), followed by sonohysterography where necessary to ascertain its/their location(s). The histologic findings/diagnosis of the tumor postsurgery for those who had myomectomy in course of the study was correlated to the sonographic diagnosis. The number of fibroid nodules, location in the uterus, sonographic patterns, classification, and histological diagnosis were assessed descriptively and inferentially using the Statistical Package for the Social Sciences version 20 (SPSS20). The results were presented in the form of tables and charts. Results: The mean age for the participants was 32.66 ± 7.66 years ranging from 21 to 50 years, and the mean age of the sonographically confirmed fibroid cases was 34.99 ± 6.79 years with a range of 21–48 years. This study indicated that 28.33% (83/295) of the subjects had fibroid; the highest prevalence (49.7%) of the fibroid case occurred among women in their fourth decade and the lowest (8.4%) at the extremes of reproductive age. A significant positive association (P = 0.043) between nulliparity and the presence of fibroid was noted. The average number of fibroid nodules and volume of the largest nodule were estimated as 2.76 ± 1.93 and 344 ± 69.24 cm3, respectively; 57.80% of the fibroid were intramural with only 9.6% been submucosal. Most (86.70%) of the fibroids were located within the uterine corpus and the most common (38.6%) sonographic pattern of the nodules was hypoechoic. The histological findings postmyomectomy for those that had surgery in the course of the study showed cellular leiomyoma to be the most common (95.23%) type; there was no evidence of malignant transformation. Conclusion: The prevalence and sonographic pattern of leiomyoma among women of reproductive age in Jos have been assessed; it was found that characteristics of the fibroid and its location determine the clinical presentation and possibly the reproductive outcome of the patient; this could help in appropriate management of cases in the North Central or the whole nation.

Keywords: Classification, prevalence, sonographic patterns, uterine fibroid


How to cite this article:
Ukaonu CB, Ibinaiye PO, Owoeye SC, Birma MR, Angbalaga A, Ogbu AE. Prevalence and sonographic patterns of uterine fibroid among women of reproductive age in Jos, Plateau state, Nigeria. J Radiat Med Trop 2022;3:50-6

How to cite this URL:
Ukaonu CB, Ibinaiye PO, Owoeye SC, Birma MR, Angbalaga A, Ogbu AE. Prevalence and sonographic patterns of uterine fibroid among women of reproductive age in Jos, Plateau state, Nigeria. J Radiat Med Trop [serial online] 2022 [cited 2023 Feb 5];3:50-6. Available from: http://www.jrmt.org/text.asp?2022/3/2/50/364180




  Introduction Top


Ultrasound is the first choice of imaging modality in the field of gynecology.[1] Dynamics and static images can be produced and displayed as a spectrum during ultrasound scanning. Ultrasound utilizes nonionizing radiation and has no obvious untoward bioeffects and has excellent soft tissue and pelvic organ resolution like the uterus;[1] thus as a valuable tool in making diagnosis on women with this condition (uterine leiomyoma), it is the preferred imaging modality for gynecological investigations.[2] More so, with the advent of high-resolution vaginal probes, transvaginal sonography has assumed an important role in assessing the myometrium and the endometrial echo complex.[3]

A common gynecologic condition that demands the use of ultrasound is uterine fibroid also known as fibromyoma, myoma, or leiomyoma. It represents a major public health problem, the most common female reproductive tract tumors affecting premenopausal women[2],[3],[4] and are often associated with considerable hospitalization and morbidity.[4],[5],[6] Fibromyoma is known to be the most common masses of the female pelvis, which is estimated to occur in 20%–40% of women of reproductive age;[6],[7] it is believed that these tumors develop in the majority of American women and becomes symptomatic in one-third of these women.[7],[8] African-American women are at a higher risk for fibroids and Nigroid women are more likely than Caucasian women to have larger and more symptomatic tumors at the time of treatment.[3]

Uterine fibroids are the most frequent indication for hysterectomy in premenopausal women[9] and, therefore, are a major public health issue indeed. However, uterine fibroid is asymptomatic in many cases, despite the fact that the cause of uterine fibroid is still unknown; estrogen and progesterone are hypothesized to enhance their growth.[10],[11],[12],[13],[14],[15]

A paucity of studies on fibroid cases in the North Central of Nigeria indicated a knowledge gap.

Therefore, on account of the morbidity and resultant considerable hospitalization associated with leiomyoma as well as limited reliable population-based studies on it in the North Central geopolitical zone, this study addressed questions on its prevalence and sonographic pattern, which will help in individualizing patients management.


  Materials and Methods Top


This was a descriptive cross-sectional hospital-based study that was carried out at the Radiology Department of Jos University Teaching Hospital (JUTH), Plateau State, in Northern Nigerian over the period 1 year (January 2016 to December 2016), which involved women between the age of twenty and fifty years that presented at the gynecology outpatient clinic.

Ethical approval for the research was obtained from the Ethics and Research Committee of JUTH, Plateau State. Informed consent was obtained from the subjects, and multistage cluster sampling method was used to recruit the subjects involved in the study until the desired size was obtained.

The ultrasound scanning machine used in the study has the following features:

  • Model: GE LOGIC 5 real-time ultrasound scan machine
  • Probe types: 3.5-MHz curvilinear probe for abdominopelvic scan and 7.5-MHz frequency transvaginal probe.


Initially, all examinations were carried out using a GE LOGIC 5 real-time ultrasound machine fitted with 3.5-MHz curvilinear transducer and full bladder was required. Each patient was asked to lie supine on the examination couch, a coupling gel was applied to the anterior part of the abdominopelvic region, and a transducer from the machine was moved gently over the pelvis/abdomen to visualize the uterus. Images of uterus were obtained in longitudinal and transverse planes [Figure 1], on longitudinal scan; the length (XY) and the height (AP) were measured, while on transverse scan, the width (EF) was obtained.
Figure 1: Transverse and longitudinal pelvic scan images

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The subjects that were found to have uterine fibroid were asked to empty their bladder, after which a transvaginal scan was done for them, using a transvaginal probe with a frequency of 7.5 MHz. Having emptied their bladder, subjects were asked to undress from their waist down and put on a gown given to them. Patients were asked to lie supine on the couch with their hip and knee flexed (dorsal position), a transvaginal probe covered with condom and lubricated with a warm gel was inserted into the patients' vagina afterward and moved gently around it to ascertain the location(s) of the fibroids; their numbers, echogenicity, and the diameter of the largest was measured and documented [Figure 2].
Figure 2: Longitudinal transvaginal sonograms of (a) normal uterus and (b) uterus with submucous fibroid

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For those found to have submucous uterine fibroid(s), sonohysterography (used aseptic technique to insert a vaginal speculum, steadying of the cervical lip with a vulsellum, introduction of Foleys catheter size 6F or 8F into the cervical canal followed by inflation of the catheter balloon using 2 mls of normal saline to secure it, thereafter, scanned in both coronal and sagittal plane using the Tran°vaginal probe as normal saline was been introduced into the uterine cavity via the catheter) was done for them to ascertain its location and to differentiate it from polyps [Figure 3].
Figure 3: Saggital sonohysterograms of (a) a normal uterus and (b) a uterus with a submucous fibroid

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All the patients that had their fibroid removed and sent for histology in the course of the study had their histology reports documented.


  Results Top


Descriptive statistic of patient data

The age range for patients (N = 295) whose imaging finding and histological diagnosis (where necessary) were analyzed was 21.00–48.00 years, with a mean age of 32.66 ± 7.66 years [Table 1].
Table 1: Age distribution of respondents

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The study showed that 28.33% (83) of the patients had fibroid [Figure 4]; the highest prevalence (27.70%) of the fibroid case was found among women aged 31–35 years and the lowest (8.4%) was found among women aged 21–25 years and 46–50 years [Table 2].
Figure 4: A pie chart showing the distribution of uterine fibroid among women of reproductive age in Jos, Plateau

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Table 2: Age related prevalence of uterine fibroid among women of reproductive age in Jos

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The study showed a significant positive relationship between nulliparity and the presence of fibroid (P = 0.043); 32.7% of the nulliparous patients have fibroid, while 22.0% of the parous patients have uterine fibroid [Table 3].
Table 3: Chi-square showing the relationship between parity and presence of uterine fibroid

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Fibroid characteristics

[Table 4] shows the descriptive analysis of the sonographically confirmed fibroid cases. The range and mean age of the patients (n = 83) sonographically confirmed to have fibroid were 21.00–48.00 years and 34.99 ± 6.96 years, respectively. The average number of fibroid nodules and volume of the largest nodule were 2.76 and 344.79 cm3, respectively.
Table 4: Descriptive analysis of the fibroid characteristics

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The study showed that 57.8% of the fibroids were intramural; 9.6% were submucosal and 86.7% were located within the uterine corpus with only 8.4% located at the cervical region. The most common (38.6%) pattern of presentation of the nodules was hypoechoic. [Table 5] demonstrates the fibroid classification and location as well as the sonographic pattern.
Table 5: Type, location and sonographic pattern of the fibroid

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Chi-square analysis table showed a positive relationship between the presence of fibroid and its location at the uterine corpus, which is statistically significant [Table 6].
Table 6: A Chi-square analysis showing relationship between the presence of fibroid and its location

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The study illustrated that 25.30% of the patients had myomectomy afterward [Figure 5]; histological findings revealed that all had leiomyoma [Table 7], for which cellular leiomyoma, and lipoleiomyoma accounted for 95.23% and 4.76% of the histological types, respectively [Table 8].
Figure 5: A pie chart showing myomectomy status among women with fibroid in Jos

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Table 7: Correlating the ultrasound and histological diagnosis for the patients that had myomectomy

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Table 8: Histological types of leiomyoma found postmyomectomy

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  Discussion Top


A total of 295 patients were recruited for the study and scanned; the imaging findings were analyzed out of which 83 patients representing 28.33% were confirmed to have fibroid. This finding is almost similar to the available data on studies done at Enugu[9] and Ghana,[14] which suggest that fibroids are the most common pelvic tumor in women, causing symptoms in approximately 25% of the reproductive age women with the overall prevalence of fibroids increasing to over 70%.

The range and mean age of the sample population (cases of confirmed fibroid; n = 83) were 21–48 years and 34.99 ± 6.96 years, respectively. The study showed that the highest prevalence (27.71%) occurred among women between the age of 31–35 years followed by 21.69% prevalence between 36 and 40 years, accounting for a cumulative prevalence of 49.4% in the fourth decade of life (i.e. 31–40 years). The above findings are consistent with available data on a study conducted in a West African country.[15] The current study showed that women between the age of 21–25 years and 46–50 year recorded same fibroid prevalence of 8.40% which suggest that uterine fibroid by sonography is more common among women in their midreproductive age and declines at the extremes of reproductive age. This study is in contrast with that of Lurie et al.,[20] which estimated the prevalence of uterine fibroid as 4% in women aged 20–30 years, 11% to 18% in women between 30 and 40 years, and 33% in women >40 years. Having uterine fibroid much younger may be related to a strong family history and the increased risk of uterine myoma in people of African origin.[3]

Chi-square analysis showed a significant positive relationship between nulliparity and the incidence of uterine fibroid; this lends credence to the saying that a nulliparous woman is five times at risk of developing uterine myoma.[9],[14],[16],[17],[18],[19],[21],[22],[23],[24],[25],[26]

The average number of fibroid nodules and volume of the largest were estimated as 2.76 and 56.83 cm3, respectively. These findings in women of child bearing age may be associated with symptoms such as dysmenorrhea, menorrhagia, and miscarriage. The average number (2.76) of nodules recorded in the sample population is lower than that reported in various literatures reviewed.[3],[7],[14]

The result in this study showed a significant positive association between the presence of fibroid and its location at the uterine corpus (P = 0.001); this corroborates the fact that fibroids arise from uterine muscle.[26],[27],[28],[29],[30],[31],[32],[33],[34],[35],[36],[37] Most (86.70%) of the fibroids were located within the corpus of the uterus with only 8.40% located at the cervix.

Fibroid nodules are mostly seen in different locations inside the uterus, within the walls of the uterus or outside of the uterus.[10],[27] Intramural fibroids located entirely within the uterine wall are noted to be the most common occurrence.[3],[7],[8],[9],[14] This is consistent with the current study (57.80%); it accounts for red degeneration, which manifests clinically as pain, especially in the pregnancy. Submucosal fibroids which recorded the least (9.60%) as seen in various studies[7],[8],[9],[14] is located beneath the mucosa or the endometrial lining of the uterus which is indirectly adjacent to the uterine cavity and are clinically noted as the greatest cause of irregular bleeding and poor reproductive out comes due to their closeness to the endometrium; it may also distort the endometrial lining based on its size.[3],[7],[9],[10],[27],[39],[40],[41],[42],[43],[44],[45] This often results in problems with implantation of the embryo and bleeding.[10],[27],[43],[44],[45],[46],[47],[48],[49],[50],[51],[52],[53],[54],[55]

Subserosal fibroids recorded the second highest (25.30%), which is consistent with the findings in many studies.[3],[7],[8],[9],[14] It lies beneath the serosa as they are located at the outer layer of the uterus and tend to distort the outer contour of the uterus.

The most common (38.6%) pattern of sonographic features of the fibroid nodules was hypoechoic. The hypoechogenic nodules reflect the early stage of fibroids and thus less calcification in the nodules. Isoechoic, hyperechoic, mix-echogenic, and cystic nodules accounted for 28.90%, 27.70%, 3.60%, and 1.20%, respectively. Hyperechogenicity, mix-echogenicity, and cystic appearance of the nodules are due to the various degenerative changes that occurred within the fibroid nodules.

This study also showed that 21 out of the 83 sonographically confirmed fibroid cases (25%) had myomectomy of which all were histologically diagnosed to be leiomyomas; cellular leiomyoma and lipoleiomyoma accounted for 95.23% (20) and 4.76% of the histological types, respectively, which is in keeping with the findings in a study done by Flake et al., buttressing the fact that the other histological types of leiomyoma are very rare.

The histological results showed no malignant transformation; this corroborate the fact that the rate of malignant transformation is negligible (0.13%–0.23%) as seen in a previous study.[38],[39],[43],[44],[45],[46]

Limitations of the study

  1. Some patients who should have benefited from SHG did not consent due to sociocultural and religious belief
  2. The patients were initially evaluated using abdominopelvic approach; thus, there is a tendency to miss very small fibroid nodules most especially ones that are isoechoic. This was taken care of by TVS and adjustment of the gain
  3. Some of the patients were obese and as such images obtained were suboptimal which may affect interpretation; this was also taken care of by TVS
  4. TVS is limited in the scanning of large uterine masses; this was overcome by merging the findings in TVS and abdominopelvic scan.



  Conclusion Top


Uterine fibroid has a prevalence of 28.3% in this study, which is about the same with values documented in studies done in some parts of South-South and South-East of Nigeria. The results showed a significant positive relationship between nulliparity and the presence of uterine fibroid. The average number of fibroid nodules and the largest were 2.76 and 56.8 cm3, respectively; intramural type accounted for 57.80% of the fibroid occurrence, while hypoechogenicity (38.60%) accounted for the common sonographic pattern. The characteristics of the fibroid and its location determine the clinical presentation and possibly the reproductive outcome of the patient. Postmyomectomy histological findings showed that cellular leiomyoma was the common (95.23%) histological type. No malignant transformation seen in this study.

Reproduction is indispensible in the sustenance of human existence; women of reproductive age constitute about 42.4% of the country's general work force.[56] The findings in this study will help in individualizing the management of the health of Nigerian women (with regard to fibroid) which is vital in the socioeconomic and numerical growth of the nation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
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