Background: Radiofrequency ablation (RFA) has emerged as a safe and effective treatment option for women with symptomatic uterine fibroids and can be delivered by laparoscopic, transvaginal, or transcervical approaches. The evidence regarding typical patient outcomes with RFA has not previously been examined in a comprehensive fashion. Materials and Methods: We performed a systematic review of prospective studies for treatment of uterine fibroids with RFA. Main outcomes were procedure time, patient recovery metrics, change in fibroid volume, symptom severity score (SSS), health-related quality of life (HRQL), and reinterventions. Data were analyzed with random effects meta-analysis and metaregression. Results: We identified 32 articles of 1283 unique patients (median age: 42 years) treated with laparoscopic RFA (19 articles), transvaginal RFA (8 articles), or transcervical fibroid ablation (5 articles). Mean procedure time was 49 minutes, time to discharge was 8.2 hours, time to normal activities was 5.2 days, and time to return to work was 5.1 days. At 12 months follow-up, fibroid volume decreased by 66%, HRQL increased by 39 points, and SSS decreased by 42 points (all P < .001 versus baseline). The annual cumulative rate of reinterventions due to fibroid-related symptoms was 4.2%, 8.2%, and 11.5% through 3 years. Conclusions: RFA of uterine fibroids significantly reduces fibroid volume, provides significant durable improvements in fibroid-related quality of life, and is associated with favorable reintervention rates.
Most investigators comparing ligand-binding procedures for quantifying estrogen and progestin receptors in human breast cancer with procedures employing monoclonal antibody-based methods have utilized an inappropriate variety of reaction conditions, including the elimination of sodium molybdate in the steroid-binding assays. We studied 197 biopsies of human breast cancer, comparing the results of simultaneous measurements of both estrogen and progestin receptors in identical cytosols by enzyme immunoassay and by radioligand binding using the commercially available kits developed by Abbott Laboratories and by DuPont/NEN Products, respectively. Regression analyses comparing the results from the two procedures indicated a linear relationship, with correlation coefficients ranging from 0.79 to 0.93 for both types of receptors over a wide range of data. Using the widely established cutoff value of 10 fmol/mg of cytosol protein for the ligand-binding method, and calculating sensitivity and specificity limits according to McNeil et al. (1975), an equivalent cutoff value of 15 fmol/mg of cytosol protein was determined for the enzyme immunoassay of these receptors. Endocrine status of the patient did not appear to alter the cutoff values of either estrogen or progestin receptors when determined by enzyme immunoassay. We recommend that these cutoff values be considered until the results of clinical correlations are completed.
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