A pictorial review of ultrasonography of the FIGO classification for uterine leiomyomas

Uterine leiomyomas are the most common gynecological and pelvic neoplasm, reported in up to 80 percent of women by age 50. While the majority are asymptomatic, uterine leiomyomas, depending on size, number, and location can result in bulk symptoms, abnormal uterine bleeding (AUB), infertility or recurrent pregnancy loss. Ultrasonography (USG) remains first-line for the diagnosis of leiomyomas and is the most appropriate imaging modality for the initial assessment of abnormal uterine bleeding. In an effort to standardize nomenclature and identify causes of AUB, the International Federation of Gynecology and Obstetrics (FIGO) developed a classification system based on the acronym PALM-COEIN (polyp; adenomyosis; leiomyoma; malignancy and hyperplasia; coagulopathy; ovulatory dysfunction; endometrial; iatrogenic; and not yet classified). For the L category of leiomyoma, when present, a secondary and tertiary subclassification system is described distinguishing submucosal masses from others and categorizing the relationship of the mass to the endometrium and serosa. With advancements in newer minimally to non-invasive techniques developed for the management of leiomyomas, uniform characterization, mapping, and classification of leiomyomas is necessary to decide the optimal therapeutic approach. While this classification system has recently been reviewed on MR, to our knowledge, it has not been reviewed on ultrasound in the radiology literature. We hereby present a pictorial review of USG images of all the FIGO categories of leiomyomas to provide a standard guide for radiology reporting. Graphic abstract Similar content being viewed by others Data availability All the images are original and were acquired by the authors from the affiliated institution. Code availability Not applicable. Abbreviations - USG: - Ultrasonography - CT: - Computed tomography - MRI: - Magnetic resonance imaging - MRCP: - Magnetic resonance cholangiopancreatography - ERCP: - Endoscopic retrograde cholangiopancreatography - FIGO: - International Federation of Gynecology and Obstetrics

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Radiographics, 2008. 28(7): p. 1931–48. Munro, M.G., H.O. Critchley, and I.S. Fraser, The FIGO classification of causes of abnormal uterine bleeding in the reproductive years. Fertil Steril, 2011. 95(7): p. 2204–8, 2208.e1–3. Laughlin-Tommaso, S.K., et al., Clinical limitations of the International Federation of Gynecology and Obstetrics (FIGO) classification of uterine fibroids. Int J Gynaecol Obstet, 2017. 139(2): p. 143–148. Funding No funding was received to assist with the preparation of this manuscript. Author information Authors and Affiliations Contributions All the authors have contributed significantly in doing the literature review, writing, editing, and reviewing the manuscript. The idea of the article was given by Dr. SB. Literature review and preparation of the first draft was done by Dr. SB. Figures were acquired by Dr. SB, Dr. MJC and Dr. NG. Figure editing was done by Dr. SB, Dr. SB, Dr. MJC and Dr. NG critically revised the article for the preparation of the final manuscript. Corresponding author Ethics declarations Conflict of interest The authors have no conflicts of interest to declare. Consent for publication Not required for this paper. Consent to participate Not applicable. Ethical approval No IRB approval was needed for this article. Informed consent Not required for this paper. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions About this article Cite this article Bajaj, S., Gopal, N., Clingan, M.J. et al. A pictorial review of ultrasonography of the FIGO classification for uterine leiomyomas. Abdom Radiol 47, 341–351 (2022). https://doi.org/10.1007/s00261-021-03283-6 Received: Revised: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00261-021-03283-6