Quality of ultrasonography reporting and factors associated with selection of imaging modality for uterine fibroids in Canada: results from a prospective cohort registry

Abstract

Background: Uterine fibroids are common in women and their management is heavily influenced by information gathered through imaging. We aimed to evaluate the type and quality of imaging performed for assessment of uterine fibroids in Canada.

Methods: Starting in July 2015, premenopausal women with symptomatic fibroids were enrolled in a prospective, noninterventional, observational registry (Canadian Women With Uterine Fibroids Registry [CAPTURE]) that included 19 Canadian sites. Clinical characteristics were extracted from the baseline visit. We evaluated the association between demographic and clinical variables of interest with regard to imaging type using unadjusted and adjusted logistic regression models.

Results: Of 1493 women, 1148 had ultrasonography, 135 had magnetic resonance imaging (MRI), 80 had other types of imaging and 130 did not have imaging reported within 12 months of the baseline visit. After adjusting for demographic and clinical characteristics, patients who underwent MRI had larger fibroids (odds ratio [OR] per 1-cm increase 1.11, 95% confidence interval [CI] 1.05-1.17) and more numerous fibroids (1 v. > 1; OR 1.74, 95% CI 1.14-2.64) compared with those who underwent ultrasonography only. For ultrasonography reporting, quality criteria were met for 268 of 1148 patients (23.3%). There was a difference in the quality of reporting among the 19 sites (p < 0.001). Logistic regression model accounting for within-site variability showed that reporting results from ultrasonography in the province of Quebec were less likely to meet all quality criteria (OR 0.20, 95% CI 0.06-0.66) and those from sites in more populated cities (≥ 400 000 inhabitants) were more likely to do so (OR 6.15, 95% CI 2.20-17.18).

Interpretation: We determined that imaging modality for fibroids is associated with patient characteristics. The quality of reporting results for ultrasonography of fibroids in Canada falls short of internationally endorsed guidelines and needs improvement.

Study registration: ClinicalTrials.gov, no. NCT02580578.

Conflict of interest statement

Competing interests: Olga Bougie has presented at continuing medical education events sponsored by Allergan Canada, Bayer, Hologic and AbbVie. Mohamed Bedaiwy is a member of the advisory boards for AbbVie and Allergan. Philippe Laberge is the Chair of the CAPTURE study and a consultant for Allergan, AbbVie, Hologic, Medtronic, Minerva and Olympus. Nicholas Leyland has received research support from Allergan and AbbVie. Ally Murji is a member of Speaker Bureaus and advisory boards for AbbVie, Allergan, Bayer and Hologic. No other competing interests were declared.

Copyright 2020, Joule Inc. or its licensors.

Figures

Figure 1:

Distribution of ultrasonography reports that met each quality criterion. Note: Bold horizontal bars are the medians, lower and upper horizontal bars of the box are the first and third quartiles, short horizontal lines (whiskers) represent either 1.5 times the interquartile range (IQR) or the minimum and maximum as appropriate. A dot represents an outlier falling outside the whisker (1.5 × IQR).

Figure 2:

Site-specific rates (in ascending order) of high-quality reporting of ultrasonography results (per 100 procedures). Note: Each bar represents an individual Canadian Women with Uterine Fibroids Registry (CAPTURE) site, the identity of which is kept anonymous. Each bullet point is the site estimate and the vertical line is a 95% confidence interval based on the exact binomial distribution. The horizontal dashed line is the overall (across all subjects) average.