Concordance of Preoperative Transvaginal Ultrasound and Intraoperative Findings in Fibroid Ablation Using Transcervical Ultrasound

OBJECTIVE: To evaluate concordance between the number of uterine fibroids deemed clinically significant on preoperative transvaginal sonography (TVS) and the number of fibroids treated intraoperatively during transcervical radiofrequency ablation (RFA) under intrauterine ultrasound guidance. METHODS: This is a retrospective, paired-sample cohort study that is conducted in two tertiary care centers. Sixty-seven women underwent transcervical RFA for symptomatic uterine fibroids. This study compares TVS-significant with intraoperatively treated fibroid counts. RESULTS: TVS identified a mean of 1.60 ± 0.94 clinically significant fibroids, whereas 1.90 ± 1.23 were treated intraoperatively (mean paired difference + 0.30; 95% CI 0.11-0.49, P = .0036). Intraoperative counts exceeded TVS in 28%, were identical in 66%, and were lower in 6% of patients. Categorized exact agreement was 73.1% with substantial concordance (weighted κ = 0.61; 95% CI 0.42-0.76). In the a priori multifibroid subgroup (≥2 clinically significant fibroids on TVS; n = 23), the mean paired difference (+0.26) was not statistically significant (P = .266). Treated fibroid count correlated strongly with TVS count (ρ = 0.72, P < .001) and modestly with ablation time (ρ = 0.26, P = .033), but not with postoperative changes in hemoglobin or inflammatory markers (all P > .10). CONCLUSION: Preoperative TVS demonstrates substantial diagnostic agreement with the fibroid burden treated during transcervical RFA. While TVS may numerically underrepresent the actionable fibroid count in a subset, systematic underestimation is not confirmed in multifibroid disease. The potential for intraoperative expansion should be considered during procedural planning.