Clinical Predictors of Long-term Success in Ultrasound-guided High-intensity Focused Ultrasound Ablation Treatment for Adenomyosis

Abstract

The long-term outcomes of ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation treatment for adenomyosis and the relevant factors affecting the durability of symptom relief were assessed in this study.A total of 230 women with adenomyosis who were treated with USgHIFU ablation between January 2007 and December 2013 were retrospectively analyzed. The contrast-enhanced ultrasonography (CEUS) was performed immediately after the treatment to evaluate the ablation effect, and the nonperfused volume (NPV) ratio was then calculated. Regular follow-up was conducted and the visual analog scale (VAS) score was used to assess the changes in dysmenorrhea. The effect of treatment was evaluated after an average follow-up length of 3 months and the factors affecting clinical success and symptom relapse were identified.Of the 230 treated patients, 208 (90.4%) were followed up regularly, with a median follow-up length of 40 months (range, 18–94 months). Mean value of the NPV ratio calculated immediately after the treatment was 57.4 ± 24.4%. Varying degrees of symptomatic relief of dysmenorrhea based on the VAS scores were observed in 173 (83.2%) patients and 71.0% of the patients were asymptomatic during follow-up. Women with higher NPV ratio (OR = 0.964, 95% CI = 0.947–0.982, P = 0.000) and older age (OR = 0.342, 95% CI = 0.143–0.819, P = 0.016) were more likely to achieve clinical success. Dysmenorrhea recurred in 45 (26%) out of 173 cases; the median recurrence time was 12 months after treatment. The lower BMI (OR = 1.221, 95% CI = 1.079–1.381, P = 0.001) and the higher acoustic power (OR = 0.992, 95% CI = 0.986–0.998, P = 0.007) were associated with less risk of relapse. Twelve of the 14 patients who were retreated by USgHIFU ablation after experiencing dysmenorrhea recurrence achieved clinical success.USgHIFU ablation is an effective uterus-conserving treatment for symptomatic adenomyosis with an acceptable long-term success rate. Higher chance of clinical success can be achieved in patients with larger NPV ratio and older age, whereas higher BMI and lower acoustic power may result in a higher chance of recurrence. These factors are helpful in selecting suitable patients for USgHIFU and in predicting the durability of symptom relief.

Predictive Value of Quantitative Uterine Fibroid Perfusion Parameters From Contrast‐Enhanced Ultrasound for the Therapeutic Effect of High‐Intensity Focused Ultrasound Ablation

“…In the multivariate analysis of predictive factors associated with efficacy, we found that the abdominal wall thickness, fibroid volume, fibroid location in the uterus, enhancement time, enhancement intensity, and enhancement rate were independent predictive factors for the treatment outcome after HIFU. Several previous studies confirmed that the abdominal wall thickness, fibroid volume, and fibroid location in the uterus are significantly affected by the sonication dose and thus associated with the efficacy of HIFU . Therefore, we further confirmed that the enhancement rate is a predictive factor for the efficacy of HIFU, independent of conventional predictive factors.…”

High intensity focused ultrasound for the treatment of adenomyosis: selection criteria, efficacy, safety and fertility

“…Recently, Liu et al. and Shui et al. reported that common adverse effects after HIFU treatment include pain in the treated region, vaginal discharge, and mild sacral pain.…”

Current status of high-intensity focused ultrasound for the management of uterine adenomyosis

“…The criteria used in most studies can be summarized as follows: (1) premenopausal women of over 18 years of age with no plans for future childbearing [11-16]; (2) significant symptoms related to adenomyosis [11-17]; (3) features of adenomyosis on MR imaging [11,13-16]; (4) adenomyotic lesions greater than 3 cm but less than 10 cm in diameter [11,14]; (5) no evidence of known or suspected extensive pelvic adhesions, such as a history of acute pelvic inflammatory disease, severe pelvic endometriosis, or lower abdominal surgery [12-18]; and (6) body weight of less than 100 kg [16] or abdominal wall thickness of less than 5 cm [17]. …”

“…Two articles were excluded because their reported treatment(s) were likely duplicates of those reported in other articles [22,23]. Among the reviewed articles, seven were prospective cohort studies [11,12,14-16,18,21], three were retrospective reviews [13,17,20], and one was a case report [19]. All articles reported the degree of symptom improvement, but only four reported the degree of uterine volume or adenomyotic lesion reduction [11,12,14,17].…”