Percutaneous High Frequency Microwave Ablation of Uterine Fibroids: Systematic Review

Abstract

Uterine fibroids are the most common benign pelvic tumor of the female genital tract and tend to increase with age; they cause menorrhagia, dysmenorrhea, pelvic pressure symptoms, back pain, and subfertility. Currently, the management is based mainly on medical or surgical approaches. The nonsurgical and minimally invasive therapies are emerging approaches that to the state of the art include uterine artery embolization (UAE), image-guided thermal ablation techniques like magnetic resonance-guided focused ultrasound surgery (MRgFUS) or radiofrequency ablation (RF), and percutaneous microwave ablation (PMWA). The purpose of the present review is to describe feasibility results and safety of PMWA according to largest studies available in current literature. Moreover technical aspects of the procedure were analyzed providing important data on large scale about potential efficacy of PMWA in clinical setting. However larger studies with international registries and randomized, prospective trials are still needed to better demonstrate the expanding benefits of PMWA in the management of uterine fibroids.

Ultrasound-guided Microwave Ablation in the Management of Symptomatic Uterine Myomas: A Systematic Review and Meta-analysis

“…These treatments can create a continuous range of ablation sizes up to 5.0 cm diameter in a single application and there are no prohibitions to multiple ablations within a single fibroid [36]. In comparison, MWA can achieve larger areas of ablation (up to 6 cm in diameter) in single access with a single antenna [37].…”

Myoma Expulsion after Uterine Artery Embolization

“…Leiomyomas can be classified based upon their location within the uterine wall into four types: submucous, intramural, subserous, and transmural. Pedunculated submucous, transmural, and submucous tumors have a higher risk for expulsion after embolization; therefore, determining the precise location of the fibroid is extremely important [12][13][14]. Knowledge in anatomical variations of uterine artery's origin is extremely necessary, especially for surgeons and interventional radiologists.…”

Successful Transvaginal Microwave Ablation of a Heterotopic Cervical Pregnancy. A Case Report

“…Microwave ablation is largely used to treat solid tumors and has demonstrated to be a precise and safe technique with many potential advantages as it allows to obtain predictable spherical ablation volume, immediate evidence of tissue coagulation on ultrasound, and blood vessels in the coagulation area that do not create ablation zone distortion because of the minimal heat sink effect. The microwaves produced by the system penetrate into targeted tissues causing its coagulative necrosis when the temperature increases [ 4 – 6 ]. In pregnancy, thus far MWA has been used to perform selective feticide in monochorionic diamnotic twin pregnancies [ 7 , 8 ] including cases of twin reversed arterial perfusion [ 8 , 9 ] and to treat successfully a rare case of diaphragmatic ectopic pregnancy [ 10 ].…”