Ultrasound-guided microwave ablation for symptomatic adenomyosis: More areas of concern for more uniform and promising outcomes

Zhang, Huili; Yu, Song-Yuan; Xu, Huixiong

doi:10.1016/j.jimed.2022.06.001

Cited by 7 publications

(6 citation statements)

References 44 publications

(61 reference statements)

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“…Radiofrequency ablation (RFA) uses probes tipped with electrodes that deliver high‐frequency electrical energy to the tissue under laparoscopic and laparoscopic ultrasound direction 24 or transcervically utilizing the guidance provided by transvaginal ultrasound 25 . Microwave ablation involves the insertion of a microwave probe transcutaneously into the target under ultrasound guidance, 26 after which microwave energy is applied to destroy tissue. In contrast, HIFU does not require the insertion of a probe; instead, it is delivered transabdominally and targeted most often by MRI, although ultrasound‐guided systems are available in some countries 27 …”

Section: Procedural Interventionsmentioning

confidence: 99%

“…All three methods can be used on their own or in conjunction with the LNG‐IUS and/or GnRH agonists 21,22,26 ; this combined approach may have superior outcomes 22,23,26,91,92 . Although increasingly used, hyperthermic ablation still has limited availability worldwide 21 .…”

Section: Specific Therapeutic Applicationsmentioning

confidence: 99%

“…23,27 Radiofrequency ablation and microwave ablation require a shorter ablation time than HIFU and have been shown to cause a more significant reduction in uterine volume. 27 All three methods can be used on their own or in conjunction with the LNG-IUS and/or GnRH agonists 21,22,26 ; this combined approach may have superior outcomes. 22,23,26,91,92 Although increasingly used, hyperthermic ablation still has limited availability worldwide.…”

Section: Hyperthermic Ablationmentioning

confidence: 99%

“…27 All three methods can be used on their own or in conjunction with the LNG-IUS and/or GnRH agonists 21,22,26 ; this combined approach may have superior outcomes. 22,23,26,91,92 Although increasingly used, hyperthermic ablation still has limited availability worldwide. 21 Data demonstrating an effect on future fertility and pregnancy outcomes are currently insufficient, and more research is needed.…”

Section: Hyperthermic Ablationmentioning

confidence: 99%

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Therapeutic options for the management of abnormal uterine bleeding

MacGregor

Munro

Lumsden

2023

Intl J Gynecology & Obste

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Just as the investigation of abnormal uterine bleeding (AUB) is approached systematically using the two FIGO systems for AUB in the reproductive years, treatment options can be considered similarly. Therapeutic options fall into two categories—medical and surgical—and while medical management is typically regarded as first‐line therapy, there are several exceptions defined by the presenting cause or causes, mainly when infertility is a concurrent issue. In the early 1990s, up to 60% of women underwent a hysterectomy for the symptom of heavy menstrual bleeding (HMB), but this figure has decreased. The number of women undergoing a hysterectomy for benign disorders continues to decline, along with an increase in hysterectomies performed using minimally invasive techniques. Discussions about therapeutic options are tailored to the individual patient, and we include the risks and benefits of each option, including no management, to enable the patient to make an informed choice. The different types of treatment options and the factors affecting decision‐making are considered in this article.

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Section: Procedural Interventionsmentioning

confidence: 99%

Section: Specific Therapeutic Applicationsmentioning

confidence: 99%

Section: Hyperthermic Ablationmentioning

confidence: 99%

Section: Hyperthermic Ablationmentioning

confidence: 99%

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Therapeutic options for the management of abnormal uterine bleeding

MacGregor

Munro

Lumsden

2023

Intl J Gynecology & Obste

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“…The thermal effect produced by MWA induces coagulative necrosis in the viable tissue and micro-vessels within the targeted areas, leading to the reduction or elimination of the targeted lesions [11]. Numerous studies have demonstrated that MWA is a safe and effective alternative for the clinical treatment of symptomatic adenomyosis [12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Value of contrast-enhanced ultrasonography in microwave ablation treatment of symptomatic focal uterine adenomyosis

Li,

et al. 2024

Ultrasonography

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Purpose: This study evaluated the value of contrast-enhanced ultrasonography (CEUS) in the ultrasound-guided microwave ablation (MWA) treatment of symptomatic focal uterine adenomyosis.Methods: This retrospective study was conducted between March 2020 and January 2023, enrolling 52 patients with symptomatic focal uterine adenomyosis who had undergone MWA. All patients were examined with CEUS before and after MWA. The non-perfused volume (NPV) was compared between CEUS and dynamic contrast-enhanced magnetic resonance imaging (DCEMRI) following ablation. Therapeutic efficacy and safety were evaluated at 3-, 6-, and 12-month follow-ups. Additionally, this study explored the correlations between pre-treatment CEUS features and a volume reduction ratio indicating sufficient ablation, defined as 50% or more at the 3-month follow-up.Results: No significant differences in NPV were noted between CEUS and DCE-MRI immediately after MWA and during follow-up (all P>0.05). At the 3-month follow-up, the median VRRs for the uterus and adenomyosis were 33.2% and 63.9%, respectively. Sufficient ablation was achieved in 69.2% (36/52) of adenomyosis cases, while partial ablation was observed in the remaining 30.8% (16/52). The identification of non-enhancing areas on pre-treatment CEUS was associated with sufficient ablation (P=0.016). At the 12-month follow-up, significant decreases were observed in both the uterine and adenomyosis volumes (all P<0.001). Dysmenorrhea and menorrhagia were significantly alleviated at 12 months, and no major complications were encountered.Conclusion: CEUS can be used to evaluate the ablation zone of focal adenomyosis that has been treated with MWA, similarly to DCE-MRI. The identification of non-enhancing areas on pretreatment CEUS indicates satisfactory treatment outcomes.

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