Ultrasound-guided percutaneous microwave ablation for adenomyosis: efficacy of treatment and effect on ovarian function

Abstract

A total of 142 premenopausal women with symptomatic adenomyosis underwent ultrasound (US)-guided percutaneous microwave ablation (PMWA) at the Chinese PLA General Hospital. This study aimed to evaluate changes in serum pituitary, gonadal hormone and cancer antigen 125 (CA125) levels after US-guided PMWA. Therefore, estradiol (E2), follicle-stimulating hormone (FSH), prolactin (PRL) and CA125 levels were evaluated before ablation and at 3, 6, 9 and 12 months after ablation. No significant differences were observed in the E2 and FSH levels pre-ablation and during follow-up (E2: p = 0.933, p = 0.987, p = 0.106, p = 0.936; FSH: p = 0.552, p = 0.295, p = 0.414, p = 0.760). The mean absolute values of serum CA125 and PRL were significantly decreased at 3, 6, 9 and 12 months after ablation (CA125: p < 0.001, p < 0.001, p < 0.001, p = 0.003; PRL: p < 0.001, p < 0.001, p < 0.001, p < 0.001). A significant correlation between changes in CA125 levels and uterine volume was found (p < 0.001). No evidence of a decline in ovarian function was observed after US-guided PMWA.

Percutaneous microwave ablation with artificial ascites for symptomatic uterine adenomyosis: initial experience

“…The results of our study demonstrate that MWA with artificial ascites is feasible and effective for the improvement of access to enable safe treatment in patients with adenomyosis. The median NPV ratio was 76%, which was similar to our previous experience without artificial ascites for adenomyosis [13]. However, our value was greater than the value reported by Ling (61%) with HIFU treatments for adenomyosis [9].…”

“…However, it is difficult to compare the present results with previous studies because the severity of the adenomyosis, follow-up period and criteria for defining the degrees of improvement are different. Depending on the series, 84.7-96.4% [7][8][9][10][11] of patients reportedly had overall improvements, including full, moderate or slight improvement of dysmenorrhoea and 79.8-93% improvement of menorrhagia at three months after the thermal ablation as described in the literature [7][8][9][10][11][12][13][14]. Our results are within the ranges reported.…”

“…However, the effect of this treatment modality upon fertility and ovary function remains to be determined [4][5][6]. Recently, image-guided tumour ablation techniques have been introduced for the treatment of adenomyosis [7][8][9][10][11][12][13][14]. The safety and efficacy of this relatively new strategy for adenomyosis are currently under evaluation.…”

“…In the case of uterine adenomyosis, the microwave ablation (MWA) can provide symptomatic relief and uterine volume reduction. It also has no influence on ovary function [13][14][15].…”

Anti-platelet therapy holds promises in treating adenomyosis: experimental evidence

“…Tissue factor plays a critical role in the initiation of platelet activation and coagulation [ 32 ]. In addition, considerable experimental data [ 33 , 34 ] and limited clinical data [ 35 ] support the involvement of hyperprolactinemia in adenomyosis, yet prolactin is a potent cofactor for platelet aggregation [ 36 , 37 ]. These data, taken together, seem to suggest that patients with adenomyosis may be in a hypercoagulable state as those with endometriosis [ 38 ].…”