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Bertogli H, Lucot JP, Lafourcade J, Warembourg S, Detchev R, Nguyen Ba E, Dubernard G, Philip CA. [Laparoscopic ultrasound-guided radiofrequency ablation of uterine fibroid: A retrospective study]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024; 52:495-504. [PMID: 38604536 DOI: 10.1016/j.gofs.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 03/31/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE To assess clinical and radiological efficacy and safety of laparoscopic ultrasound-guided radiofrequency ablation of uterine leiomyomas. MATERIAL AND METHODS Thirty-three patients with symptomatic uterine leiomyomas FIGO type 2 to 7, have undergone a laparoscopic ultrasound-guided radiofrequency ablation at Croix Rousse University Hospital Center (Hospices civils de Lyon) and at Saint-Vincent de Paul Hospital in Lille, between June 2020 and December 2022. The characteristics of each myoma and the symptoms were assessed with pelvic MRI and with Higham score, SSS and HRQL scores preoperatively and at 6 months. RESULTS A total of 54 fibroids have been treated in 33 patients. We observed a significant decrease of the volume 6 months after the surgery, on average 21mL (55.97 vs. 74.37mL, 95% CI [7.13-34.88], P=0.001). The maximum diameter of each fibroid was also significantly reduced on average 11.78mm (41.89 vs. 52.06, 95% CI [8.83-14.73], P<0.05). We noticed a significant decrease of the NRS for dysmenorrhea on average 2.79 points (2.1 vs. 4.89, 95% CI [1.14-4.42], P<0.05). There was also a trend to improvement of menorrhagia, assess by Higham score. Indeed, 70.8% of the patients had menorrhagia. Menorrhagia was improved of 108,3 points with an average Higham score before surgery of 197.3 versus 87.9 after surgery (95% CI [47.9-168.8], P=0.001). Concerning UFS-QOL score: the symptom severity score (SSS) decreased on average 33 points, testifying of symptom improvement (27.04 vs. 60.89, 95% CI [22.92-43.39], P<0.001) and the HRQL score increased on average 20 points testifying quality of life improvement (65.57 vs. 42.7, 95% CI [15.83-37.85]. P<0.001). No severe adverse event has been reported. CONCLUSION In this first French study about radiofrequency ablation. We confirm its efficiency for improvement of symptoms and quality of life but other study is mandatory to confirm the safety of this procedure in particular in patients with a wish to conceive.
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Affiliation(s)
- Helloïse Bertogli
- Hospices civils de Lyon, Croix Rousse Hospital, 103, grande rue de la Croix Rousse, 69004 Lyon, France
| | | | | | - Sophie Warembourg
- Hospices civils de Lyon, Croix Rousse Hospital, 103, grande rue de la Croix Rousse, 69004 Lyon, France
| | | | - Emilie Nguyen Ba
- Hospices civils de Lyon, Croix Rousse Hospital, 103, grande rue de la Croix Rousse, 69004 Lyon, France
| | - Gil Dubernard
- Hospices civils de Lyon, Croix Rousse Hospital, 103, grande rue de la Croix Rousse, 69004 Lyon, France
| | - Charles-André Philip
- Hospices civils de Lyon, Croix Rousse Hospital, 103, grande rue de la Croix Rousse, 69004 Lyon, France.
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Escalante Ariza D, Rodríguez García I, Ávila Cabreja JA, Hidalgo Carmona E. Outcomes of transvaginal radiofrequency ablation for symptomatic leiomyomas. J Gynecol Obstet Hum Reprod 2024; 53:102812. [PMID: 38851321 DOI: 10.1016/j.jogoh.2024.102812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/01/2024] [Accepted: 06/05/2024] [Indexed: 06/10/2024]
Abstract
OBJECTIVE Describe the effect of transvaginal radiofrequency ablation for leiomyoma in symptomatic patients and post procedure follow-up. MATERIAL AND METHODS A retrospective forward-looking observational study was performed including 63 patients who underwent transvaginal radiofrequency ablation between January 2016 and December 2022 at San Cecilio University Hospital in Granada, Spain. The variables registered were: age, parity, the clinical features that lead to the medical visit and pre-surgical treatment. Prior to the procedure, leiomyoma location and volume were determined by transvaginal ultrasound. Follow-ups were scheduled at 6 and 12 months to evaluate symptom improvement, adverse outcomes, leiomyoma volume and if any necessary post-surgical treatment was required. RESULTS Mean leiomyoma volume at baseline, 6 months and 12 months was 83.3 (24.9-130.7), 42.4 (4.7-89.0) and 19.2 (1.9-80.4) cm3, respectively (p < .001). Significant differences were found between the baseline and 12 month visits (p < .001). At the annual follow-up, the mean rate of volume reduction was 79.5 %, being higher in women who reported symptom improvement compared to those who reported no change in symptom intensity from baseline (84.6% vs. 30.8 %). Patients with a lower initial volume and age over 40 were more likely to have treatment efficacy. 8 pregnancies were registered post procedure. CONCLUSION Radiofrequency is well tolerated, allowing for same-day discharge, rapid recovery and a safe approach for women who want to preserve their reproductive potential. Initial volume and age over 40 appear to be factors that should be considered in patient selection. Further studies are needed to continue evaluating the outcomes and identifying predictive factors.
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Affiliation(s)
- Daniela Escalante Ariza
- From the Department of Obstetrics and Gynecology, San Cecilio University Hospital, Avenida del Conocimiento s/n, Granada, 18016, Spain.
| | - Isabel Rodríguez García
- From the Department of Obstetrics and Gynecology, San Cecilio University Hospital, Avenida del Conocimiento s/n, Granada, 18016, Spain
| | - José Alejandro Ávila Cabreja
- From the Department of Obstetrics and Gynecology, San Cecilio University Hospital, Avenida del Conocimiento s/n, Granada, 18016, Spain
| | - Esther Hidalgo Carmona
- From the Department of Obstetrics and Gynecology, San Cecilio University Hospital, Avenida del Conocimiento s/n, Granada, 18016, Spain
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Vitale SG, Saponara S, Sicilia G, Klarić M, Sorrentino F, D'Alterio MN, Nappi L, Angioni S. Hysteroscopic diode laser myolysis: from a case series to literature review of incisionless myolysis techniques for managing heavy menstrual bleeding in premenopausal women. Arch Gynecol Obstet 2024; 309:949-959. [PMID: 37831177 PMCID: PMC10866768 DOI: 10.1007/s00404-023-07218-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 09/02/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE This case series examined the safety and effectiveness of hysteroscopic myolysis using laser-induced interstitial thermo-therapy (LITT) for treating heavy menstrual bleeding (HMB) in premenopausal women with FIGO type 1 or 2 uterine fibroids, not planning for future fertility. Additionally, a comprehensive review of innovative, minimally invasive, incisionless myolysis techniques was conducted. METHODS Women with HMB, sonographically diagnosed with a single FIGO type 1 or 2 fibroid, underwent hysteroscopic myolysis using the Leonardo® diode laser. Effectiveness was assessed via transvaginal ultrasound measurement of myoma size, volume and vascularization pre and post-procedure. Moreover, we also evaluated any improvements in symptoms using the Pictorial Blood Loss Assessment Chart (PBAC score) scores. RESULTS The procedure resulted in significant HMB reductions and noticeable fibroid size, volume, and vascularization decrease in all three patients, with no reported complications. The literature review revealed both advantages and limitations of the minimally invasive, incisionless myolysis techniques. CONCLUSIONS Hysteroscopic laser myolysis is a safe and effective therapeutic intervention for patients experiencing HMB, diagnosed with FIGO type 1 or 2 fibroids, and not planning for future fertility. The procedure resulted in significant reductions in menstrual blood loss and fibroid size. Despite the promising results, it is essential to note the limitations of this report, including its case series design, a small number of patients, and a short follow-up period. Further research is necessary to confirm these results.
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Affiliation(s)
- Salvatore Giovanni Vitale
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Stefania Saponara
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
| | - Gilda Sicilia
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Marko Klarić
- Clinical Hospital Center of Rijeka, Department of Obstetrics and Gynaecology, Rijeka, Croatia
| | - Felice Sorrentino
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynaecology, University of Foggia, Foggia, Italy
| | - Maurizio Nicola D'Alterio
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Luigi Nappi
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynaecology, University of Foggia, Foggia, Italy
| | - Stefano Angioni
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
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Santalla-Hernández A, Naveiro-Fuentes M, Benito-Villena R, Villegas-Alcazar J, López-Criado MS, Lara-Serrano A, Parra JF, Alcázar JL, Pelayo-Delgado I. Complications of transvaginal radiofrequency ablation of fibroids: A 5-year experience. Eur J Obstet Gynecol Reprod Biol X 2023; 20:100244. [PMID: 37869066 PMCID: PMC10587728 DOI: 10.1016/j.eurox.2023.100244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023] Open
Abstract
Introduction Transvaginal radiofrequency ablation is a relatively noninvasive approach for the treatment of fibroids in patients who do not wish to undergo conventional surgery. Information on potential complications of this novel technique is very scarce. Methods Retrospective, descriptive, epidemiological study of 115 patients who underwent transvaginal radiofrequency ablation of fibroids and for whom complications were recorded. Results We performed 115 transvaginal radiofrequency ablation procedures, we recorded a total of 11 complications (9.6%; 95% CI, 3.8-14.8). Of these, 8 (7.0%) were classified as Clavien-Dindo type I, 1 (0.9%,) as type II, and 2 (1.7%) as type IIIb (severe). No other complications were recorded in a year follow-up. Conclusion Transvaginal radiofrequency ablation is a treatment option that makes it possible to treat fibroids that are difficult to manage using other techniques. Few associated complications have been described, and most of them are mild.
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Affiliation(s)
- Angel Santalla-Hernández
- Obstetrics and Gynecology department, Virgen de las Nieves University Hospital, 18014 Granada, Spain
| | - Mariña Naveiro-Fuentes
- Obstetrics and Gynecology department, Virgen de las Nieves University Hospital, 18014 Granada, Spain
| | - Rebeca Benito-Villena
- Obstetrics and Gynecology department, Virgen de las Nieves University Hospital, 18014 Granada, Spain
| | - Jesus Villegas-Alcazar
- Obstetrics and Gynecology department, Virgen de las Nieves University Hospital, 18014 Granada, Spain
| | | | - Ana Lara-Serrano
- Obstetrics and Gynecology department, Virgen de las Nieves University Hospital, 18014 Granada, Spain
| | - Jorge Fernández Parra
- Obstetrics and Gynecology department, Virgen de las Nieves University Hospital, 18014 Granada, Spain
- PhD. Program in clinical medicine and Public Health, University of Granada,18006 Granada, Spain
| | - Juan Luis Alcázar
- Obstetrics and Gynecology Department. Clínica Universidad de Navarra, 31008 Pamplona, Spain
| | - Irene Pelayo-Delgado
- Obstetrics and Gynecology Department, Ramón y Cajal University Hospital, Faculty of Medicine Alcala de Henares University, 28034 Madrid, Spain
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Akhatova A, Aimagambetova G, Bapayeva G, Laganà AS, Chiantera V, Oppelt P, Sarria-Santamera A, Terzic M. Reproductive and Obstetric Outcomes after UAE, HIFU, and TFA of Uterine Fibroids: Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20054480. [PMID: 36901489 PMCID: PMC10001943 DOI: 10.3390/ijerph20054480] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/24/2023] [Accepted: 03/01/2023] [Indexed: 06/07/2023]
Abstract
Novel treatment options for uterine fibroids, such as uterine artery embolization (UAE), ultrasound-guided and magnetic resonance-guided high-intensity focused ultrasound (USgHIFU and MRgHIFU), and transcervical radiofrequency ablation (TFA) methods, are widely used in clinical practice. This systematic review and meta-analysis (CRD42022297312) aims to assess and compare reproductive and obstetric outcomes in women who underwent these minimally invasive approaches for uterine fibroids. The search was performed in PubMed, Google Scholar, ScienceDirect, Cochrane Library, Scopus, Web of Science and Embase. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) and Cochrane guidelines. The articles were selected to meet the following eligibility criteria: (1) research article, (2) human subject research, and (3) the study of pregnancy outcomes after the treatment of uterine fibroids by either one of three methods-UAE, HIFU, and TFA. The analysis of 25 eligible original articles shows a similar rate of live births for UAE, USgHIFU, MRgHIFU, and TFA (70.8%, 73.5%, 70%, and 75%, respectively). The number of pregnancies varied considerably among these studies, as well as the mean age of pregnant women. However, the results of pregnancy outcomes for TFA are insufficient to draw firm conclusions, since only 24 women became pregnant in these studies, resulting in three live births. The miscarriage rate was highest in the UAE group (19.2%). USgHIFU was associated with a higher rate of placental abnormalities compared to UAE (2.8% vs. 1.6%). The pooled estimate of pregnancies was 17.31% to 44.52% after UAE, 18.69% to 78.53% after HIFU, and 2.09% to 7.63% after TFA. The available evidence confirmed that these minimally invasive uterine-sparing treatment options for uterine fibroids are a good approach for patients wishing to preserve their fertility, with comparable reproductive and obstetric outcomes among the different techniques.
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Affiliation(s)
- Ayazhan Akhatova
- School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street 5/1, Astana 010000, Kazakhstan
| | - Gulzhanat Aimagambetova
- Department of Surgery, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street 5/1, Astana 010000, Kazakhstan
| | - Gauri Bapayeva
- Clinical Academic Department of Women’s Health, CF “University Medical Center”, Turan Ave. 32, Astana 010000, Kazakhstan
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS “Civico–Di Cristina–Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS “Civico–Di Cristina–Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Peter Oppelt
- Department of Gynecology, Obstetrics and Gynecologic Endocrinology, Kepler University Hospital, Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
| | - Antonio Sarria-Santamera
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street 5/1, Astana 010000, Kazakhstan
| | - Milan Terzic
- Department of Surgery, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street 5/1, Astana 010000, Kazakhstan
- Clinical Academic Department of Women’s Health, CF “University Medical Center”, Turan Ave. 32, Astana 010000, Kazakhstan
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, 300 Halket Street, Pittsburgh, PA 15213, USA
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Lin M, He J, Lyu G, Li Z, Li X, Qiu S, Chen S, Zhang T, Wang J, Li S. Combined transabdominal and transvaginal ultrasound-guided percutaneous microwave ablation of uterine myomas: an effective monitoring technique. Int J Hyperthermia 2022; 40:2154576. [PMID: 36535945 DOI: 10.1080/02656736.2022.2154576] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE This study compared the feasibility and efficacy of transabdominal ultrasound (TAU) and combined transabdominal and transvaginal ultrasound (TA/TV US)-guided percutaneous microwave ablation (PMWA) for uterine myoma (UM). METHOD This study enrolled 73 patients with UM who underwent PMWA via the transabdominal ultrasound-guided (TA group) or the combined transabdominal and transvaginal ultrasound-guided (TA/TV group) approaches. The intraoperative supplementary ablation rates, postoperative immediate ablation rates, lesion reduction rates and other indicators three months postoperatively were compared between the groups. The display of the needle tip, endometrium, uterine serosa, rectum and myoma feeding vessels under the guidance of TAU, transvaginal ultrasound (TVU) and TA/TV US were evaluated in the TA/TV group. RESULTS In the TA/TV group, the real-time position of the needle tip and the endometrium complete display rate of the same lesions with TVU guidance were significantly higher than those using TAU. TA/TV US guidance significantly improved the complete display rate of each indicator. The intraoperative supplementary ablation rate in the TA/TV group was lower than that in the TA group. Similarly, the postoperative immediate ablation and volume reduction rates of the lesions three months postoperatively were higher than those in the TA group, especially for lesions with a maximum diameter ≥6 cm. CONCLUSION TA/TV US is an effective monitoring method that can be used to improve imaging display. Its use is recommended in patients with obesity, poor transabdominal ultrasound image quality and large myoma volumes.
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Affiliation(s)
- Min Lin
- Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Jinghua He
- Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Guorong Lyu
- Collaborative Innovation Centre for Maternal and Infant Health Service Application Technology, Quanzhou Medical College, Quanzhou, China.,Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Zuolin Li
- Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Xiaolian Li
- Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Sihua Qiu
- Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Shujin Chen
- Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Tingting Zhang
- Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Jinyong Wang
- Department of Gynecology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Shuiping Li
- Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
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Polin M, Hur HC. Radiofrequency Ablation of Uterine Fibroids and Pregnancy Outcomes: An Updated Review of the Literature. J Minim Invasive Gynecol 2022; 29:709-715. [PMID: 35123041 DOI: 10.1016/j.jmig.2022.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/06/2022] [Accepted: 01/23/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To provide a systematic review of pregnancy outcomes after radiofrequency ablation of uterine fibroids. DATA SOURCES A literature search was conducted using PubMed, Cochrane Library, Scopus, Web of Science, and EMBASE, from database inception until October 2021. METHODS OF STUDY SELECTION Two reviewers conducted independent literature searches. Studies that met criteria based on title and abstract underwent full text review. Publications were included if they reported pregnancies and obstetric outcomes after laparoscopic or transcervical radiofrequency ablation (RFA) of fibroids. TABULATION, INTEGRATION, AND RESULTS 405 publications were initially identified and screened, 39 underwent full text review, and 10 publications were ultimately included. There were 50 pregnancies reported among 923 RFA patients: 40 pregnancies after 559 laparoscopic RFAs and 10 pregnancies after 364 transcervical RFAs. The number of patients from these studies actively trying to conceive after RFA is unknown. Among the RFA patients who conceived, the average age at ablation was 37 years old (range 27 to 46 years). The majority of patients had between 1 and 3 fibroids ablated, and fibroid size ranged from less than 2 centimeters to 12.5 centimeters. There were 6 spontaneous abortions (12%) and 44 full-term pregnancies (88%), of which 24 were vaginal deliveries and 20 were cesarean deliveries. There were only 2 complications among 44 deliveries: 1 placenta previa that underwent an uncomplicated cesarean delivery and 1 delayed postpartum hemorrhage with expulsion of a degenerated myoma, with no long-term sequelae. There were no cases of uterine rupture, uterine window, or invasive placentation, and no fetal complications. The spontaneous abortion rate was comparable to the general obstetric population. CONCLUSION Almost all pregnancies after radiofrequency ablation of fibroids were full-term deliveries with no maternal or neonatal complications. These findings add to the literature that radiofrequency fibroid ablation may offer a safe and effective alternative to existing treatments for women who desire future fertility.
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Affiliation(s)
- Melanie Polin
- Department of Obstetrics and Gynecology, Division of Gynecologic Specialty Surgery, Columbia University Irving Medical Center, New York, New York.
| | - Hye-Chun Hur
- Department of Obstetrics and Gynecology, Division of Gynecologic Specialty Surgery, Columbia University Irving Medical Center, New York, New York
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Perforación intestinal tras ablación por radiofrecuencia de mioma uterino. Reporte de caso y revisión bibliográfica. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2022. [DOI: 10.1016/j.gine.2021.100715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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9
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Santalla-Hernández Á, Naveiro-Fuentes M, Benito-Villena R, López-Criado MS, González-Paredes A, Parra JF. Efficacy, Complications and Factors Predictive of Response to Treatment with Transvaginal Radiofrequency Ablation for Symptomatic Uterine Myomas. J Minim Invasive Gynecol 2022; 29:743-752. [DOI: 10.1016/j.jmig.2022.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 10/19/2022]
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10
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Zhang J, Go VA, Blanck JF, Singh B. A Systematic Review of Minimally Invasive Treatments for Uterine Fibroid-Related Bleeding. Reprod Sci 2021; 29:2786-2809. [PMID: 34480321 DOI: 10.1007/s43032-021-00722-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/22/2021] [Indexed: 12/09/2022]
Abstract
Newer minimally invasive techniques provide treatment options for symptomatic uterine fibroids while allowing uterus preservation. The objective of this review was to analyze the efficacy of uterine-preserving, minimally invasive treatment modalities in reducing fibroid-related bleeding. A comprehensive search was conducted of PubMed, Embase, PsycINFO, ClinicalTrials.gov, Scopus, and Cochrane Library databases from inception to July 2020. English-language publications that evaluated premenopausal women with fibroid-related bleeding symptoms before and after treatment were considered. Randomized controlled trials were assessed for bias with the established Cochrane Risk of Bias Tool 2.0 and observational studies were assessed for quality under the New Castle-Ottawa Scale guidelines. Eighty-four studies were included in the review, including 10 randomized controlled trials and 74 observational studies. Six studies on myomectomy demonstrated overall bleeding symptom improvement in up to 95.9% of patients, though there was no significant difference between mode of myomectomy. Forty-one studies on uterine artery embolization reported significant reduction of fibroid-related bleeding, with symptomatic improvement in 79 to 98.5% of patients. Three studies suggested that embolization may be superior to myomectomy in reducing fibroid-related bleeding. Six studies reported that laparoscopic uterine artery occlusion combined with myomectomy led to greater reduction of bleeding than myomectomy alone. Fifteen studies demonstrated significantly reduced bleeding severity after radiofrequency ablation (RFA). Additional research is needed to establish the superiority of these modalities over one another. Long-term evidence is limited in current literature for magnetic resonance-guided focused ultrasound surgery, cryomyolysis, microwave ablation, and laser ablation.
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Affiliation(s)
- Jiahui Zhang
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Virginia-Arlene Go
- Department of Obstetrics and Gynecology, Saint Joseph Hospital Denver, Denver, CO, USA
| | - Jaime Friel Blanck
- Informationist Services, Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bhuchitra Singh
- Division of Reproductive Sciences & Women's Health Research, Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Rodríguez J, Isern J, Pons N, Carmona A, Vallejo E, Cassadó J, De Marcos JA, Paraira M, Giménez N, Pessarrodona A. Pregnancy outcomes after ultrasound-guided high-intensity focused ultrasound (USgHIFU) for conservative treatment of uterine fibroids: experience of a single institution. Int J Hyperthermia 2021; 38:9-17. [PMID: 34420443 DOI: 10.1080/02656736.2021.1908633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To assess the impact of ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation for uterine fibroids on fertility. MATERIAL AND METHODS A retrospective observational study was conducted of 560 reproductive-age women with symptomatic uterine fibroids who underwent USgHIFU therapy at Mútua Terrassa University Hospital, Spain, between February 2008 and February 2018. We analyzed pregnancy outcomes including time to conception, pregnancy approach, gestational age, delivery mode, neonatal outcomes and complications during pregnancy and delivery. RESULTS After USgHIFU treatment, 71 pregnancies were obtained in 55 patients. Of these, 58 (82%) cases were natural pregnancies and 13 (18%) were in vitro fertilization (IVF) pregnancies. The median time to conception was 12 (range 1-72) months. There were 43 (61%) successful deliveries, including a twin gestation, 22 (31%) spontaneous abortions and 6 (8%) therapeutic abortions. The rate of full-term deliveries was 91% (39/43) and the remaining 9% (4/43) were preterm deliveries. Of the 44 live births, 25 (57%) were born vaginally and 19 (43%) by cesarean section. The complications reported included 3 women with retained placenta (7%), 2 with placenta previa (5%) and 1 with severe preeclampsia (2%). The mean birth weight was 3.1 (range: 1.4-4.3) kg, and except for a baby born with a tetralogy of Fallot, all newborns developed well without complications during postpartum and breastfeeding. CONCLUSION Patients undergoing USgHIFU treatment of uterine fibroids can achieve full-term pregnancies with few intrapartum or postpartum complications. More studies are required to compare fertility and perinatal outcomes between patients who underwent or not USgHIFU.
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Affiliation(s)
- J Rodríguez
- HIFU Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain.,Department of Obstetrics and Gynecology, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - J Isern
- HIFU Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain.,Department of Obstetrics and Gynecology, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - N Pons
- HIFU Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain.,Department of Obstetrics and Gynecology, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - A Carmona
- HIFU Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain.,Department of Obstetrics and Gynecology, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - E Vallejo
- Department of Obstetrics and Gynecology, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - J Cassadó
- Department of Obstetrics and Gynecology, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - J A De Marcos
- Department of Radiology, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - M Paraira
- Department of Radiology, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - N Giménez
- Research Unit, Research Foundation Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain
| | - A Pessarrodona
- HIFU Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain.,Department of Obstetrics and Gynecology, Hospital Universitari Mútua Terrassa, Barcelona, Spain
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12
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Hai N, Hou Q, Dong X, Guo R. Comparison between radiofrequency ablation combined with mifepristone and radiofrequency ablation for large uterine fibroids. Int J Hyperthermia 2021; 38:777-780. [PMID: 33980123 DOI: 10.1080/02656736.2021.1922763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To evaluate the clinical outcomes of transvaginal ultrasound-guided (US-guided) radiofrequency ablation (RFA) combined with mifepristone for the treatment of large uterine fibroids. METHODS Between June 2016 and December 2018, a total of 30 patients with symptomatic uterine fibroids (≥5cm) who underwent transvaginal US-guided RFA combined with mifepristone were included in this retrospective study. A matching cohort of 30 patients underwent transvaginal US-guided RFA without mifepristone as controls. The technical efficacy, complications and mid-term treatment effectiveness were assessed and compared with the controls. RESULTS The mean volume of uterine fibroid was 168.3 ± 40.1 cm3. The mean ablation time was 23.5 ± 11.3 min in the combined treatment group, which was demonstrably less than that of the RFA group, which was 45.7 ± 6.8 min. The mean number of punctures was 2.2 ± 0.6 in the combined treatment group, which was significantly less than that of the RFA group. No major complications occurred. The mean percentages of regression of fibroid at 3 and 12 months after the course of the combined treatment were 73.3% and 90.1%, respectively, which were significantly more than those of the RFA group. Quality of life and symptom scores improved in both groups but to a greater extent in the combined treatment group. CONCLUSIONS US-guided RFA combined with mifepristone might be a simple, safe and effective alternative for the treatment of large uterine fibroids.
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Affiliation(s)
- Ning Hai
- Department of Ultrasound, Beijing Chaoyang Hospital Capital Medical University, Beijing, PR China.,Department of Gynecology, the PLA Rocket Force General Hospital, Beijing, PR China
| | - Qingxiang Hou
- Department of Gynecology, the PLA Rocket Force General Hospital, Beijing, PR China
| | - Xiangping Dong
- Department of Gynecology, the PLA Rocket Force General Hospital, Beijing, PR China
| | - Ruijun Guo
- Department of Ultrasound, Beijing Chaoyang Hospital Capital Medical University, Beijing, PR China
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13
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Ierardi AM, Carnevale A, Pellegrino F, Stefano GD, Bonelli C, Renzulli M, Giganti M, Carrafiello G. Uterine Myomas: Extravascular Treatment. Semin Ultrasound CT MR 2020; 42:56-74. [PMID: 33541590 DOI: 10.1053/j.sult.2020.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Uterine fibroids are common benign tumors that affect the female reproductive tract. They are responsible for considerable morbidity and deterioration of life quality. The main advantages offered by mini invasive techniques are low grade of invasiveness and short times of hospitalization. The most diffuse technique is uterine artery embolization (UAE). Common concerns with UAE include postprocedural pain, postembolization syndrome, and risk of infection. Image-guided thermal ablation techniques like radiofrequency ablation, percutaneous microwave ablation, and imaging-guided high-intensity focused ultrasound were introduced to overcome the side effects related to UAE and surgery. The aim of this review is to briefly analyze the ablative procedures and their role in the management of symptomatic fibroids, and to describe the safety profile and outcomes of these modalities.
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Affiliation(s)
- Anna Maria Ierardi
- Radiology Unit, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Aldo Carnevale
- Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, Ferrara, Italy
| | - Fabio Pellegrino
- Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, Ferrara, Italy
| | - Giuseppina Di Stefano
- Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, Ferrara, Italy
| | - Cristian Bonelli
- Healthcare Professional Department, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Renzulli
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Melchiore Giganti
- Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, Ferrara, Italy
| | - Gianpaolo Carrafiello
- Radiology Unit, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
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14
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Shi B, Zhang B, Zhang Y, Gu Y, Zheng C, Yan J, Chen W, Yan F, Ye J, Zhang H. Multifunctional gap-enhanced Raman tags for preoperative and intraoperative cancer imaging. Acta Biomater 2020; 104:210-220. [PMID: 31927113 DOI: 10.1016/j.actbio.2020.01.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/07/2020] [Accepted: 01/07/2020] [Indexed: 12/12/2022]
Abstract
Multi-modality imaging agents are desirable for tumor diagnosis because they can provide more alternative and reliable information for accurate detection and therapy of diseases than single imaging technique. However, most reported conventional imaging agents have not been found to successfully overcome the disadvantages of traditional diagnoses such as sensitivity, spatial resolution, short half-decay time and complexity. Therefore, exploring a multifunctional nanocomposite with the combination of their individual modality characteristics has great impact on preoperative imaging and intraoperative diagnosis of cancer. In our study, mesoporous silica gadolinium-loaded gap-enhanced Raman tags (Gd-GERTs) specifically for preoperative and intraoperative imaging are designed and their imaging capability and biosafety are examined. They exhibit strong attenuation property for computed X-ray tomography (CT) imaging, high T1 relaxivity for magnetic resonance (MR) imaging capability and surface-enhanced Raman spectroscopy (SERS) signal with good dispersity and stability, which presents CT/MR/SERS multi-mode imaging performance of the tumor of mice within a given time. Furthermore, in vivo biodistribution and long-term toxicity studies reveal that the Gd-GERTs have good biocompatibility and bio-safety. Therefore, Gd-GERTs are of great potential as a multifunctional nanoplatform for accurate preoperative CT/MRI diagnosis and intraoperative Raman imaging-guide resection of cancers. STATEMENT OF SIGNIFICANCE: Recent advances in molecular imaging technology have provided a myriad of opportunities to prepare various nanomaterials for accurate diagnosis and response evaluation of cancer via different imaging modalities. However, single bioimaging modality is still challenging to overcome the issues such as sensitivity, spatial resolution, imaging speed and complexity for clinicians. In this work, we designed a kind of unique multifunctional nanoprobes with computed X-ray tomography/magnetic resonance/surface-enhanced Raman spectroscopy (CT/MR/SERS) triple-modal imaging capabilities. Multifunctional nanotags offer the capabilities of preoperative noninvasive CT/MR imaging for identification of tumors as well as intraoperative real-time SERS imaging for guidance of complete resection of tumors. These multifunctional nanoprobes show critical clinical significance on the improvement of tumor diagnosis and therapy.
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15
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Bradley LD, Pasic RP, Miller LE. Clinical Performance of Radiofrequency Ablation for Treatment of Uterine Fibroids: Systematic Review and Meta-Analysis of Prospective Studies. J Laparoendosc Adv Surg Tech A 2019; 29:1507-1517. [PMID: 31702440 PMCID: PMC7387230 DOI: 10.1089/lap.2019.0550] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Radiofrequency ablation (RFA) has emerged as a safe and effective treatment option for women with symptomatic uterine fibroids and can be delivered by laparoscopic, transvaginal, or transcervical approaches. The evidence regarding typical patient outcomes with RFA has not previously been examined in a comprehensive fashion. Materials and Methods: We performed a systematic review of prospective studies for treatment of uterine fibroids with RFA. Main outcomes were procedure time, patient recovery metrics, change in fibroid volume, symptom severity score (SSS), health-related quality of life (HRQL), and reinterventions. Data were analyzed with random effects meta-analysis and metaregression. Results: We identified 32 articles of 1283 unique patients (median age: 42 years) treated with laparoscopic RFA (19 articles), transvaginal RFA (8 articles), or transcervical fibroid ablation (5 articles). Mean procedure time was 49 minutes, time to discharge was 8.2 hours, time to normal activities was 5.2 days, and time to return to work was 5.1 days. At 12 months follow-up, fibroid volume decreased by 66%, HRQL increased by 39 points, and SSS decreased by 42 points (all P < .001 versus baseline). The annual cumulative rate of reinterventions due to fibroid-related symptoms was 4.2%, 8.2%, and 11.5% through 3 years. Conclusions: RFA of uterine fibroids significantly reduces fibroid volume, provides significant durable improvements in fibroid-related quality of life, and is associated with favorable reintervention rates.
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Affiliation(s)
- Linda D. Bradley
- Department of Obstetrics and Gynecology, Women's Health Institute, Center for Menstrual Disoders, Cleveland Clinic, Cleveland, Ohio
| | - Resad P. Pasic
- Department of Obstetrics and Gynecology, University of Louisville Hospital, Louisville, Kentucky
| | - Larry E. Miller
- Miller Scientific Consulting, Inc., Asheville, North Carolina
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16
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Ming WK, Wu H, Wu Y, Chen H, Meng T, Shen Y, Wang Z, Huang X, Sun W, Chow TS, Wang Y, Ding W, Chen H, Li Z, Wang Z. Health-related quality of life in pregnancy with uterine fibroid: a cross-sectional study in China. Health Qual Life Outcomes 2019; 17:89. [PMID: 31126289 PMCID: PMC6534849 DOI: 10.1186/s12955-019-1153-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 05/01/2019] [Indexed: 12/27/2022] Open
Abstract
Background Uterine fibroids (UFs) are the most common benign tumors in women. They are likely to cause numerous clinical symptoms, such as pain, menorrhagia, and other obstetric complications in pregnant women. This study aimed to determine the health-related quality of life (HRQoL) during pregnancy with uterine fibroids (UF), thus providing a utility-based case value in pregnant women with UF and understanding of whether HRQoL is associated with clinical outcomes in pregnant women with UFs. Method This study was conducted in a cross-sectional manner. This study was based on questionnaire surveys completed by sequential out- and in-patients and was conducted in a regional university hospital in Guangzhou, China. The EuroQoL five-dimension-five-level (EQ-5D-5 L) questionnaire was used, and demographic data were collected. An electronic record of the clinical outcomes of pregnant women with UF was retrieved from the hospital’s electronic medical record system. The association between UF and HRQoL was evaluated by ordered regression. Results Seven-hundred-sixty-seven pregnant women with a mean age (SD) of 32.7 (4.8) years completed 707 questionnaires. Overall, when comparing the UF with non-UF groups, we detected statistical differences in age, body mass index (BMI), gravidity and abortion times, partner’s smoking and alcoholic habits, advanced maternal age, and uterine scars (p < 0.05). Furthermore, pregnant women without UF scored significantly higher than those with UF on the EQ-5D value system (0.84 versus 0.79; p = 0.017). Moreover, pregnant women with UF suffered more health-related problems, especially with respect to self-care (odds ratio [OR] = 3.69, p < 0.01) and usual activity dimensions (OR = 2.11; p = 0.01). Conclusion We found that UF has a negative impact on the HRQoL of pregnant women with respect to self-care and usual activity dimensions. Also, the EQ-5D score was a better index than the EQ-VAS score for HRQoL when evaluating of the QoL of our population of pregnant women.
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Affiliation(s)
- Wai-Kit Ming
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. .,Pharmacoepidemiology and Pharmacoeconomic, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Huailiang Wu
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,School of Medicine, Jinan University, Guangzhou, China
| | - Yanxin Wu
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hanqing Chen
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Tian Meng
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,School of Medicine, Jinan University, Guangzhou, China
| | - Yiwei Shen
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,School of Medicine, Jinan University, Guangzhou, China
| | - Ziyu Wang
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,School of Medicine, Jinan University, Guangzhou, China
| | - Xinyu Huang
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,School of Medicine, Jinan University, Guangzhou, China
| | - Weiwei Sun
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,School of Medicine, Jinan University, Guangzhou, China
| | - Tik Sang Chow
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,School of Medicine, Jinan University, Guangzhou, China
| | - Yuan Wang
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,School of Medicine, Jinan University, Guangzhou, China
| | - Wenjing Ding
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Haitian Chen
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhuyu Li
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zilian Wang
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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17
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Transvaginal Radiofrequency Ablation of Myomas: Technique, Outcomes, and Complications. J Laparoendosc Adv Surg Tech A 2019; 29:24-28. [DOI: 10.1089/lap.2018.0293] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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18
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Iversen H, Dueholm M. Radiofrequency Thermal Ablation for Uterine Myomas: Long-term Clinical Outcomes and Reinterventions. J Minim Invasive Gynecol 2017; 24:1020-1028. [DOI: 10.1016/j.jmig.2017.05.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 04/07/2017] [Accepted: 05/01/2017] [Indexed: 10/19/2022]
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19
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Barral M, Placé V, Dautry R, Bendavid S, Cornelis F, Foucher R, Guerrache Y, Soyer P. Magnetic resonance imaging features of uterine sarcoma and mimickers. Abdom Radiol (NY) 2017; 42:1762-1772. [PMID: 28246921 DOI: 10.1007/s00261-017-1076-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Uterine myometrial tumors are predominantly benign conditions that affect one-third of women and represent the main indication for hysterectomy. Preoperative imaging is of utmost importance for characterization and for precise mapping of myometrial tumors to best guide therapeutic strategy. New minimally invasive therapeutic strategies including morcellation, myolysis, uterine artery embolization and image-guided radiofrequency or focused ultrasound ablation have been developed for the treatment of uterine leiomyoma. However, preoperative differentiation between atypical leiomyomas and leiomyosarcomas is critical on imaging as uterine sarcoma requires a specific surgical technique to prevent dissemination. A single, rapidly growing uterine tumor, associated with endometrial thickening and ascites, in post-menopausal women is suspicious of uterine endometrial stromal sarcoma and carcinosarcoma. Suggestive magnetic resonance imaging features have been described, but overlap in imaging appearance between uterine leiomyosarcomas and cellular leiomyomas makes it challenging to ascertain the diagnosis. This review aims to illustrate the imaging features of uterine sarcomas and potential mimickers to make the reader more familiar with this serious condition which needs special consideration.
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Affiliation(s)
- Matthias Barral
- Sorbonne Paris Cité, Hôpital Lariboisière, Université Paris Diderot, Paris, France.
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance Publique- Hôpitaux de Paris, 2 rue Ambroise Paré, 75475, Paris, France.
- Inserm U-965, CART, Carcinose Angiogénèse et recherche translationnelle, 41 bvd de La Chapelle, 75010, Paris, France.
| | - Vinciane Placé
- Sorbonne Paris Cité, Hôpital Lariboisière, Université Paris Diderot, Paris, France
| | - Raphaël Dautry
- Sorbonne Paris Cité, Hôpital Lariboisière, Université Paris Diderot, Paris, France
| | - Sandra Bendavid
- Sorbonne Paris Cité, Hôpital Lariboisière, Université Paris Diderot, Paris, France
| | - Françoise Cornelis
- Department of Pathology, Hôpital Lariboisière, Assistance Publique- Hôpitaux de Paris, 2 rue Ambroise Paré, 75475, Paris, France
| | - Romain Foucher
- Sorbonne Paris Cité, Hôpital Lariboisière, Université Paris Diderot, Paris, France
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance Publique- Hôpitaux de Paris, 2 rue Ambroise Paré, 75475, Paris, France
| | - Youcef Guerrache
- Sorbonne Paris Cité, Hôpital Lariboisière, Université Paris Diderot, Paris, France
| | - Philippe Soyer
- Sorbonne Paris Cité, Hôpital Lariboisière, Université Paris Diderot, Paris, France
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance Publique- Hôpitaux de Paris, 2 rue Ambroise Paré, 75475, Paris, France
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20
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Hai N, Hou Q, Ding X, Dong X, Jin M. Ultrasound-guided transcervical radiofrequency ablation for symptomatic uterine adenomyosis. Br J Radiol 2016; 90:20160119. [PMID: 27792415 DOI: 10.1259/bjr.20160119] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To retrospectively evaluate the midterm outcomes of transvaginal ultrasound-guided radiofrequency ablation (RFA) for the treatment of symptomatic uterine adenomyosis. METHODS 87 patients with symptomatic uterine adenomyosis, who met the inclusion criteria, were enrolled in our study from January 2013 to October 2015. All of the patients underwent transvaginal ultrasound-guided RFA and were followed up for 12 months. Assessment end points included uterus volume reduction rate, lesion regression rate, dysmenorrhoeal score, symptom severity score (SSS) and adverse events. RESULTS In all 87 patients, 81 patients fulfilled the follow-up evaluations post-ablation. The mean uterine volume reduction rate was 35.8% at 1 month, 40.8% at 6 months and 41.2% at 12 months post-ablation. Dysmenorrhoea and SSS statistically significantly declined. Reintervention rate was 18.5%. Two patients developed intrauterine adhesion after ablation. No serious complications including penetration or burn injuries of the nearby organs were observed. CONCLUSION Ultrasound-guided RFA might be a safe and effective minimally invasive alternative in the treatment of symptomatic adenomyosis. Advances in knowledge: This is the first study to evaluate the efficacy and safety of ultrasound-guided RFA for the treatment of adenomyosis to our knowledge. This is also the first study to provide various changes of intrauterine cavity after this treatment.
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Affiliation(s)
- Ning Hai
- Department of Gynecology, PLA Rocket Force General Hospital, Beijing, China
| | - Qingxiang Hou
- Department of Gynecology, PLA Rocket Force General Hospital, Beijing, China
| | - Xiaoping Ding
- Department of Gynecology, PLA Rocket Force General Hospital, Beijing, China
| | - Xiangping Dong
- Department of Gynecology, PLA Rocket Force General Hospital, Beijing, China
| | - Meijuan Jin
- Department of Gynecology, PLA Rocket Force General Hospital, Beijing, China
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21
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Review of nonsurgical/minimally invasive treatments and open myomectomy for uterine fibroids. Curr Opin Obstet Gynecol 2016; 27:391-7. [PMID: 26536205 DOI: 10.1097/gco.0000000000000223] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The main purpose of this review is to collect the most recent evidence with regards to safety and effectiveness of the nonsurgical and minimally invasive treatment options for uterine fibroids. RECENT FINDINGS Among the nonsurgical options, uterine artery embolization (UAE), and in eligible patients, magnetic resonance-guided high-intensity focused ultrasound (MRgFUS) are emerging as effective alternatives to surgical options for treatment of symptomatic fibroids. MRgFUS is comparable to UAE, and appears to be a cost effective treatment option, especially in older women, although long-term data are awaited. The transvaginal route for radiofrequency ablation is a promising new nonsurgical alternative, which needs to be studied in larger trials to establish its safety and efficacy.The laparoscopic myomectomy results in less postoperative pain, reduced febrile morbidity, and shorter hospital stay when compared with open laparotomy. The newer robotic approach is comparable to traditional laparoscopic technique in short surgical outcomes but is associated with higher costs. Hysteroscopic myoma resection is an effective surgical intervention for submucous fibroids and prior misoprostol use can help in reducing cervical lacerations. SUMMARY UAE and MRgFUS can be offered as an alternative nonsurgical option for eligible women with symptomatic fibroids. Laparoscopic myomectomy remains a safe and effective surgical option with advantage of less postoperative pain and faster recovery compared with open laparotomy for women who wish to retain their fertility options.
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22
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Luo X, Shu SR, Ma XF, Shuai HL. The Research of Feasibility and Efficacy of Radiofrequency Ablation in Treating Uterine Fibroids. Medicine (Baltimore) 2015; 94:e1956. [PMID: 26632689 PMCID: PMC5058958 DOI: 10.1097/md.0000000000001956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
To explore the feasibility and efficacy of radiofrequency ablation in treating uterine fibroids.Ninety patients with multiple uterine fibroids, who had undergone hysterectomy were included in the study. After the uterus was resected, the temperature of 60, 80, 100°C were adopted to ablate the in vitro fibroid with each temperature dealing with 30 patients. Simultaneously, 5 patients were included, whose in vivo fibroid were ablated with the temperature of 100°C before the fibroids were removed after laparotomy. After the fibroids were ablated, the smooth muscle in the ablated center (group A), the ablated edge (group B) and 1 cm away from the ablated edge (group C) were taken. Then, the samples were stained with hematoxylin and eosin (HE) to examine the histopathological changes, and immunohistochemistry was performed to detect the expression of estrogen receptor (ER) and progesterone receptor (PR).After radiofrequency ablation, the ablated lesions were round, toast tan, and dry on gross appearance. There were no obvious tissue carbonization and there were distinct boundary from periphery tissue. In vitro: On automated analysis, the average optical density of ER and PR in group A, B, and C was lower than the control group (P < 0.05), and which were gradually raised with the increased distance to electrode. In the same treatment group, ER optical density was gradually decreased with the increased temperature among 3 different groups. The PR optical density was decreased with the increased temperature under different temperatures in group A and group B, there was significant difference among groups (P < 0.05). But in group C, there was no difference in PR expression among the temperature of 60, 80, and 100°C (P > 0.05). In vivo: Compared with the control group, the average optical density of ER and PR were significantly different among group A, B, and C (P < 0.05), what's more, it was gradually raised with the increased distance to electrode.After radiofrequency ablation, the tissues displayed coagulative necrosis, and decreased ER and PR expression. Radiofrequency ablation may be considered a minimally invasive alternative for those women who wish to retain their reproductive potential. Eighty degree Celsius was expected to be the optimum temperature in radiofrequency ablation treatment of uterine fibroid.
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Affiliation(s)
- Xin Luo
- From Department of Obstetrics and Gynecology, The First Affiliated Hospital of JiNan University, Guangzhou, People's Republic of China
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23
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Hai N, Ding X. Intrauterine adhesion after transvaginal ultrasound-guided radiofrequency myolysis. J Obstet Gynaecol Res 2015; 41:1851-4. [PMID: 26311404 DOI: 10.1111/jog.12796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 05/16/2015] [Accepted: 06/06/2015] [Indexed: 11/28/2022]
Abstract
Transvaginal ultrasound-guided radiofrequency myolysis offers an alternative to surgery for symptomatic uterine myomas, with encouraging efficacy and safety, suggesting low complication rates. This case study describes the first reported intrauterine adhesion after transvaginal ultrasound-guided radiofrequency myolysis. Women who desire further pregnancy should be warned about the particular risk of intrauterine adhesion of radiofrequency myolysis.
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Affiliation(s)
- Ning Hai
- Department of Gynecology, The PLA Second Artillery Force General Hospital, Beijing, China
| | - Xiaoping Ding
- Department of Gynecology, The PLA Second Artillery Force General Hospital, Beijing, China
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24
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Gao Y, Li Y, Chen J, Zhu S, Liu X, Zhou L, Shi P, Niu D, Gu J, Shi J. Multifunctional gold nanostar-based nanocomposite: Synthesis and application for noninvasive MR-SERS imaging-guided photothermal ablation. Biomaterials 2015; 60:31-41. [DOI: 10.1016/j.biomaterials.2015.05.004] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 05/03/2015] [Indexed: 01/24/2023]
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25
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Patel A, Malik M, Britten J, Cox J, Catherino WH. Alternative therapies in management of leiomyomas. Fertil Steril 2014; 102:649-55. [PMID: 25106764 DOI: 10.1016/j.fertnstert.2014.07.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 07/02/2014] [Accepted: 07/02/2014] [Indexed: 01/20/2023]
Abstract
Leiomyomas are benign soft-tissue neoplasms that arise from smooth muscle. Relief of symptoms (abnormal uterine bleeding, pain, pressure) is the major goal in management of women with significant symptoms. For symptomatic myomas, hysterectomy is a definitive solution; however, there are emerging less-invasive options. Magnetic resonance imaging-guided focused ultrasound surgery, cryomyolysis, and temporary occlusion of the uterine arteries are treatment options that are minimally invasive interventions with the benefit of preserving the uterus. This review summarizes procedure techniques, eligibility, complications, and outcomes of these alternate therapies.
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Affiliation(s)
- Amrita Patel
- Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Minnie Malik
- Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Joy Britten
- Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Jeris Cox
- Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - William H Catherino
- Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
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