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Razakamanantsoa L, Bodard S, Najdawi M, Dabi Y, Bendifallah S, Touboul C, Lehrer R, Agbonon R, Di Giuseppe R, Barral M, Bazot M, Brun JL, Roman H, Marcelin C, Thomassin-Naggara I, Cornelis FH. Surgical and Percutaneous Image-guided Therapies of Abdominal Wall Endometriosis: a Systematic Review of Current Evidence. J Minim Invasive Gynecol 2024:S1553-4650(24)00266-8. [PMID: 38901689 DOI: 10.1016/j.jmig.2024.06.007] [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: 03/19/2024] [Revised: 06/09/2024] [Accepted: 06/10/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVE Despite various surgical and non-surgical strategies for abdominal wall endometriosis, the lack of definitive guidance on optimal treatment choice leads to clinical uncertainty. This review scrutinizes the safety and efficacy of abdominal wall endometriosis treatments to aid in decision-making. DATA SOURCES We performed a systematic literature review of PubMed, Embase and Cochrane Library databases from 1947 until December 2023. METHODS OF STUDY SELECTION A comprehensive literature search identified studies that assessed both surgical and nonsurgical interventions, including high-intensity focused ultrasound (HIFU), cryoablation, radiofrequency ablation (RFA), and microwave ablation (MWA). This review is registered in NIHR-PROSPERO (CRD 42023494969). Local tumor control (LTC), local pain relief (LPR) and adverse events (AE) were recorded. TABULATION, INTEGRATION, AND RESULTS This review included 51 articles among 831 identified. All study designs were considered eligible for inclusion. A total of 2,674 patients are included: 2,219 patients (83%) undergoing surgery, and 455 (17%) undergoing percutaneous interventions (342 HIFU, 103 cryoablation, 1 RFA, 9 MWA). Follow-up length was 18 months in median, ranging from 1 to 235 months. Overall LTC rates ranged from 86% to 100%. Surgical interventions consistently demonstrated the highest rate of LTC with a median rate of 100%, and LPR with a median rate of 98.2% (95% confidence interval [CI]: 93.9-97.7). HIFU showed median LTC and LPR rates, respectively of 95.65% (95% CI, 87.7-99.9) and 76.1% (95% CI, 61.8-90.4); and cryoablation of 85.7% (95% CI, 66.0-99.9) and 79.2% (95% CI, 67.4-91.03). Minor AE were reported after surgery in 17.5% of patients (225/1284) including 15.9% (199/1284) of mesh implantation; 76.4% (239/313) after HIFU; and 8.7 % (9/103) after cryoablation. Severe AE were reported in 25 patients in the surgery group and 1 in the percutaneous group. CONCLUSION The safety profile and efficacy of nonsurgical interventions support their clinical utility for management of abdominal wall endometriosis.
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Affiliation(s)
- Leo Razakamanantsoa
- Sorbonne University, Department of Specialized Radiology and Interventional Imaging, Tenon Hospital, 4 rue de la Chine, 75020 Paris, France; Saint-Antoine Research Center (CRSA), INSERM, CNRS, Sorbonne University, F-75012, Paris, France.
| | - Sylvain Bodard
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Milan Najdawi
- Sorbonne University, Department of Specialized Radiology and Interventional Imaging, Tenon Hospital, 4 rue de la Chine, 75020 Paris, France
| | - Yohann Dabi
- Saint-Antoine Research Center (CRSA), INSERM, CNRS, Sorbonne University, F-75012, Paris, France; Sorbonne University, Department of Obstetrics and Gynecology, Tenon Hospital, 4 rue de la Chine, 75020 Paris, France
| | - Sofiane Bendifallah
- American Hospital of Paris, Department of Gynecology, 40 rue Chauveau, 92200, Neuilly-sur-Seine, France
| | - Cyril Touboul
- Sorbonne University, Department of Obstetrics and Gynecology, Tenon Hospital, 4 rue de la Chine, 75020 Paris, France
| | - Raphael Lehrer
- Sorbonne University, Department of Specialized Radiology and Interventional Imaging, Tenon Hospital, 4 rue de la Chine, 75020 Paris, France
| | - Remi Agbonon
- Sorbonne University, Department of Specialized Radiology and Interventional Imaging, Tenon Hospital, 4 rue de la Chine, 75020 Paris, France
| | - Raphael Di Giuseppe
- Sorbonne University, Department of Specialized Radiology and Interventional Imaging, Tenon Hospital, 4 rue de la Chine, 75020 Paris, France
| | - Matthias Barral
- Sorbonne University, Department of Specialized Radiology and Interventional Imaging, Tenon Hospital, 4 rue de la Chine, 75020 Paris, France
| | - Marc Bazot
- Sorbonne University, Department of Specialized Radiology and Interventional Imaging, Tenon Hospital, 4 rue de la Chine, 75020 Paris, France
| | - Jean-Luc Brun
- Department of Gynecology, CHU Bordeaux, place Amélie Raba Léon, 33076 Bordeaux, France
| | - Horace Roman
- Franco-European Multidisciplinary Endometriosis Institute, Clinique Tivoli-Ducos (Drs. Boulus, Merlot, Chanavaz-Lacheray, Dennis, and Roman), Bordeaux, France; Franco-European Multidisciplinary Endometriosis Institute Middle East Clinic (Drs. Merlot, Kade, and Roman), Burjeel Medical City, Abu Dhabi, United Arab Emirates; Department of Gynecology and Obstetrics (Dr. Roman), Aarhus University Hospital, Denmark.
| | - Clement Marcelin
- Department of Radiology, CHU Bordeaux, place Amélie Raba Léon, 33076 Bordeaux, France
| | - Isabelle Thomassin-Naggara
- Sorbonne University, Department of Specialized Radiology and Interventional Imaging, Tenon Hospital, 4 rue de la Chine, 75020 Paris, France; Saint-Antoine Research Center (CRSA), INSERM, CNRS, Sorbonne University, F-75012, Paris, France
| | - Francois H Cornelis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Department of Radiology, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
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Ali MM, Awad Elderiny H, Shaaban Abdelgalil M, Mohamed Othman A. Is high-intensity focused ultrasound a magical solution to endometriosis? A systematic review. Proc AMIA Symp 2024; 37:625-637. [PMID: 38910796 PMCID: PMC11188790 DOI: 10.1080/08998280.2024.2352290] [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: 02/07/2024] [Accepted: 04/23/2024] [Indexed: 06/25/2024] Open
Abstract
Background Endometriosis presents a significant challenge in gynecological endocrinology, affecting approximately 1 in 10 women of reproductive age. Abdominal wall endometriosis (AWE) and rectosigmoid deep infiltrating endometriosis (DIE) pose unique clinical complexities. High-intensity focused ultrasound (HIFU) has emerged as a novel alternative for treating these conditions, offering a noninvasive option with potential therapeutic benefits. Methods A systematic review was conducted following PRISMA guidelines to investigate the safety and efficacy of HIFU therapy for AWE and rectosigmoid DIE. The literature search encompassed databases from inception to January 20, 2024. Eligible studies included observational studies, case reports, and clinical trials evaluating HIFU treatment for endometriosis. Data extraction and risk of bias assessment were performed following established protocols. Results Fourteen studies were included, comprising 330 patients with AWE and 28 patients with rectosigmoid DIE. HIFU treatment demonstrated significant efficacy, with many patients experiencing complete remission, and clinical effectiveness. Reductions in lesion volume posttreatment were consistent across studies. However, safety concerns were noted, including pain at the treatment site, hematuria, and skin burns. Adverse effects underscored the importance of careful patient selection and monitoring during HIFU therapy. Conclusion HIFU therapy shows promise as a noninvasive approach for managing AWE and rectosigmoid DIE. While efficacy outcomes are encouraging, safety considerations warrant attention. Further research, particularly randomized controlled trials with larger sample sizes, is needed to validate findings and optimize treatment protocols.
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Affiliation(s)
- Mostafa Maged Ali
- Obstetrics and Gynecology Department, Fayoum General Hospital, Egyptian Ministry of Health and Population, Fayoum, Egypt
| | - Hind Awad Elderiny
- Samannoud Central Hospital, Ministry of Health, Gharbia Governorate, Cairo, Egypt
| | | | - Ahmed Mohamed Othman
- Clinical Research Department, Avicemer Contract Research Organization, Cairo, Egypt
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Knorren ER, de Ridder LA, Nijholt IM, Dijkstra JR, Braat MNGJA, Huirne JAF, Boomsma MF, Schutte JM. Effectiveness and complication rates of high intensity focused ultrasound treatment for abdominal wall endometriosis: A systematic review. Eur J Obstet Gynecol Reprod Biol 2024; 297:15-23. [PMID: 38555851 DOI: 10.1016/j.ejogrb.2024.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/18/2024] [Accepted: 03/22/2024] [Indexed: 04/02/2024]
Abstract
In this review, a systematic literature search on the effectiveness and complication rates of ultrasound-guided and magnetic resonance-guided high-intensity focused ultrasound (USg-/MRgHIFU) for abdominal wall endometriosis (AWE) was conducted in six databases in May/June 2023. Original articles of (non)randomized trials, cohort studies, case-control studies and case series published in peer-reviewed journals were included. Of the included studies the level of evidence (LoE) and methodological quality using the ROBINS-I and IHE-QAT was assessed. Primary outcomes were non-perfused volume ratio (NPV%), lesion size, pain scores, side effects and complication rates according to Society of Interventional Radiology (SIR) guidelines. Secondary outcomes were recurrence and re-intervention rates. Seven cohort studies (one of good methodological quality) (LoE 3) on USgHIFU were included (n = 212, AWE lesions = 240-245). Six months after USgHIFU treatment, pain scores were reduced with 3.3-5.2 points (baseline: 5.1-6.8, n = 135). Self-limiting side effects were pain (85.7 % (114/133)) and swelling (34.6 % (46/133)) in the treatment area. Complications occurred in 17.7 % (32/181), all of which were minor. Recurrence occurred in 12.8 % (11/86). Three of these seven cohort studies compared USgHIFU (n = 61) with surgical excision (n = 74). Pooled results showed no significant differences in pain scores, complications (resp. 26.3 % (10/38) vs. 32.6 % (15/46) (p = 0.53)) and recurrences (resp. 4.9 % (3/61) vs. 5.4 % (4/74) (p = 0.90)). This systematic review suggests that HIFU is an effective and safe treatment option for AWE. USgHIFU treatment led to reduced pain scores and lesion size, was free of major complications and had a pooled recurrence rate of 12.8 %. Compared to surgical excision pooled results showed no significant differences in pain scores, complications and recurrences after USgHIFU. However, many of the included studies had limitations in their methodological quality and therefore the results should be interpreted with caution. Well-structured high-quality randomized controlled trials comparing HIFU to standard care should be conducted to provide more conclusive evidence.
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Affiliation(s)
- Elisabeth R Knorren
- Department of Obstetrics and Gynecology, Isala Hospital, Dokter van Deenweg 2, 8025AB Zwolle, The Netherlands; Department of Radiology, Isala Hospital, Dokter van Deenweg 2, 8025AB Zwolle, The Netherlands.
| | - Larissa A de Ridder
- Department of Obstetrics and Gynecology, Isala Hospital, Dokter van Deenweg 2, 8025AB Zwolle, The Netherlands
| | - Ingrid M Nijholt
- Department of Radiology, Isala Hospital, Dokter van Deenweg 2, 8025AB Zwolle, The Netherlands
| | - Jeroen R Dijkstra
- Department of Obstetrics and Gynecology, Isala Hospital, Dokter van Deenweg 2, 8025AB Zwolle, The Netherlands
| | - Manon N G J A Braat
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584XC Utrecht, The Netherlands
| | - Judith A F Huirne
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centre, location VUmc, Amsterdam Research Institute, Reproduction and Development, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands
| | - Martijn F Boomsma
- Department of Radiology, Isala Hospital, Dokter van Deenweg 2, 8025AB Zwolle, The Netherlands; Imaging & Oncology Division, Image Sciences Institute, University Medical Center Utrecht, Heidelberglaan 100, 3584XC Utrecht, The Netherlands
| | - Joke M Schutte
- Department of Obstetrics and Gynecology, Isala Hospital, Dokter van Deenweg 2, 8025AB Zwolle, The Netherlands
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Mahdavi A, Forouzannia SA, Goudarzi E, Forouzannia SM, Rafiei R, Yousefimoghaddam F, Rafiei N, Padmehr R. Radiofrequency Ablation: A Promising Treatment Method for Abdominal Wall Endometriosis. Cardiovasc Intervent Radiol 2024:10.1007/s00270-024-03755-4. [PMID: 38811406 DOI: 10.1007/s00270-024-03755-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 05/09/2024] [Indexed: 05/31/2024]
Abstract
PURPOSE To evaluate the application of radiofrequency ablation (RFA) as a treatment method for abdominal wall endometriosis (AWE). MATERIALS AND METHODS The characteristics of the AWE lesions in the patients were obtained using ultrasound (US). The patients received general and local anesthesia, and then, AWE lesions were divided into 1 cm3 sections visually, and each of these sections underwent US-guided RFA using the moving shot technique. Follow-up included outpatient appointments, including a US examination 1, 3, and 6 months after the treatment to assess the volume of the lesions. In addition, the level of pain experienced by the patients was measured using a visual analogue scale (VAS) before and the day after the procedure, as well as at each follow-up appointment. RESULTS Ten patients were treated with RFA. The procedural success was achieved in all of the patients. The median volume of the lesions decreased from 7.3 cm3 (IQR = 4.39,23.75) to 2.95 cm3 (IQR = 1.65,9.09) (P = 0.005). All patients reported reduced pain levels, and the median of their VAS score decreased from 9 (IQR = 8,9) to 0 (IQR = 0,1.25) (P = 0.004) at the end of the follow-up period. None of the patients experienced complications related to RFA treatment. CONCLUSION Based on the study's findings, RFA appears to be a promising minimally invasive treatment for AWE. However, larger studies with longer follow-up periods are required for a more comprehensive understanding of its efficacy and safety. LEVEL OF EVIDENCE Level 4, Case Series.
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Affiliation(s)
- Ali Mahdavi
- Department of Radiology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Forouzannia
- Department of Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Ehsan Goudarzi
- Department of Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Romina Rafiei
- Department of Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fateme Yousefimoghaddam
- Department of Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niloufar Rafiei
- Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Roya Padmehr
- Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
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Marcelin C, Maas P, Jambon E, Maaloum R, Andreo IM, Le Bras Y, Roman H, Grenier N, Brun JL, Cornelis FH. Long-term outcomes after percutaneous cryoablation of abdominal wall endometriosis. Eur Radiol 2024:10.1007/s00330-024-10689-5. [PMID: 38512491 DOI: 10.1007/s00330-024-10689-5] [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: 10/18/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE To retrospectively evaluate the long-term outcomes after percutaneous cryoablation of abdominal wall endometriosis (AWE). METHOD The Institutional Review Board approved this retrospective observational review of 40 consecutive patients, of a median age of 37 years (interquartile range [IQR] 32-40 years), presenting with a total of 52 symptomatic AWE nodules. All patients underwent cryoablation between January 2013 and May 2022 with a minimum follow-up period of 12 months. Outcomes were assessed using a visual analog scale (VAS) that measured pain, as well as by magnetic resonance imaging (MRI). The pain-free survival rates were derived using the Kaplan-Meier estimator. Adverse events were analyzed and graded using the classification system of the Cardiovascular and Interventional Radiological Society of Europe. RESULTS The median follow-up time was 40.5 months (IQR 26.5-47.2 months). The median VAS score before cryoablation was 8 (IQR 7-9). Complete relief of symptoms was documented in 80% (32/40) of patients at 3 months after initial cryoablation and correlated with the absence of residual endometriosis nodules on MRI. The median pain-free survival rates were 89.2% [95% CI, 70.1-96.4%] at 36 months and 76.8% [95% CI, 55.3-83.8%] after 60 months. No patient or lesion characteristics were found to be prognostic of failure. No major adverse events or side effects were reported in long term. CONCLUSION Cryoablation safely and effectively afforded long-term pain relief for patients with AWE nodules. CLINICAL RELEVANCE STATEMENT AWE cryoablation was found to be safe and effective in the long-term. KEY POINTS • Cryoablation is highly effective with 80% of patients experiencing complete relief of AWE symptoms after a single procedure. • Cryoablation is safe without long-term adverse events or side effects. • The median pain-free survival rates are 89.2% at 36 months and 76.8% at 60 months.
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Affiliation(s)
- Clément Marcelin
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Service d'imagerie diagnostique et thérapeutique de l'adulte, 3300, Bordeaux, France.
- Université de Bordeaux, INSERM, Bordeaux Institute of Oncology, BRIC U1312, 33000, Bordeaux, France.
| | - Philippe Maas
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Service d'imagerie diagnostique et thérapeutique de l'adulte, 3300, Bordeaux, France
| | - Eva Jambon
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Service d'imagerie diagnostique et thérapeutique de l'adulte, 3300, Bordeaux, France
| | - Rim Maaloum
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Service d'imagerie diagnostique et thérapeutique de l'adulte, 3300, Bordeaux, France
| | - Isabelle Molina Andreo
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Service d'imagerie diagnostique et thérapeutique de l'adulte, 3300, Bordeaux, France
| | - Yann Le Bras
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Service d'imagerie diagnostique et thérapeutique de l'adulte, 3300, Bordeaux, France
| | - Horace Roman
- Clinique Tivoli- Ducos, Institut Franco-Européen Multidisciplinaire d'Endométriose (IFEMEndo), 33000, Bordeaux, France
| | - Nicolas Grenier
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Service d'imagerie diagnostique et thérapeutique de l'adulte, 3300, Bordeaux, France
| | - Jean-Luc Brun
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Service de gynécologie, 33000, Bordeaux, France
| | - Francois H Cornelis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
- Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, USA
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Barat M, Dohan A, Kohi M, Marcelin C, Pelage JP, Denys A, Mafeld S, Kaufman CS, Soyer P, Cornelis FH. Treatment of adenomyosis, abdominal wall endometriosis and uterine leiomyoma with interventional radiology: A review of current evidences. Diagn Interv Imaging 2024; 105:87-96. [PMID: 38065817 DOI: 10.1016/j.diii.2023.11.005] [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: 11/21/2023] [Accepted: 11/21/2023] [Indexed: 01/16/2024]
Abstract
Interventional radiology shows promises in the field of women's health, particularly in pelvic interventions. This review article discusses the latest advancements in interventional radiology techniques for pelvic conditions affecting women including adenomyosis, abdominal wall endometriosis and uterine leiomyoma. Extraperitoneal endometriosis involving the abdominal wall may be treated by percutaneous thermal ablation, such as cryoablation, whereas uterine leiomyoma and adenomyosis can be managed either using percutaneous thermal ablation or using uterine artery embolization. Continued research and development in interventional radiology will further enhance the minimally-invasive interventions available for women's health, improving outcomes and quality of life for this large patient population of women.
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Affiliation(s)
- Maxime Barat
- Department of Radiology, Hopital Cochin, AP-HP, 75014 Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France
| | - Anthony Dohan
- Department of Radiology, Hopital Cochin, AP-HP, 75014 Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France
| | - Maureen Kohi
- Department of Radiology, University of North Carolina at Chapel Hill, NC 27599, USA
| | - Clement Marcelin
- Department of Radiology, Centre Hospitalo-Universitaire de Bordeaux, 33076 Bordeaux, France
| | - Jean-Pierre Pelage
- Department of Radiology, Research Institute of McGill University Health Centre, McGill University Health Centre, McGill University, Montreal, QC H4A 3J1, Canada
| | - Alban Denys
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital CHUV, Lausanne and University of Lausanne (UNIL), 1011 Lausanne, Switzerland
| | - Sebastian Mafeld
- Department of Medical Imaging, Division of Vascular and Interventional Radiology, Toronto General Hospital, University of Toronto, Toronto, ON, M5G 2C4, Canada
| | - Claire S Kaufman
- Dotter Interventional Institute, Oregon Health & Science University, Portland, OR 97239-3011, USA
| | - Philippe Soyer
- Department of Radiology, Hopital Cochin, AP-HP, 75014 Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France
| | - Francois H Cornelis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College, New York, NY 10065, USA.
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Marcelin C, Brun JL, Caprais J, Molina-Andreo I, Jambon E, Le Bras Y, Hocké C, Grenier N. Percutaneous cryoablation of symptomatic uterine adenomyomas: Initial experience. J Gynecol Obstet Hum Reprod 2024; 53:102727. [PMID: 38237806 DOI: 10.1016/j.jogoh.2024.102727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 12/03/2023] [Accepted: 01/14/2024] [Indexed: 02/04/2024]
Abstract
OBJECTIVE To assess the efficacy and safety of percutaneous image-guided cryoablation of adenomyomas MATERIAL AND METHODS: Five symptomatic women who wanted to preserve their uterus and fertility underwent a single session of percutaneous image-guided cryoablation of adenomyoma. Three to six 17-gauge cryoprobes were introduced percutaneously into the adenomyoma under ultrasound and laparoscopy guidance. Clinical efficacy was defined as the diminution of the Visual Analogue Scale of pain (VAS), the decrease in uterine bleeding and the improvement of quality of life assessed by the endometriosis health profile 5 (EHP-5) 12 months after treatment. Technical efficacy was defined by the reduction in volume of each treated adenomyoma on MRI. Complications were classified using the Clavien-Dindo classification system. Hysterosonography was performed at least 3 months after the procedure. RESULTS Compared to the baseline, all symptom scores had decreased after 12 months: median VAS 8/10 (range, 5-10) to 4/10 (range, 0-7); median dyspareunia score 7/10 (range, 0-10) to 2/10 (range, 0-8); median bleeding score 335 (range, 102-920) to 76 (range, 0-88); median EHP-5 score 60/100 (range, 50-75) to 50/100 (range, 32-55). The median volume of adenomyosis decreased from 57 cm3 (range, 8-87) to 9 cm3 (range, 2-45) at 12 months. No postoperative complications occurred. Two patients had incomplete intrauterine adhesions that were easily removed hysteroscopically. CONCLUSION Cryoablation may be a promising alternative treatment for symptomatic adenomyoma in women who want to preserve their uterus.
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Affiliation(s)
- Clément Marcelin
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - Jean-Luc Brun
- Service de chirurgie gynécologique, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076, Bordeaux, France.
| | - Julie Caprais
- Service de chirurgie gynécologique, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - Isabelle Molina-Andreo
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - Eva Jambon
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - Yann Le Bras
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - Claude Hocké
- Service de chirurgie gynécologique, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - Nicolas Grenier
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076, Bordeaux, France
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Cheng H, Zhu X, He Y, Liu M, Xue M, Sun X. Efficacy and influencing factor analysis of high-intensity focused ultrasound therapy for abdominal wall endometriosis: a case series. Int J Hyperthermia 2024; 41:2320416. [PMID: 38413385 DOI: 10.1080/02656736.2024.2320416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/14/2024] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVE The aim of this retrospective study was to investigate the short-term and long-term efficacy of high-intensity focused ultrasound (HIFU) therapy for abdominal wall endometriosis (AWE) and explore its potential influencing factors. MATERIALS AND METHODS A total of 80 patients with AWE who underwent HIFU therapy were retrospectively analyzed. Follow-ups were also conducted to evaluate the changes in lesion size and pain relief. Multivariate logistic regression analysis was applied to investigate factors influencing HIFU therapy for AWE. RESULTS Among the 80 patients with AWE who received HIFU therapy, the effective rates were 76.3%, 80.5%, and 90.5% after 3, 12 and 24 months of follow-up, respectively. Multivariate logistic regression analysis revealed that the AWE lesion diameter and sonication intensity had statistically significant effects on the 3-month and 12-month efficacy of HIFU therapy for AWE, while age, BMI, disease duration, average sonication power and grey-scale changes did not have statistically significant effects. Four patients with AWE experienced recurrence after HIFU therapy, for a three-year cumulative recurrence rate of 6.3%. Furthermore, ten patients required reintervention after treatment, for a five-year cumulative reintervention rate of 13.9%. CONCLUSIONS This study further confirmed the safety and effectiveness of HIFU therapy for AWE. Factors such as AWE lesion diameter and sonication intensity have been identified as key influencers affecting the short-term and long-term efficacy of HIFU therapy for AWE. The first two years following HIFU therapy constitute crucial periods for observation, and judiciously extending follow-up intervals during this timeframe is advised.
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Affiliation(s)
- Hui Cheng
- Department of Obstetrics and Gynecology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Xiaogang Zhu
- Department of Obstetrics and Gynecology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Yuyin He
- Department of Obstetrics and Gynecology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Mengying Liu
- Department of Obstetrics and Gynecology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Min Xue
- Department of Obstetrics and Gynecology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Xin Sun
- Department of Obstetrics and Gynecology, Third Xiangya Hospital of Central South University, Changsha, China
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9
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Zhang M, Yin C, Jiang J, Chen Y, Wang J, Wang Q, Zeng Y, Zhou H. Application value of contrast-enhanced ultrasonography in the treatment of uterine fibroids by high-intensity focused ultrasound ablation: A retrospective study. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:113-120. [PMID: 36054335 DOI: 10.1002/jcu.23294] [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: 04/02/2022] [Revised: 06/01/2022] [Accepted: 06/24/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To determine efficacy and safety of contrast-enhanced ultrasonography (CEUS) in high-intensity focused ultrasound (HIFU) ablation of uterine fibroids (UFs). METHODS We retrospectively reviewed women undergoing HIFU ablation for UFs between June 2018 and January 2020. Before and after HIFU, patients underwent CEUS and magnetic resonance imaging (MRI) examinations. The relationship between CEUS features and ablation rate was analyzed. The time-intensity curves on CEUS were measured before and after HIFU ablation, and compared with those obtained using MRI. Adverse reactions were recorded. RESULTS A total of 64 patients were included. The immediate HIFU ablation rate significantly differed between low-, iso-, and high-enhancement UFs (87.2% ± 1.6%, 83.3% ± 2.1%, and 72.9% ± 3.1%, respectively; p < 0.05). On CEUS, the peak time of the time-intensity curve was significantly longer after treatment than before treatment (32.2 ± 9.7 and 26.7 ± 9.4 s, respectively; p < 0.05). Peak intensity was significantly lower after treatment than before treatment (13.7 ± 7.5 and 30.9 ± 11.2 dB, respectively; p < 0.05). All measurements were comparable between CEUS and MRI. The most common peri- and post-procedure adverse reaction was pain, which was temporary. CONCLUSION CEUS could dynamically and safely evaluate the immediate effects of the HIFU ablation of UFs.
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Affiliation(s)
- Miao Zhang
- Department of Gynecology and Obstetrics, The Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Chengkun Yin
- Department of Radiology, Suining Central Hospital, Suining, China
| | - Jing Jiang
- Department of Gynecology and Obstetrics, The Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yan Chen
- Department of Gynecology and Obstetrics, The Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Juan Wang
- Department of Gynecology and Obstetrics, The Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Qi Wang
- Department of Gynecology and Obstetrics, The Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yuhua Zeng
- Department of Gynecology and Obstetrics, The Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Honggui Zhou
- Department of Gynecology and Obstetrics, The Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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10
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Xu D, Meng Y, An S, Meng W, Li H, Zhang W, Xue Y, Lan X, Wang X, Li M, Zhang X, Zhihao Z, Zhao Y, Yang H, Zhang C, Zhang R, Zhen Z. Swimming exercise is a promising early intervention for autism-like behavior in Shank3 deletion rats. CNS Neurosci Ther 2022; 29:78-90. [PMID: 36221783 PMCID: PMC9804047 DOI: 10.1111/cns.13920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/14/2022] [Accepted: 06/20/2022] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION SHANK3 is an important excitatory postsynaptic scaffold protein, and its mutations lead to genetic cause of neurodevelopmental diseases including autism spectrum disorders (ASD), Philan McDermid syndrome (PMS), and intellectual disability (ID). Early prevention and treatment are important for Shank3 gene mutation disease. Swimming has been proven to have a positive effect on neurodegenerative diseases. METHODS Shank3 gene exon 11-21 knockout rats were intervened by a 40 min/day, 5 day/week for 8-week protocol. After the intervention, the rats were tested to behavioral measures such as learning and memory, and the volume and H-spectrum of the brain were measured using MRI; hippocampal dendritic spines were measured using Golgi staining and laser confocal. RESULTS The results showed that Shank3-deficient rats had significant deficits in social memory, object recognition, and water maze learning decreased hippocampal volume and number of neurons, and lower levels of related scaffold proteins and receptor proteins were found in Shank3-deficient rats. CONCLUSION It is suggested that early swimming exercise has a positive effect on Shank3 gene-deficient rats, which provides a new therapeutic strategy for the prevention and recovery of neurodevelopmental disorders.
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Affiliation(s)
- Dan Xu
- College of P.E and SportsBeijing Normal UniversityBeijingChina,Sports and Health Editorial OfficePeople's education pressBeijingChina
| | - Yunchen Meng
- Department of P.E.China University of Mining and Technology‐BeijingBeijingChina
| | - Shasha An
- College of P.E and SportsBeijing Normal UniversityBeijingChina
| | - Wenshu Meng
- College of Life SciencesBeijing Normal UniversityBeijingChina
| | - Hanran Li
- Centre for Cognitive and Brain Sciences and Department of PsychologyUniversity of MacauTaipaMacau
| | - Weinan Zhang
- College of P.E and SportsBeijing Normal UniversityBeijingChina
| | - Yaqi Xue
- College of P.E and SportsBeijing Normal UniversityBeijingChina
| | - Xinyu Lan
- Department of Neurobiology, School of Basic Medical SciencesPeking UniversityBeijingChina,Neuroscience Research InstitutePeking UniversityBeijingChina,Key Laboratory for Neuroscience, Ministry of Education/National Health and Family Planning CommissionPeking UniversityBeijingChina,Autism Research Center of Peking University Health Science CenterBeijingChina
| | - Xiaoxi Wang
- Institute of Acupuncture and MoxibustionChina Academy of Chinese Medical SciencesBeijingChina
| | - Mingjuan Li
- Department of Neurobiology, School of Basic Medical SciencesPeking UniversityBeijingChina,Neuroscience Research InstitutePeking UniversityBeijingChina,Key Laboratory for Neuroscience, Ministry of Education/National Health and Family Planning CommissionPeking UniversityBeijingChina,Autism Research Center of Peking University Health Science CenterBeijingChina
| | - Xiaoyan Zhang
- College of P.E and SportsBeijing Normal UniversityBeijingChina
| | - Zhang Zhihao
- College of P.E and SportsBeijing Normal UniversityBeijingChina
| | - Yu Zhao
- College of P.E and SportsBeijing Normal UniversityBeijingChina
| | - Haodong Yang
- College of P.E and SportsBeijing Normal UniversityBeijingChina
| | - Chen Zhang
- Department of Neurobiology, School of Basic Medical Sciences, Beijing Key Laboratory of Neural Regeneration and Repair, Advanced Innovation Center for Human Brain ProtectionCapital Medical UniversityBeijingChina
| | - Rong Zhang
- Department of Neurobiology, School of Basic Medical SciencesPeking UniversityBeijingChina,Neuroscience Research InstitutePeking UniversityBeijingChina,Key Laboratory for Neuroscience, Ministry of Education/National Health and Family Planning CommissionPeking UniversityBeijingChina,Autism Research Center of Peking University Health Science CenterBeijingChina,Department of Integration of Chinese and Western MedicineSchool of Basic Medical Sciences, Peking UniversityBeijingChina
| | - Zhiping Zhen
- College of P.E and SportsBeijing Normal UniversityBeijingChina
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11
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Smith KA, Welch BT, Kurup AN, Schmitz JJ, VanBuren WM, Ehman EC, Welch TL, Cope AG, Koepsel EK, Atwell TD, Burnett TL. Feasibility and safety of percutaneous image-guided cryoablation of abdominal wall endometriosis. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:2669-2673. [PMID: 34773468 DOI: 10.1007/s00261-021-03344-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/31/2021] [Accepted: 11/01/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE To evaluate the feasibility and safety of percutaneous image-guided cryoablation of abdominal wall endometriosis (AWE). MATERIALS AND METHODS A retrospective review of percutaneous cryoablation (CT or MR) of AWE was performed from January 2018 to December 2020. Eighteen patients were identified from an internal percutaneous ablation database. Technical success, complications, and outcomes were analyzed according to standard nomenclature. RESULTS Patients comprised 18 females (mean age 36.9 years) who underwent 18 cryoablation procedures to treat 23 AWE deposits. Three of the 18 cases were performed under MR guidance, while the remaining 15 employed CT guidance. Technical success was achieved in all 18 cases (100%). Fifteen of 18 patients (83%) had biopsy proven AWE deposits prior to treatment. Hydrodisplacement was used to displace adjacent bowel, bladder, or neurovascular structures in 13/18 cases (72%). The mean number of probes used per case was 3. Sixteen of 23 (70%) of AWE deposits had imaging follow-up (median 85 days). Of the 16 lesions with imaging follow-up, 15 (94%) demonstrated no residual enhancement or T1 hyperintensity at the treatment site and 1 lesion (6%) demonstrated residual/progressive disease. At clinical follow-up, 13 of 14 (93%) patients reported improvement in AWE-related symptoms. Eleven patients had clinically documented pain scores before and after ablation and all demonstrated substantial symptomatic improvement. No society of interventional radiology (SIR) major complications were observed. CONCLUSIONS Percutaneous cryoablation of AWE is feasible with a favorable safety profile. Further longitudinal studies are needed to document durable response over time.
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Affiliation(s)
- Katherine A Smith
- Department of Radiology, Mayo Clinic, 200 1st ST SW, Rochester, MN, 55905, USA
| | - Brian T Welch
- Department of Radiology, Mayo Clinic, 200 1st ST SW, Rochester, MN, 55905, USA.
| | - A Nicholas Kurup
- Department of Radiology, Mayo Clinic, 200 1st ST SW, Rochester, MN, 55905, USA
| | - John J Schmitz
- Department of Radiology, Mayo Clinic, 200 1st ST SW, Rochester, MN, 55905, USA
| | | | - Eric C Ehman
- Department of Radiology, Mayo Clinic, 200 1st ST SW, Rochester, MN, 55905, USA
| | - Tasha L Welch
- Department of Anesthesiology, Mayo Clinic, Rochester, USA
| | - Adela G Cope
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, USA
| | | | - Thomas D Atwell
- Department of Radiology, Mayo Clinic, 200 1st ST SW, Rochester, MN, 55905, USA
| | - Tatnai L Burnett
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, USA
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12
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Zhou MY, Bui NQ, Charville GW, Ghanouni P, Ganjoo KN. Current management and recent progress in desmoid tumors. Cancer Treat Res Commun 2022; 31:100562. [PMID: 35460976 DOI: 10.1016/j.ctarc.2022.100562] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/31/2022] [Accepted: 04/04/2022] [Indexed: 06/14/2023]
Abstract
Desmoid tumors are rare soft tissue tumors that can have aggressive infiltrative growth and relapse locally. Desmoid tumors can impact functionality and cause treatment-related morbidity and mortality. Here, the authors review current management strategies and avenues for further investigation. As part of the evolution of therapy away from primary surgical approaches to less invasive options, image-guided ablation has been accepted as less morbid and include cryoablation and high-intensity focused ultrasound. Systemic therapy options currently include hormonal agents, nonsteroidal anti-inflammatory drugs, tyrosine kinase inhibitors, and anthracycline-based regimens. Hormonal agents and nonsteroidal anti-inflammatory drugs have benign side effect profiles but generally limited efficacy. Anthracycline-based therapies are limited by the risk of secondary malignancies and cardiomyopathy. Tyrosine kinase inhibitors are well studied, and sorafenib is now one of the most utilized therapies, though limited by its side effect profile. Nirogacestat (PF-0308401) is an investigational small molecule gamma-secretase (GS) inhibitor that has demonstrated efficacy in phase 1 and II trials. A phase III trial investigating patients with desmoid tumors or aggressive fibromatosis is estimated to be completed December 2021 (NCT03785964). In addition to nirogacestat, the gamma-secretase inhibitor AL102 is being investigated for the treatment of patients with progressing desmoid tumors in the phase II/III RINGSIDE trial. Finally, the beta-catenin inhibitor Tegavivint (BC2059) is being investigated in a phase 1 open-label trial in patients with a proven primary or recurrent desmoid tumor that is unresectable and symptomatic or progressive.
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Affiliation(s)
- Maggie Y Zhou
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Nam Q Bui
- Department of Medicine (Oncology), Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA, 94305, USA
| | - Gregory W Charville
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Pejman Ghanouni
- Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Kristen N Ganjoo
- Department of Medicine (Oncology), Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA, 94305, USA.
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13
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Hu S, Liu Y, Chen R, Xiao Z. Exploring the Diagnostic Performance of Magnetic Resonance Imaging in Ultrasound-Guided High-Intensity Focused Ultrasound Ablation for Abdominal Wall Endometriosis. Front Physiol 2022; 13:819259. [PMID: 35242052 PMCID: PMC8886207 DOI: 10.3389/fphys.2022.819259] [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] [Received: 11/21/2021] [Accepted: 01/12/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE This study aimed to explore the clinical value of magnetic resonance imaging (MRI) combined with ultrasound-guided high-intensity focused ultrasound (USg-HIFU) for the diagnosis and treatment of abdominal wall endometriosis (AWE). METHODS Magnetic resonance imaging was performed before and after USg-HIFU. Information on clinical characteristics of patients, MRI characteristics of lesions, and treatment outcomes were collected. Thirty AWE lesions in 29 patients were examined before HIFU treatment, while 27 patients were examined after treatment. The results of MRI and color doppler ultrasound before surgery, as well as the volume and the apparent diffusion coefficient (ADC) values of the lesions before and after USg-HIFU treatment were compared. We also observed the clinical symptoms remission, recurrence, and ablation rates of the lesions in follow-up after HIFU treatment. RESULTS The locations of the 30 AWE lesions were identified by MRI before USg-HIFU treatment. Their sizes appeared larger on MRI than ultrasound (P < 0.05). A total of 27 lesions were evaluated by MRI after USg-HIFU treatment, of which 92.6% (25/27) lesions were of high or slightly high signal intensity on T1-weighted images, and 77.8% (21/27) lesions were of mixed signal intensity on T2-weighted images. The mean ADC values of AWE lesions were 1.47 (1.20-1.59) × 10-3mm2/s and 1.86 (1.61-2.12) × 10-3mm2/s for pre-and post-HIFU treatment (P < 0.05). Patients with higher ablation rates (>50%) had a higher complete/partial remission rate than those with lower ablation rates (<50%), and had a lower recurrence rate (P < 0.05). CONCLUSION MRI is a useful tool for identifying the location, size, and concurrent changes of AWE before and after USg-HIFU treatment, which is beneficial for follow-up monitoring and defining treatment efficacy.
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Affiliation(s)
- Shangying Hu
- Department of Gynecology and Obstetrics, The University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Yuhang Liu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rongsheng Chen
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhibo Xiao
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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14
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Wang S, Li BH, Wang JJ, Guo YS, Cheng JM, Ye H, Zang CY, Zhang Y, Duan H, Zhang XY. The safety of echo contrast-enhanced ultrasound in high-intensity focused ultrasound ablation for abdominal wall endometriosis: a retrospective study. Quant Imaging Med Surg 2021; 11:1751-1762. [PMID: 33936962 DOI: 10.21037/qims-20-622] [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: 12/19/2022]
Abstract
Background We aimed to investigate the efficacy and safety of echo contrast-enhanced ultrasound (CEUS) during high-intensity focused ultrasound (HIFU) ablation therapy for abdominal wall endometriosis (AWE). Methods A total of 67 patients with AWE were treated with HIFU ablation, and their demographic characteristics were retrospectively analysed. Blood perfusion of the focal lesion was assessed before the operation, during ablation and after the operation with the use of an ultrasound contrast agent, and the effect of the ultrasound contrast agent on treatment was assessed over a 1-year follow-up period. The degree of symptom relief and adverse effects were evaluated after HIFU ablation. Results Eighty-two lesions were ablated in 67 patients. CEUS showed that all lesions were successfully ablated with HIFU. The shrinkage ratio of the lesions significantly increased over the follow-up period. Intermittent pain disappeared at 1 month after the operation, and the patients' pain scores significantly decreased at the 1-year follow-up. The mean [± standard deviation (SD)] lesion volume was 7.64±8.95 cm3 on B-mode ultrasound. The post-HIFU non-perfused volume was 18.34±24.08 cm3, and the rate of massive changes on greyscale imaging was 96.16%±5.44% at 12 months. During the procedure, the main complications were a prickling sensation and tenderness in the treatment area and/or a transient "hot" sensation on the skin. After the procedure, there was no obvious discomfort except for pain. Two patients developed an approximately 1-cm area of skin that exhibited a waxy appearance. Seven patients had haematuria. No severe complications were observed. Conclusions Ultrasound contrast agents are effective and safe for evaluating the effect of HIFU ablation on AWE, and this approach provides significant guidance and evaluation benefits for the use of HIFU treatment for AWE without obvious side effects.
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Affiliation(s)
- Sha Wang
- Department of Gynecologic Minimally Invasive Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Bo-Han Li
- Department of Gynecologic Minimally Invasive Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Jin-Juan Wang
- Department of Gynecologic Minimally Invasive Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Ying-Shu Guo
- Department of Gynecologic Minimally Invasive Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Jiu-Mei Cheng
- Department of Gynecologic Minimally Invasive Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Hong Ye
- Department of Gynecologic Minimally Invasive Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Chun-Yi Zang
- Department of Gynecologic Minimally Invasive Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Ying Zhang
- Department of Gynecologic Minimally Invasive Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Hua Duan
- Department of Gynecologic Minimally Invasive Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Xiao-Ying Zhang
- Department of Gynecologic Minimally Invasive Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
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15
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Welch BT, Ehman EC, VanBuren WM, Cope AG, Welch TL, Woodrum DA, Kurup AN, Burnett TL. Percutaneous cryoablation of abdominal wall endometriosis: the Mayo Clinic approach. Abdom Radiol (NY) 2020; 45:1813-1817. [PMID: 31894380 DOI: 10.1007/s00261-019-02379-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Abdominal wall endometriosis (AWE) is a rare form of endometriosis that often results in substantial pain and debility. The current treatment algorithm for AWE is not well established. The purpose of this review is to describe the Mayo Clinic experience with thermal ablation of symptomatic AWE as well as to review current imaging and interventional literature regarding the diagnosis and treatment of AWE.
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Affiliation(s)
- Brian T Welch
- Department of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA.
| | - Eric C Ehman
- Department of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | | | - Adela G Cope
- Department of Obstetrics and Gynecology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | - Tasha L Welch
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | - David A Woodrum
- Department of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | - A Nick Kurup
- Department of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | - Tatnai L Burnett
- Department of Obstetrics and Gynecology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
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16
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Cope AG, Narasimhulu DM, Khan Z, VanBuren WM, Welch BT, Burnett TL. Nonsurgical radiologic intervention for management of abdominal wall endometriosis: A systematic review and meta-analysis. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2020. [DOI: 10.1177/2284026520906060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objective: To describe reported outcomes of nonsurgical radiologic interventions for abdominal wall endometriosis in comparison with surgery where available. Data sources: A systematic search of Ovid Medline, Embase, PubMed, and Cochrane Controlled Register of Trials was performed from inception to January 2019 with no language restrictions. Study eligibility criteria: Studies were included if they evaluated a nonsurgical intervention in women with symptomatic abdominal wall endometriosis with both comparative and noncomparative study designs. Study appraisal and synthesis methods: Titles and abstracts were reviewed for relevance, and full-text articles were obtained and evaluated for inclusion, all in duplicate. Meta-analysis was performed when possible using a fixed effects model. Results: Of the 114 records reviewed, 16 full-text articles were assessed and 7 were included in analysis. The standard mean difference between pre- and post-intervention pain scores was similar between ultrasound-guided high-intensity focused ultrasound (USgHIFU) (−3.00; 95% confidence interval −3.34, −2.66) and cryoablation (−3.93; 95% confidence interval −5.73, −2.12). The mean percent decrease in lesion size following intervention was similar between USgHIFU (−61.38%; 95% confidence interval −78.64%, −44.11%), and cryoablation (−88.16%; 95% confidence interval −83.90%, −55.06%). When compared with surgical excision, mean length of stay was 2.78 days less in the nonsurgical intervention group (95% confidence interval −3.78, −1.79). Conclusions: Both USgHIFU and cryoablation are effective at reducing pain scores and lesion size in abdominal wall endometriosis. Mean length of stay was significantly less following a nonsurgical radiologic intervention for abdominal wall endometriosis compared with surgery. More studies are needed comparing complication and recurrence rates between nonsurgical radiologic interventions for abdominal wall endometriosis and surgery.
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Affiliation(s)
- Adela G Cope
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | | | - Zaraq Khan
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | | | - Brian T Welch
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Tatnai L Burnett
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
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17
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Shi S, Ni G, Ling L, Ding H, Zhou Y, Ding Z. High-Intensity Focused Ultrasound in the Treatment of Abdominal Wall Endometriosis. J Minim Invasive Gynecol 2020; 27:704-711. [DOI: 10.1016/j.jmig.2019.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 02/06/2019] [Accepted: 06/12/2019] [Indexed: 11/16/2022]
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18
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Nguyen MD. Magnetic Resonance Imaging-guided High-intensity Focused Ultrasound Ablation for Endometriosis of the Abdominal Wall. Gynecol Minim Invasive Ther 2020; 9:45-46. [PMID: 32090015 PMCID: PMC7008641 DOI: 10.4103/gmit.gmit_47_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 09/20/2019] [Accepted: 10/03/2019] [Indexed: 11/04/2022] Open
Affiliation(s)
- Minh Duc Nguyen
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
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19
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Lee JE, Diederich CJ, Bok R, Sriram R, Santos RD, Noworolski SM, Salgaonkar VA, Adams MS, Vigneron DB, Kurhanewicz J. Assessing high-intensity focused ultrasound treatment of prostate cancer with hyperpolarized 13 C dual-agent imaging of metabolism and perfusion. NMR IN BIOMEDICINE 2019; 32:e3962. [PMID: 30022550 PMCID: PMC6338537 DOI: 10.1002/nbm.3962] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 05/17/2018] [Accepted: 05/19/2018] [Indexed: 05/05/2023]
Abstract
The goal of the study was to establish early hyperpolarized (HP) 13 C MRI metabolic and perfusion changes that predict effective high-intensity focused ultrasound (HIFU) ablation and lead to improved adjuvant treatment of partially treated regions. To accomplish this a combined HP dual-agent (13 C pyruvate and 13 C urea) 13 C MRI/multiparametric 1 H MRI approach was used to measure prostate cancer metabolism and perfusion 3-4 h, 1 d, and 5 d after exposure to ablative and sub-lethal doses of HIFU within adenocarcinoma of mouse prostate tumors using a focused ultrasound applicator designed for murine studies. Pathologic and immunohistochemical analysis of the ablated tumor demonstrated fragmented, non-viable cells and vasculature consistent with coagulative necrosis, and a mixture of destroyed tissue and highly proliferative, poorly differentiated tumor cells in tumor tissues exposed to sub-lethal heat doses in the ablative margin. In ablated regions, the intensity of HP 13 C lactate or HP 13 C urea and dynamic contrast-enhanced (DCE) MRI area under the curve images were reduced to the level of background noise by 3-4 h after treatment with no recovery by the 5 d time point in either case. In the tissues that received sub-lethal heat dose, there was a significant 60% ± 12.4% drop in HP 13 C lactate production and a significant 30 ± 13.7% drop in urea perfusion 3-4 h after treatment, followed by recovery to baseline by 5 d after treatment. DCE MRI Ktrans showed a similar trend to HP 13 C urea, demonstrating a complete loss of perfusion with no recovery in the ablated region, while having a 40%-50% decrease 3-4 h after treatment followed by recovery to baseline values by 5 d in the margin region. The utility of the HP 13 C MR measures of perfusion and metabolism in optimizing focal HIFU, either alone or in combination with adjuvant therapy, deserves further testing in future studies.
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Affiliation(s)
- Jessie E. Lee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
- University of California, Berkeley, and University of California, San Francisco Joint Graduate Program in Bioengineering
| | - Chris J. Diederich
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
- University of California, Berkeley, and University of California, San Francisco Joint Graduate Program in Bioengineering
- Department of Radiation Oncology, University of California, San Francisco
| | - Robert Bok
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Renuka Sriram
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Romelyn Delos Santos
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Susan M. Noworolski
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
- University of California, Berkeley, and University of California, San Francisco Joint Graduate Program in Bioengineering
| | | | - Matthew S. Adams
- University of California, Berkeley, and University of California, San Francisco Joint Graduate Program in Bioengineering
- Department of Radiation Oncology, University of California, San Francisco
| | - Daniel B. Vigneron
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
- University of California, Berkeley, and University of California, San Francisco Joint Graduate Program in Bioengineering
| | - John Kurhanewicz
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
- University of California, Berkeley, and University of California, San Francisco Joint Graduate Program in Bioengineering
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Zhu X, Chen L, Deng X, Xiao S, Ye M, Xue M. A comparison between high-intensity focused ultrasound and surgical treatment for the management of abdominal wall endometriosis. BJOG 2019; 124 Suppl 3:53-58. [PMID: 28856859 DOI: 10.1111/1471-0528.14737] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of this study was to compare the therapeutic outcomes of high-intensity focused ultrasound (HIFU) and surgical treatment for abdominal wall endometriosis. DESIGN A retrospective study. SETTING Gynaecological department of a teaching hospital in China. POPULATION Patients with abdominal wall endometriosis. METHODS Among the 51 patients, 23 patients were treated with ultrasound-guided HIFU and 28 patients with surgery. Pain relief and the size change of the nodule after each management were evaluated 1, 3, 6 and 12 months after treatment, respectively. The hospital stay and blood loss were also compared. MAIN OUTCOME MEASURES Difference between HIFU and surgical treatment for abdominal wall endometriosis. RESULTS No statistically significant differences were observed between the two groups in the pain relief in 1, 3, 6 and 12 months after treatment, respectively. The hospital stay was clearly shorter in the HIFU group than in the surgery group. Change in nodules was more remarkable in the group treated with surgery; no palpable nodules existed in most patients in the surgery group. HIFU had more advantages over surgery, such as no blood loss, no new scar, no anaesthesia and lower pain score immediately after treatment. CONCLUSIONS Based on our results, it appears that either HIFU or surgery is safe and effective in treating patients with AWE in short-term. Compared with surgery, HIFU treatment for AWE has the advantages of shorter hospital stay, no blood loss, no new scar, no anaesthesia and a lower immediate pain score. TWEETABLE ABSTRACT Either HIFU or surgical treatment is safe and effective in treating patients with AWE. HIFU has the advantages of a less invasive procedure and shorter hospital stay.
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Affiliation(s)
- X Zhu
- Department of Gynaecology, Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - L Chen
- Department of Gynaecology, Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - X Deng
- Department of Gynaecology, Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - S Xiao
- Department of Gynaecology, Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - M Ye
- Department of Gynaecology, Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - M Xue
- Department of Gynaecology, Third Xiangya Hospital of Central South University, Changsha, Hunan, China
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Luo S, Zhang C, Huang JP, Huang GH, He J. Ultrasound-guided high-intensity focused ultrasound treatment for abdominal wall endometriosis: a retrospective study. BJOG 2019; 124 Suppl 3:59-63. [PMID: 28856852 DOI: 10.1111/1471-0528.14741] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of ultrasound-guided high-intensity focused ultrasound (USgHIFU) for treating abdominal wall endometrioses (AWE). DESIGN A retrospective study. SETTING Department of Obstetrics and Gynaecology in China. POPULATION Patients with abdominal wall endometriosis. METHODS From August 2010 to April 2014, 32 patients with AWE were treated with USgHIFU in our hospital. USgHIFU treatment was performed with the Model JC-200 High Intensity Focused Ultrasound Tumor Therapeutic System. The symptom relief and the adverse effects were evaluated after USgHIFU ablation. MAIN OUTCOME MEASURES USgHIFU as a new treatment option for patients with AWE. RESULTS Contrast-enhanced ultrasound showed that all lesions were successfully ablated with USgHIFU. The follow-up results showed that the average volume of AWE lesions at 6 months after USgHIFU was significantly smaller than that before treatment (2.80 ± 0.12 versus 1.33 ± 0.31 cm3 ). The pain scores at 6 months after treatment were significantly lower than those before treatment (6.80 ± 2.64 versus 1.80 ± 0.3). The non-perfused volume (indicative of successful ablation) was measured in all patients immediately after treatment, ranging from 0.9 to 2.1 cm3 (median: 1.6 cm3 ), and the fractional ablation ranged from 87% to 100% (median: 94%). Local oedema was observed in these patients, lasting for 1-3 days only. No severe complications occurred during the follow-up period. CONCLUSIONS Based on our study, USgHIFU ablation is a safe and effective method for treating AWE. TWEETABLE ABSTRACT As a non-invasive treatment technique, HIFU could be used to treat abdominal wall endometriosis.
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Affiliation(s)
- S Luo
- Department of Obstetrics and Gynaecology, Suining Central Hospital, Sichuan, China
| | - C Zhang
- Department of Obstetrics and Gynaecology, Suining Central Hospital, Sichuan, China
| | - J P Huang
- Department of Obstetrics and Gynaecology, Suining Central Hospital, Sichuan, China
| | - G H Huang
- Department of Obstetrics and Gynaecology, Suining Central Hospital, Sichuan, China
| | - J He
- Department of Obstetrics and Gynaecology, Suining Central Hospital, Sichuan, China
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Stehouwer BL, Braat MN, Veersema S. Magnetic Resonance Imaging–Guided High-Intensity Focused Ultrasound is a Noninvasive Treatment Modality for Patients with Abdominal Wall Endometriosis. J Minim Invasive Gynecol 2018; 25:1300-1304. [DOI: 10.1016/j.jmig.2018.03.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 03/17/2018] [Accepted: 03/28/2018] [Indexed: 11/26/2022]
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Zhao L, Deng Y, Wei Q, Chen J, Zhao C. Comparison of ultrasound-guided high-intensity focused ultrasound ablation and surgery for abdominal wall endometriosis. Int J Hyperthermia 2018; 35:528-533. [PMID: 30208746 DOI: 10.1080/02656736.2018.1511836] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Surgery constitutes the standard approach for abdominal wall endometriosis (AWE), but is invasive. High-intensity focused ultrasound (HIFU) ablation is effective and safe for the treatment of AWE, but no study has compared HIFU and surgery. OBJECTIVE To report our experience about the benefits and adverse events of surgery compared to HIFU for the treatment of AWE. METHODS This was a retrospective study of 54 consecutive Chinese women with AWE after cesarean section treated at the First Affiliated Hospital of Chongqing Medical University (China) between January 2012 and December 2014. The patients underwent surgery (n = 29) or HIFU (n = 25). The technical success rate, adverse events, and recurrence were assessed. RESULTS The technical success rate was 100% in both groups. The complete remission rate was 92.0% (23/25) in the HIFU group, and 100% (29/29) in the surgery group. Numeric rating scale (NRS) scores after HIFU were significantly improved from 6.9 to 0.3.During the median follow-up period of 32 months (range, 19-46 months), the durations of pain relief were 29.7 ± 12.6 months and 25.0 ± 13.5 months in the surgery and HIFU groups, respectively (p = .337). Three patients (10.7%) experienced pain recurrence in the surgery group, and two (8.0%) in the HIFU group. Major adverse events occurred in four (13.8%) and one (4.0%) patients in the surgery and HIFU groups, respectively (p > .05). CONCLUSIONS HIFU appears to be beneficial for the treatment of AWE, and may reduce adverse events. Compared with surgery, HIFU does not induce blood loss or tissue defects.
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Affiliation(s)
- Ling Zhao
- a Department of Obstetrics and Gynecology , 1st Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Youlin Deng
- a Department of Obstetrics and Gynecology , 1st Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Qing Wei
- b College of Biomedical Engineering , Chongqing Medical University , Chongqing , China
| | - Jinyun Chen
- b College of Biomedical Engineering , Chongqing Medical University , Chongqing , China.,c HIFU Center for Tumor Therapy , 1st Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Chunquan Zhao
- a Department of Obstetrics and Gynecology , 1st Affiliated Hospital of Chongqing Medical University , Chongqing , China
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Suardika A, Astawa Pemayun TG. New insights on the pathogenesis of endometriosis and novel non-surgical therapies. J Turk Ger Gynecol Assoc 2018; 19:158-164. [PMID: 30008440 PMCID: PMC6085523 DOI: 10.4274/jtgga.2018.0090] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 07/16/2018] [Indexed: 12/19/2022] Open
Abstract
Endometriosis is a disease of theories, but none has succeeded to explain the whole picture. Most widely available drugs for endometriosis aim to relieve symptoms and improve fertility. Unfortunately, many short and long-term side-effects are associated with the treatments. To overcome this problem, researchers have developed many novel therapeutic agents, including non-invasive technique. We aim to provide new insights on pathogenesis model and novel non-surgical treatments for endometriosis, including drugs already available in the market and also drugs which are still under research. Seven novel treatment modalities are recognized, namely dienogest, aromatase inhibitor (AI), gonadotrophine-releasing hormone (GnRH) antagonist, anti tumor necrosing factor (TNF)-α, selective estrogen receptor modulator (SERM), selective progesterone receptor modulator (SPRM), and high-intensity focused ultrasound (HIFU). Dienogest, AI, and GnRH antagonists are effective novel treatments with good tolerance and safety. SERM and SPRM show inconsistent results, while anti-TNF-α is still in the animal experimental stage. HIFU is a potential futuristic treatment. However, it is still a long way until this technology is truly applicable.
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Affiliation(s)
- Anom Suardika
- Department of Obstetrics and Gynecology, Udayan University, Sangah Hospital, Bali, Indonesia
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Lopez-Soto A, Sanchez-Zapata MI, Martinez-Cendan JP, Ortiz Reina S, Bernal Mañas CM, Remezal Solano M. Cutaneous endometriosis: Presentation of 33 cases and literature review. Eur J Obstet Gynecol Reprod Biol 2017; 221:58-63. [PMID: 29310043 DOI: 10.1016/j.ejogrb.2017.11.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 11/20/2017] [Accepted: 11/30/2017] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Cutaneous endometriosis is a rare condition that usually affects the abdominal wall in women with a history of open abdominal surgery. It has a characteristic clinical picture of a mass and pain associated with menstruation. The diagnosis is difficult on being an uncommon and little known condition. Once there is suspicion, a correct anamnesis and examination is usually sufficient. The treatment is normally surgery. STUDY DESIGN The study included all women identified with a diagnosis of cutaneous endometriosis over a period of 20 years. The variables collected and analysed included, age, surgical history, gynaecology history, symptoms, time period between surgery and consultation, specialist consulted, location, size, tests performed, treatment, and recurrence. RESULTS A total of 33 women were identified, with a mean age of 35.4 ± 2.33 years. A surgical history was found in 31 (93%) of 33 women. The main symptom was abdominal mass (96%), followed by period pain (51%), and non-period pain (42%). The initial diagnosis was correct in 15 (45%) of 33 women, and after performing further tests it was correct in 23 (69%) of 33 women. The main additional test was fine needle aspiration (FNA) in 24 (72%) of 33 patients. Surgery was performed on 30 (90%) of 33 women, with 8 (24%) women requiring a prosthesis. There was a recurrence of cutaneous endometriosis in 3 (9%) women. CONCLUSION Although it is a rare disease, its association with gynaecological surgery, and in particular caesarean section, means that there should be more awareness of this condition. Its diagnosis may be complicated due to lack of knowledge, when a proper examination and anamnesis can give us the key.
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Affiliation(s)
- Alvaro Lopez-Soto
- Department of Gynecology, HGU Santa Lucía, Cartagena, Spain; Doctoral Program in Health Sciences. Catholic University of Murcia (UCAM), Murcia, Spain.
| | | | - Juan Pedro Martinez-Cendan
- Department of Gynecology, HGU Santa Lucía, Cartagena, Spain; Department of Obstetrics and Gynecology, Medical School, Catholic University of Murcia (UCAM), Murcia, Spain
| | | | | | - Manuel Remezal Solano
- Department of Obstetrics and Gynecology, Medical School, Catholic University of Murcia (UCAM), Murcia, Spain; Department of Gynecology, HCU Virgen de la Arrixaca, Murcia, Spain
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Abstract
OBJECTIVE The objective of this study is to present cryoablation as a minimally invasive definitive treatment for abdominal wall endometriosis. We describe our experience with the outpatient application of cryoablation to treat symptomatic abdominal wall endometriosis in three patients. CONCLUSION This feasibility study shows that minimally invasive cryoablation treated abdominal wall endometriosis in three patients and provided a prompt clinical response.
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Maillot J, Brun JL, Dubuisson V, Bazot M, Grenier N, Cornelis FH. Mid-term outcomes after percutaneous cryoablation of symptomatic abdominal wall endometriosis: comparison with surgery alone in a single institution. Eur Radiol 2017; 27:4298-4306. [PMID: 28396995 DOI: 10.1007/s00330-017-4827-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/09/2017] [Accepted: 03/20/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To compare the outcomes of percutaneous image-guided cryoablation of symptomatic abdominal wall endometriosis (AWE) versus surgery alone. METHODS From 2004 to 2016, cryoablation or surgery alone was performed under local (n = 5) or general anaesthesia (n = 15) for AWE in a single institution in 7 (mean age, 36.1 years) and 13 (mean age, 31.9 years) patients, respectively. Fifteen lesions were treated by cryoablation (mean size, 2.3 cm; range, 0.5-7 cm) and 16 by surgery (2.5 cm; 1.1-3.4 cm). Tolerance, efficacy and patient and procedural characteristics were compared. RESULTS Median follow-up was 22.5 (range, 6-42) months after cryoablation and 54 (14-149) after surgery. The median procedure and hospitalisation durations were 41.5 min (24-66) and 0.8 days (0-1) after cryoablation, and 73.5 min (35-160) and 2.8 days (1-12 days) after surgery (both P = 0.01). Three patients (23.1%) had severe complications and nine aesthetic sequels (69.2%) after surgery, none after cryoablation (P = 0.05). The median 12- and 24-month symptom free-survival rates were 100% and 66.7% (95% CI, 5.4; 94.5) after cryoablation and 92% (55.3; 98.9) after surgery at both time points (P = 0.45). CONCLUSIONS Cryoablation presents similar effectiveness to surgery alone for local control of AWE while reducing hospitalisation duration and complications. Any aesthetic sequels were associated with the cryoablation treatment. KEY POINTS • Hospitalisation is shorter after cryoablation than after surgery of abdominal wall endometriosis. • A significantly lower rate of complications is observed after cryoablation compared to surgery. • Cryoablation of abdominal wall endometriosis presents similar effectiveness to surgery alone. • A significant reduction of pain is observed 6 months after treatment. • A significant reduction of abdominal wall endometriosis is observed at 6 months.
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Affiliation(s)
- Julie Maillot
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, CHU Bordeaux, place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - Jean Luc Brun
- Service de gynecologie, Hôpital Pellegrin, CHU Bordeaux, place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - Vincent Dubuisson
- Service de chirurgie, Hôpital Pellegrin, CHU Bordeaux, place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - Marc Bazot
- Service de radiologie, Hôpital Tenon, APHP, 4 rue de la Chine, 75020, Paris, France
| | - Nicolas Grenier
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, CHU Bordeaux, place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - François H Cornelis
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, CHU Bordeaux, place Amélie-Raba-Léon, 33076, Bordeaux, France.
- Service de radiologie, Hôpital Tenon, APHP, 4 rue de la Chine, 75020, Paris, France.
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High intensity focused ultrasound treatment of adenomyosis: The relationship between the features of magnetic resonance imaging on T2 weighted images and the therapeutic efficacy. Eur J Radiol 2017; 89:117-122. [DOI: 10.1016/j.ejrad.2017.02.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 01/31/2017] [Accepted: 02/01/2017] [Indexed: 11/17/2022]
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Moderate-to-deep sedation technique, using propofol and ketamine, allowing synchronised breathing for magnetic resonance high-intensity focused ultrasound (MR-HIFU) treatment for uterine fibroids: a pilot study. J Ther Ultrasound 2017; 5:8. [PMID: 28194274 PMCID: PMC5299783 DOI: 10.1186/s40349-017-0088-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 01/06/2017] [Indexed: 02/07/2023] Open
Abstract
Background Magnetic resonance high-intensity focused ultrasound (MR-HIFU) treatment for uterine fibroids is rapidly gaining popularity as a treatment modality. This procedure is generally uncomfortable, painful, and requires minimal or absence of movement and an MR-HIFU synchronised breathing pattern of the patient. Procedural sedation and analgesia protocols have become the standard practice in interventional radiology departments worldwide. The aim of this study was to explore if a sedation regimen with low-dose propofol and ketamine performed by trained non-medical sedation practitioners could result in relief of discomfort for the patient and in adequate working conditions for MR-HIFU treatment for uterine fibroids. Methods In this study, conducted from August 2013 until November 2014, 20 patients were subjected to MR-HIFU treatment of uterine fibroids. Patients were deeply sedated using intravenous propofol and esketamine according to a standardised hospital protocol to allow synchronisation of the breathing pattern to the MR-HIFU. The quality of sedation for MR-HIFU and complications were recorded and analysed. The side effects of the sedation technique, the propofol and esketamine consumption rate, the duration of recovery, and patient satisfaction after 24 h were examined. Results A total of 20 female patients (mean age 42.4 [range 32–53] years) were enrolled. Mean propofol/esketamine dose was 1309 mg/39.5 mg (range 692–1970 mg/ 23.6–87.9 mg). Mean procedure time was 269 min (range 140–295 min). Application of the sedation protocol resulted in a regular breathing pattern, which could be synchronised with the MR-HIFU procedures without delay. The required treatment was completed in all cases. There were no major adverse events. Hypoxemia (oxygen desaturation <92%) and hallucinations were not observed. Conclusions The use of a specific combination of IV propofol and esketamine for procedural sedation and analgesia reduced the discomfort and pain during MR-guided HIFU treatments of uterine fibroids. The resulting regular breathing pattern allowed for easy synchronisation of the MR-HIFU procedure. Based on our results, esketamine and propofol sedation performed by trained non-medical sedation practitioners is feasible and safe, has a low risk of major adverse events, and has a short recovery time, avoiding a session of general anaesthesia. Electronic supplementary material The online version of this article (doi:10.1186/s40349-017-0088-9) contains supplementary material, which is available to authorized users.
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Zhang L, Zhang W, Orsi F, Chen W, Wang Z. Ultrasound-guided high intensity focused ultrasound for the treatment of gynaecological diseases: A review of safety and efficacy. Int J Hyperthermia 2015; 31:280-4. [DOI: 10.3109/02656736.2014.996790] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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Moshiri M, Osman S, Bhargava P, Maximin S, Robinson TJ, Katz DS. Imaging Evaluation of Maternal Complications Associated with Repeat Cesarean Deliveries. Radiol Clin North Am 2014; 52:1117-35. [DOI: 10.1016/j.rcl.2014.05.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Percutaneous Cryoablation of Symptomatic Abdominal Scar Endometrioma: Initial Reports. Cardiovasc Intervent Radiol 2014; 37:1575-9. [DOI: 10.1007/s00270-014-0843-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 12/22/2013] [Indexed: 10/25/2022]
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Solak A, Şahin N, Genç B, Sever AR, Genç M, Sivrikoz ON. Diagnostic value of susceptibility-weighted imaging of abdominal wall endometriomas during the cyclic menstrual changes: A preliminary study. Eur J Radiol 2013; 82:e411-6. [DOI: 10.1016/j.ejrad.2013.04.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 04/12/2013] [Accepted: 04/13/2013] [Indexed: 12/19/2022]
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A retrospective review of abdominal wall endometriosis in Shanghai, China. Int J Gynaecol Obstet 2013; 121:41-4. [DOI: 10.1016/j.ijgo.2012.11.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 11/07/2012] [Accepted: 12/18/2012] [Indexed: 12/19/2022]
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Zhang L, Wang ZB. High-intensity focused ultrasound tumor ablation: Review of ten years of clinical experience. ACTA ACUST UNITED AC 2010; 4:294-302. [DOI: 10.1007/s11684-010-0092-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Accepted: 05/12/2010] [Indexed: 10/19/2022]
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