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He Y, Wu M, Guo X, Ran F, Li H, Zhang D, Wang Y, Zeng J, Chen X, Zhai L, Li X, Lei T. Feasibility, safety and efficacy of high intensity focused ultrasound ablation as a preoperative treatment for challenging hysteroscopic myomectomy. Int J Hyperthermia 2024; 41:2365974. [PMID: 38880503 DOI: 10.1080/02656736.2024.2365974] [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: 12/12/2023] [Accepted: 06/05/2024] [Indexed: 06/18/2024] Open
Abstract
PURPOSE To investigate the feasibility, safety and efficacy of high intensity focused ultrasound ablation (HIFU) as a preoperative treatment for challenging hysteroscopic myomectomies. MATERIALS AND METHODS A total of 75 patients diagnosed with types 0-III of uterine fibroids were enrolled. Based on the Size, Topography, Extension of the base, Penetration and lateral Wall position (STEPW) classification scoring system, 25 cases with a score ≥ 5 points were treated with HIFU followed by hysteroscopic myomectomy (HIFU + HM group), whereas 50 cases with a score < 5 points were treated with hysteroscopic myomectomy (HM group). RESULTS The median preoperative STEPW score was 7 in the HIFU + HM group and 2 in the HM group. The average non-perfused volume (NPV) ratio achieved in fibroids after HIFU was 86.87%. Patients in the HIFU + HM group underwent hysteroscopic myomectomy one to four days after HIFU, and downgrading was observed in 81.81% of fibroids. The operation time for patients in the HIFU + HM group was 73 min and the success rate of myomectomy in a single attempt was 60%. The volume of distention medium used during the operation was greater in the HIFU + HM group than in the HM group (15,500 ml vs. 7500 ml). No significant difference was observed between the two groups in terms of intraoperative blood loss, the incidence of intraoperative and postoperative complications, menstrual volume score, or uterine fibroid quality of life score. CONCLUSION HIFU can be utilized as a preoperative treatment for large submucosal fibroids prior to hysteroscopic myomectomy. HIFU offers a novel approach in the management of this subset of patients.
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Affiliation(s)
- Yuchun He
- Department of Gynecology and Obstetrics, Suining Municipal Hospital of Traditional Chinese Medicine, Suining, China
| | - Min Wu
- Department of Gynecology and Obstetrics, Suining Municipal Hospital of Traditional Chinese Medicine, Suining, China
| | - Xu Guo
- Department of Oncology, Suining Municipal Hospital of Traditional Chinese Medicine, Suining, China
| | - Feng Ran
- State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Medical University, Chongqing, China
| | - Haiyan Li
- Department of Gynecology and Obstetrics, Suining Municipal Hospital of Traditional Chinese Medicine, Suining, China
| | - Daibi Zhang
- Department of Gynecology and Obstetrics, Suining Municipal Hospital of Traditional Chinese Medicine, Suining, China
| | - Yaqin Wang
- Department of Gynecology and Obstetrics, Suining Municipal Hospital of Traditional Chinese Medicine, Suining, China
| | - Jin Zeng
- Department of Gynecology and Obstetrics, Suining Municipal Hospital of Traditional Chinese Medicine, Suining, China
| | - Xuelian Chen
- Department of Oncology, Suining Municipal Hospital of Traditional Chinese Medicine, Suining, China
| | - Linghui Zhai
- Department of Gynecology and Obstetrics, Suining Municipal Hospital of Traditional Chinese Medicine, Suining, China
| | - Xiaohui Li
- Department of Gynecology and Obstetrics, Suining Municipal Hospital of Traditional Chinese Medicine, Suining, China
| | - Tingting Lei
- Department of Gynecology and Obstetrics, Suining Municipal Hospital of Traditional Chinese Medicine, Suining, China
- State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Medical University, Chongqing, China
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Li S, Yang M, Yu J, Ma W, Deng Y, Hu L, Chen JY. Achieving NPVR ≥ 80% as technical success of high-intensity focused ultrasound ablation for uterine fibroids: a cohort study. BMC Womens Health 2024; 24:294. [PMID: 38762488 PMCID: PMC11102242 DOI: 10.1186/s12905-024-03093-0] [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: 12/28/2023] [Accepted: 04/15/2024] [Indexed: 05/20/2024] Open
Abstract
OBJECTIVE To report the long-term re-intervention of patients with uterine fibroids after ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation and to analyse the influencing factors of re-intervention in patients in the NPVR ≥ 80% group. MATERIALS AND METHODS Patients with a single uterine fibroid who underwent USgHIFU at our hospital from January 2012 to December 2019 were enrolled. The patients were divided into four groups according to different nonperfusion volume ratio (NPVR). Kaplan-Meier survival curve was used to analyse long-term re-intervention in different NPVR groups, and Cox regression was used to analyse the influencing factors of re-intervention in the NPVR ≥ 80% group. MAIN RESULTS A total of 1,257 patients were enrolled, of whom 920 were successfully followed up. The median follow-up time was 88 months, and the median NPVR was 85.0%. The cumulative re-intervention rates at 1, 3, 5, 8 and 10 years after USgHIFU were 3.4%, 11.8%, 16.8%, 22.6% and 24.1%, respectively. The 10-year cumulative re-intervention rate was 37.3% in the NPVR < 70% group, 31.0% in the NPVR 70-79% group, 18.2% in the NPVR 80-89% group and 17.8% in the NPVR ≥ 90% group (P < 0.05). However, no difference was found between the group of NPVR 80-89% and the group of NPVR ≥ 90% (P = 0.499). Age of patients and signal intensity on T2-weighted imaging (T2WI) of tumours were found to be independent risk factors for long-term re-intervention in the NPVR ≥ 80% group. A younger age and greater signal intensity on T2W images corresponded to a greater risk of re-intervention. CONCLUSION USgHIFU, an alternative treatment for uterine fibroids, has reliable long-term efficacy. NPVR ≥ 80% can be used as a sign of technical success, which can reduce re-intervention rates. However, an important step is to communicate with patients in combination with the age of patients and the signal intensity on T2WI of fibroids. TRIAL REGISTRATION This retrospective study was approved by the ethics committee at our institution (Registration No. HF2023001; Date: 06/04/2023). The Chinese Clinical Trial Registry provided full approval for the study protocol (Registration No. CHiCTR2300074797; Date: 16/08/2023).
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Affiliation(s)
- Shuang Li
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, No.1 Medical College Road, Yuzhong District, Chongqing, Chongqing, 400016, China
| | - Meijie Yang
- College of Medical Informatics, Chongqing Medical University, Chongqing, 400016, China
| | - Jingwen Yu
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, No.1 Medical College Road, Yuzhong District, Chongqing, Chongqing, 400016, China
| | - Wangwa Ma
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, No.1 Medical College Road, Yuzhong District, Chongqing, Chongqing, 400016, China
| | - Yongbin Deng
- Chongqing Haifu Hospital, Chongqing, 401121, China
| | - Liang Hu
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, No.1 Medical College Road, Yuzhong District, Chongqing, Chongqing, 400016, China
- Ultrasound Ablation Center, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400042, China
| | - Jin-Yun Chen
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, No.1 Medical College Road, Yuzhong District, Chongqing, Chongqing, 400016, China.
- Ultrasound Ablation Center, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400042, China.
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Tang NH, Fang CL, Hu WH, Tian L, Lin C, Hu HQ, Shi QL, Xu F. Age-stratified risk factors of re-intervention for uterine fibroids treated with high-intensity focused ultrasound. Int J Gynaecol Obstet 2024; 164:1212-1219. [PMID: 37953647 DOI: 10.1002/ijgo.15217] [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: 04/01/2023] [Revised: 07/17/2023] [Accepted: 10/17/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE To estimate the rate and risk factors of re-intervention for patients with uterine fibroids (UFs) undergoing high-intensity focused ultrasound (HIFU) at different age distributions. METHOD A retrospective cohort study was conducted in Nanchong Central Hospital, recruiting a total of 672 patients with UFs undergoing HIFU from June 2017 to December 2019. Using univariate and multivariate logistic regression, risk factors for re-intervention were assessed. RESULTS Among 401 patients with UFs who completed the follow-up visits (median 47 months, range 34-61), 50 (12.46%) patients underwent re-intervention (such as high-intensity focused ultrasound, uterine artery embolization, myomectomy and hysterectomy). In the different age distributions, the re-intervention rate was 17.5% (34/194) in patients aged <45 years and 7.7% (16/207) in those aged ≥45 years. Regarding the younger patient group (aged <45 years), hypo- or iso-intensive fibroids in T2-weighted magnetic resonance imaging (T2WI) intensity may elevate the risk of re-intervention for UFs (odds ratio [OR] 2.96, 95% confidence interval [CI] 1.37-6.62; P = 0.007). Among the older patient group (aged ≥45 years), preoperative anemic patients had an increased risk of re-intervention compared with those without anemia (OR 3.30, 95% CI 1.01-10.37; P = 0.041). CONCLUSION The re-intervention rate of HIFU decreased with increasing age. Among those aged <45 years, T2WI intensity was the independent risk factor for re-intervention, and among those aged ≥45 years, preoperative anemic status may be related to re-intervention outcome.
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Affiliation(s)
- Neng-Huan Tang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, People's Republic of China
- Department of Obstetrics and Gynecology, Affiliated Nanchong Central Hospital of North Sichuan Medical University, Nanchong, People's Republic of China
| | - Chun-Ling Fang
- Department of Obstetrics and Gynecology, Affiliated Nanchong Central Hospital of North Sichuan Medical University, Nanchong, People's Republic of China
| | - Wen-Hao Hu
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, People's Republic of China
| | - Ling Tian
- Department of Obstetrics and Gynecology, Affiliated Nanchong Central Hospital of North Sichuan Medical University, Nanchong, People's Republic of China
| | - Chuan Lin
- Department of Obstetrics and Gynecology, Affiliated Nanchong Central Hospital of North Sichuan Medical University, Nanchong, People's Republic of China
| | - Hui-Quan Hu
- Department of Obstetrics and Gynecology, Affiliated Nanchong Central Hospital of North Sichuan Medical University, Nanchong, People's Republic of China
| | - Qiu-Ling Shi
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, People's Republic of China
- School of Public Health and Management, Chongqing Medical University, Chongqing, People's Republic of China
| | - Fan Xu
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, People's Republic of China
- Department of Obstetrics and Gynecology, Affiliated Nanchong Central Hospital of North Sichuan Medical University, Nanchong, People's Republic of China
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Dou Y, Zhang L, Liu Y, He M, Wang Y, Wang Z. Long-term outcome and risk factors of reintervention after high intensity focused ultrasound ablation for uterine fibroids: a systematic review and meta-analysis. Int J Hyperthermia 2024; 41:2299479. [PMID: 38164630 DOI: 10.1080/02656736.2023.2299479] [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: 10/03/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVES To quantify the reintervention rate and analyze the risk factors for reintervention after high-intensity focused ultrasound (HIFU) ablation of uterine fibroids. METHODS Eighteen studies were selected from the seven databases. A meta-analysis was applied to synthesize the reintervention rates for fibroids across various follow-up durations. Subgroup-analysis was conducted based on the year of surgery, sample size, guide methods, and non-perfusion volume ratio (NPVR). Signal intensity of T2-weighted imaging (T2WI) was independently evaluated for reintervention risk. RESULTS The study enrolled 5216 patients with fibroids treated with HIFU. There were 3247, 1239, 1762, and 2535 women reaching reintervention rates of 1% (95% confidence interval (CI): 1-1), 7% (95% CI: 4-11), 19% (95% CI: 11-27), and 29% (95% CI: 14-44) at 12, 24, 36, and 60-month after HIFU. The reintervention rates of patients treated with US-guided HIFU (USgHIFU) were significantly lower than those of patients treated with MR-guided focused ultrasound surgery (MRgFUS). When the NPVR of fibroids was over 50%, the reintervention rates at 12, 36 and 60-month after HIFU were 1% (95% CI: 0.3-2), 5% (95% CI: 3-8), and 15% (95% CI: 9-20). The reintervention risk for hyper-intensity fibroids on T2WI was 3.45 times higher (95% CI: 2.7-4.39) for hypo-/iso-intensity fibroids. CONCLUSION This meta-analysis showed that the overall reintervention rates after HIFU were acceptable and provided consultative suggestions regarding treatment alternatives for patients with fibroids. Subgroup-analysis revealed that USgHIFU, NPVR ≥ 50%, and hypo-/iso-intensity of fibroids on T2WI were significant factors in reducing reintervention. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42023456094.
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Affiliation(s)
- Yuya Dou
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- Department of Obstetrics and Gynecology, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Lian Zhang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Yu Liu
- Department of Obstetrics and Gynecology, Hainan Hospital of PLA General Hospital, Sanya, China
| | - Min He
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Yanzhou Wang
- Department of Obstetrics and Gynecology, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Zhibiao Wang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
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Ali M, Ciebiera M, Wlodarczyk M, Alkhrait S, Maajid E, Yang Q, Hsia SM, Al-Hendy A. Current and Emerging Treatment Options for Uterine Fibroids. Drugs 2023; 83:1649-1675. [PMID: 37922098 DOI: 10.1007/s40265-023-01958-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 11/05/2023]
Abstract
Uterine fibroids are the most common benign neoplasm of the female reproductive tract in reproductive age women. Their prevalence is age dependent and can be detected in up to 80% of women by the age of 50 years. Patients affected by uterine fibroids may experience a significant physical, emotional, social, and financial toll as well as losses in their quality of life. Unfortunately, curative hysterectomy abolishes future pregnancy potential, while uterine-sparing surgical and radiologic alternatives are variously associated with reduced long-term reproductive function and/or high tumor recurrence rates. Recently, pharmacological treatment against uterine fibroids have been widely considered by patients to limit uterine fibroid-associated symptoms such as heavy menstrual bleeding. This hormonal therapy seemed effective through blocking the stimulatory effects of gonadal steroid hormones on uterine fibroid growth. However, they are contraindicated in women actively pursuing pregnancy and otherwise effective only during use, which is limited because of long-term safety and other concerns. Accordingly, there is an urgent unmet need for safe, durable, and fertility-compatible non-surgical treatment options for uterine fibroids. In this review article, we cover the current pharmacological treatments for uterine fibroids including their comparable efficacy and side effects as well as emerging safe natural compounds with promising anti-uterine fibroid effects.
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Affiliation(s)
- Mohamed Ali
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
- Clinical Pharmacy Department, Faculty of Pharmacy, Ain Shams University, Cairo, 11566, Egypt
| | - Michał Ciebiera
- Second Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw, 00-189, Poland
| | - Marta Wlodarczyk
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
- Department of Biochemistry and Pharmacogenomics, Faculty of Pharmacy, Medical University of Warsaw, Banacha 1B, Warsaw, 02-097, Poland
- Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland
| | - Samar Alkhrait
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
| | - Elise Maajid
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
| | - Qiwei Yang
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
| | - Shih-Min Hsia
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei, 11031, Taiwan
| | - Ayman Al-Hendy
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL, 60637, USA.
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Bitton RR, Fast A, Vu KN, Lum DA, Chen B, Hesley GK, Raman SS, Matsumoto AH, Price TM, Tempany C, Dhawan N, Dolen E, Kohi M, Fennessey FM, Ghanouni P. What predicts durable symptom relief of uterine fibroids treated with MRI-guided focused ultrasound? A multicenter trial in 8 academic centers. Eur Radiol 2023; 33:7360-7370. [PMID: 37553488 DOI: 10.1007/s00330-023-09984-4] [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: 01/13/2023] [Revised: 06/02/2023] [Accepted: 06/06/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVE To identify variables predictive of durable clinical success after MRI-guided focused ultrasound (MRgFUS) treatment of uterine fibroids. MATERIALS AND METHODS In this prospective, multicenter trial, 99 women with symptomatic uterine fibroids were treated using MRgFUS. Pelvic MRI was obtained at baseline and treatment day. The Uterine Fibroid Symptom-Quality of Life questionnaire was used to calculate a symptom severity score (SSS) at baseline and 6, 12, 24, and 36 months following treatment. Clinical, imaging, and treatment variables were correlated with symptom reduction sustained through the 12- and 24-month time points using univariable and multivariable logistic regression analyses. A novel parameter, the ratio of non-perfused volume to total fibroid load (NPV/TFL), was developed to determine association with durable outcomes. RESULTS Post-treatment, mean symptom severity decreased at the 6-, 12-, 24-, and 36-month follow-ups (p < 0.001, all time points). In univariable analysis, three variables predicted treatment success (defined by ≥ 30-point improvement in SSS) sustained at both the 12-month and 24-month time points: increasing ratio of NPV/TFL (p = 0.002), decreasing total fibroid load (p = 0.04), and the absence of T2-weighted Funaki type 2 fibroids (p = 0.02). In multivariable analysis, the NPV/TFL was the sole predictor of durable clinical success (p = 0.01). Patients with ratios below 30% had less improvement in SSS and lacked durable clinical response compared with those between 30-79 (p = 0.03) and ≥ 80% (p = 0.01). CONCLUSION Increased non-perfused volume relative to total fibroid volume was significantly associated with durable reduction of symptoms of abnormal uterine bleeding and bulk bother. CLINICAL RELEVANCE STATEMENT Patient selection for sustained clinical benefit should emphasize those with likelihood of achieving high ablation ratios, as determined by imaging (e.g., device access, Funaki type) and by considering the total fibroid load, not just the primary symptomatic fibroid. TRIAL REGISTRATION Clinical trial ID: NCT01285960. KEY POINTS • Patient selection/treatment approach associated with durable symptom relief in MRI-guided focused ultrasound ablation of uterine fibroids remains unclear. • The ablation ratio, non-perfused volume/total fibroid volume, was positively associated with sustained symptom relief in both bleeding and bulk bother at 1- and 2-year follow-ups. • Selecting patients with imaging features that favor a high ratio of ablation to total fibroid load (including non-targeted fibroids) is the main factor in predicting durability of symptom relief after uterine fibroid treatment.
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Affiliation(s)
- Rachel R Bitton
- Department of Radiology, Stanford University, 1024 Welch Road, MC 5488, Stanford, CA, 94305, USA.
| | - Angela Fast
- Department of Radiology, Stanford University, 1024 Welch Road, MC 5488, Stanford, CA, 94305, USA
| | - Kim-Nhien Vu
- Department of Radiology, Stanford University, 1024 Welch Road, MC 5488, Stanford, CA, 94305, USA
| | - Deirdre A Lum
- Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA
| | - Bertha Chen
- Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA
| | - Gina K Hesley
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Steven S Raman
- Interventional Radiology, University of California Los Angeles, Los Angeles, CA, USA
| | - Alan H Matsumoto
- Interventional Radiology, University of Virginia, Charlottesville, VA, USA
| | - Thomas M Price
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
| | - Clare Tempany
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | - Maureen Kohi
- Vascular and Interventional Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Fiona M Fennessey
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Pejman Ghanouni
- Department of Radiology, Stanford University, 1024 Welch Road, MC 5488, Stanford, CA, 94305, USA
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Slotman DJ, Nijholt IM, Schutte JM, Boomsma MF. No incision required for long-lasting symptom relief in a selection of women suffering from uterine fibroids. Eur Radiol 2023; 33:7357-7359. [PMID: 37740081 DOI: 10.1007/s00330-023-10197-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 07/09/2023] [Accepted: 08/15/2023] [Indexed: 09/24/2023]
Affiliation(s)
- Derk J Slotman
- Department of Radiology, Isala Hospital, Zwolle, The Netherlands.
- Imaging & Oncology Division, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Ingrid M Nijholt
- Department of Radiology, Isala Hospital, Zwolle, The Netherlands
- Imaging & Oncology Division, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joke M Schutte
- Department of Gynecology, Isala Hospital, Zwolle, The Netherlands
| | - Martijn F Boomsma
- Department of Radiology, Isala Hospital, Zwolle, The Netherlands
- Imaging & Oncology Division, University Medical Center Utrecht, Utrecht, The Netherlands
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Tinelli A, Kosmas I, Medvediev MV, Malvasi A, Morciano A, Sparić R, Mynbaev OA. Myomectomy in adult women of reproductive age: a propensity score-matched study for pregnancy rates. Arch Gynecol Obstet 2023; 308:1351-1360. [PMID: 37450263 DOI: 10.1007/s00404-023-07135-0] [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: 08/15/2022] [Accepted: 06/29/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE To study whether it is better to perform or not a myomectomy, in terms of surgical and reproductive outcomes in patients of advanced reproductive age, by an observational prospective study in university-affiliated and Community Hospitals. MATERIALS AND METHODS 40 years and older patients affected by non-submucous symptomatic uterine fibroids and desiring future fertility were enrolled and treated by laparoscopic intracapsular myomectomy by (LIM) or by open laparotomy (OIM), or by a non-surgical management as control group, while attempting to conceive. The primary outcome measures were fibroid characteristics, pre- and post-surgical parameters, pregnancy achievement; the secondary outcome measures were the spontaneous or ART pregnancy outcomes, eventual week of abortion and type of delivery. Propensity scores have been calculated with logistic regression for binary and continuous variables. RESULTS 202 patients completed the study: 112 operated by LIM, 40 by OIM and 50 patients as control group. Patients undergoing OIM have a worse surgical outcome than LIM. No difference was seen in pregnancy either after myomectomy or control group during follow-up. In the LIM group, there were 44 pregnancies (39.2%), and in the OIM group, there were 9 (22.5%) and 16 in the control group (32%). The weeks of delivery were statistically greater for the control group versus the surgical groups, with no difference in Apgar score between the 3 groups. CONCLUSION Patients aged over 40 years did not show substantial differences in reproductive outcome, whether operated or not. Myomectomy in over 40-year-old patients has no detrimental effect on future pregnancy rates and over when compared to expectant management.
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Affiliation(s)
- Andrea Tinelli
- Department of Obstetrics and Gynecology and CERICSAL (Centro di RIcerca Clinico Salentino), "Veris Delli Ponti Hospital", Scorrano, Via Giuseppina Delli Ponti, 73020, Lecce, Italy.
| | - Ioannis Kosmas
- Department of Obstetrics and Gynecology, Ioannina State General Hospital G. Chatzikosta, Ioannina, Greece
| | - Mykhailo V Medvediev
- Department of Obstetrics and Gynecology, Dnipro State Medical University, Dnipro, 49044, Ukraine
| | - Antonio Malvasi
- Department of Biomedical Sciences and Human Oncology, Unit of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Andrea Morciano
- Department of Gynaecology and Obstetrics, Pia Fondazione "Card. G. Panico", Tricase, Lecce, Italy
| | - Radmila Sparić
- Clinic for Gynecology and Obstetrics, University Clinical Centre of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ospan A Mynbaev
- Moscow Institute of Physics and Technology, 141701, Dolgoprudny, Russia
- New European Surgical Academy, Berlin, Germany
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Palheta MS, Medeiros FDC, Severiano ARG. Reporting of uterine fibroids on ultrasound examinations: an illustrated report template focused on surgical planning. Radiol Bras 2023; 56:86-94. [PMID: 37168038 PMCID: PMC10165971 DOI: 10.1590/0100-3984.2022.0048] [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: 04/19/2022] [Accepted: 08/04/2022] [Indexed: 05/13/2023] Open
Abstract
Uterine fibroids are the most common benign gynecologic tumors in women of reproductive age, and ultrasound is the first-line imaging modality for their diagnosis and characterization. The International Federation of Gynecology and Obstetrics developed a system for describing and classifying uterine fibroids uniformly and consistently. An accurate description of fibroids in the ultrasound report is essential for planning surgical treatment and preventing complications. In this article, we review the ultrasound findings of fibroids, detailing the main points to be reported for preoperative evaluation. In addition, we propose a structured, illustrated report template to describe fibroids, based on the critical points for surgical planning.
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Yuan Y, Xu W, Shen H, Lin Z, Xu F, Shi Q, Zhan P, Liu M, Shu J, Chen J, Xing HR. Long-term outcomes of ultrasound guided high intensity focused ultrasound ablation for patients with uterine fibroids classified by T2WI: a multicenter retrospective study. Int J Hyperthermia 2023; 40:2212887. [PMID: 37202174 DOI: 10.1080/02656736.2023.2212887] [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: 02/08/2023] [Revised: 05/04/2023] [Accepted: 05/07/2023] [Indexed: 05/20/2023] Open
Abstract
OBJECTIVE To evaluate the long-term outcomes of ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation of uterine fibroids classified by T2-weighted magnetic resonance imaging (T2WI-MRI). MATERIALS AND METHODS The data of 1427 premenopausal women with symptomatic uterine fibroids who underwent USgHIFU at four teaching hospitals in China were analyzed retrospectively. The uterine fibroids were classified based on their T2WI-MRI signal intensities relative to that of skeletal muscle, myometrium and endometrium as: hypointense, isointense, heterogeneous hyperintense fibroids (HHF), slightly HHF (sHHF) and markedly HHF (mHHF), respectively. The rates of symptom relief and reintervention post-USgHIFU ablation were compared between the classified groups. RESULTS A total of 1303 patients were followed up for 44 (40, 49) months. The symptom relief rate of the hypointense and isointense fibroids was 83.3% and 79.5%, respectively, which were significantly higher (p < .05) compared to that of HHF, sHHF and mHHF (58.3%, 44.2% and 60.4%), respectively. sHHF had the lowest symptom relief rate (p < .05). The cumulative reintervention rate for hypointense, isointense, HHF, sHHF and mHHF types were 8.8%, 10.8%, 21.4%, 39.9% and 19.8%, respectively. The reintervention rate of hypointense/isointense fibroids was significantly lower than that of HHF/mHHF/sHHF (p < .01), while sHHF had the highest re-intervention rate (p < .01). Thus, reintervention rate is inversely correlated to the rate of symptom relief. CONCLUSIONS USgHIFU ablation is effective for hypointense, isointense, HHF and mHHF with acceptable long-term follow-up outcomes. However, sHHF is associated with a higher reintervention rate.
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Affiliation(s)
- Yuan Yuan
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- Sichuan Provincial Center for Gynaecology and Breast Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Wei Xu
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Huangpin Shen
- Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Zhenjiang Lin
- Department of Obstetrics and Gynecology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Fan Xu
- Department of Obstetrics and Gynecology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical University, Nanchong, China
| | - Qiuling Shi
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Ping Zhan
- Sichuan Provincial Center for Gynaecology and Breast Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Mali Liu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jian Shu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jinyun Chen
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - H Rosie Xing
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
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Qin S, Lin Z, Liu N, Zheng Y, Jia Q, Huang X. Prediction of postoperative reintervention risk for uterine fibroids using clinical-imaging features and T2WI radiomics before high-intensity focused ultrasound ablation. Int J Hyperthermia 2023; 40:2226847. [PMID: 37394476 DOI: 10.1080/02656736.2023.2226847] [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: 03/31/2023] [Revised: 06/07/2023] [Accepted: 06/13/2023] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVE To predict the risk of postoperative reintervention for uterine fibroids using clinical-imaging features and T2WI radiomics before high-intensity focused ultrasound (HIFU) ablation. METHODS Among patients with uterine fibroids treated with HIFU from 2019 to 2021, 180 were selected per the inclusion and exclusion criteria (42 reintervention and 138 non-reintervention). All patients were randomly assigned to either the training (n = 125) or validation (n = 55) cohorts. Multivariate analysis was used to determine independent clinical-imaging features of reintervention risk. The Relief and LASSO algorithm were used to select optimal radiomics features. Random forest was used to construct the clinical-imaging model based on independent clinical-imaging features, the radiomics model based on optimal radiomics features, and the combined model incorporating the above features. An independent test cohort of 45 patients with uterine fibroids tested these models. The integrated discrimination index (IDI) was used to compare the discrimination performance of these models. RESULTS Age (p < .001), fibroid volume (p = .001) and fibroid enhancement degree (p = .001) were identified as independent clinical-imaging features. The combined model had AUCs of 0.821 (95% CI: 0.712-0.931) and 0.818 (95% CI: 0.694-0.943) in the validation and independent test cohorts, respectively. The predictive performance of the combined model was 27.8% (independent test cohort, p < .001) and 29.5% (independent test cohort, p = .001) better than the clinical-imaging and radiomics models, respectively. CONCLUSION The combined model can effectively predict the risk of postoperative reintervention for uterine fibroids before HIFU ablation. It is expected to help clinicians to develop accurate, personalized treatment and management plans. Future studies will need to be prospectively validated.
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Affiliation(s)
- Shize Qin
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Zhenyang Lin
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Nian Liu
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yulin Zheng
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Qing Jia
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xiaohua Huang
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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12
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Sailer A, Ghanouni P, Schade GR, Napoli A, Vidal-Jove J, Raman SS, Mendiratta-Lala M, Ghai S, Abreu A, Sundaram KM, Westphalen A, Arora S. Therapeutic US Applications for the Abdomen and Pelvis. Radiographics 2022; 42:E182-E183. [PMID: 36190852 PMCID: PMC9539095 DOI: 10.1148/rg.220044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 07/22/2022] [Accepted: 07/28/2022] [Indexed: 03/25/2023]
Abstract
US and MRI-guided therapeutic US (TUS) can aid in the treatment of prostate, liver, and pancreatic cancer, as well as uterine fibroids and osseous metastases, and understanding the selection and optimization of treatment strategies is essential to furthering TUS advances and innovations.
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Affiliation(s)
- Anne Sailer
- From the Section of Interventional Radiology, Dept of Radiology and
Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, Room
TE-2, New Haven, CT 06520 (A.S., S.A.); Dept of Rad/Body MRI, Dept of Radiology,
Stanford Univ, Lucas Ctr, Stanford, Calif (P.G.); Dept of Urology, Univ of
Washington School of Medicine, Seattle, Wash (G.R.S., A.W.); Dept of
Radiological Sciences, MRgFUS and Cardiovascular Imaging Unit, Sapienza Univ of
Rome, School of Medicine, Rome, Italy (A.N.); Institut Khuab for Interventional
Oncology, Comprehensive Tumor Ctr Barcelona, Barcelona, Spain (J.V.J.); Dept of
Interventional and Diagnostic Radiology, Univ of California Los Angeles, Los
Angeles, Calif (S.S.R.); Abdominal and Cross-Sectional Interventional Radiology,
Dept of Radiology, Univ of Michigan School of Medicine, Ann Arbor, Mich
(M.M.L.); Dept of Medical Imaging, Univ Health Network–Mount Sinai
Hosp–Women’s College Hosp, Univ of Toronto, Toronto, Canada
(S.G.); Inst of Urology, Univ of Southern California–USC School of
Medicine, Los Angeles, Calif (A.A.); and Dept of Radiology, Hosp of the Univ of
Pennsylvania, Philadelphia, Pa (K.M.S.)
| | - Pejman Ghanouni
- From the Section of Interventional Radiology, Dept of Radiology and
Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, Room
TE-2, New Haven, CT 06520 (A.S., S.A.); Dept of Rad/Body MRI, Dept of Radiology,
Stanford Univ, Lucas Ctr, Stanford, Calif (P.G.); Dept of Urology, Univ of
Washington School of Medicine, Seattle, Wash (G.R.S., A.W.); Dept of
Radiological Sciences, MRgFUS and Cardiovascular Imaging Unit, Sapienza Univ of
Rome, School of Medicine, Rome, Italy (A.N.); Institut Khuab for Interventional
Oncology, Comprehensive Tumor Ctr Barcelona, Barcelona, Spain (J.V.J.); Dept of
Interventional and Diagnostic Radiology, Univ of California Los Angeles, Los
Angeles, Calif (S.S.R.); Abdominal and Cross-Sectional Interventional Radiology,
Dept of Radiology, Univ of Michigan School of Medicine, Ann Arbor, Mich
(M.M.L.); Dept of Medical Imaging, Univ Health Network–Mount Sinai
Hosp–Women’s College Hosp, Univ of Toronto, Toronto, Canada
(S.G.); Inst of Urology, Univ of Southern California–USC School of
Medicine, Los Angeles, Calif (A.A.); and Dept of Radiology, Hosp of the Univ of
Pennsylvania, Philadelphia, Pa (K.M.S.)
| | - George R. Schade
- From the Section of Interventional Radiology, Dept of Radiology and
Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, Room
TE-2, New Haven, CT 06520 (A.S., S.A.); Dept of Rad/Body MRI, Dept of Radiology,
Stanford Univ, Lucas Ctr, Stanford, Calif (P.G.); Dept of Urology, Univ of
Washington School of Medicine, Seattle, Wash (G.R.S., A.W.); Dept of
Radiological Sciences, MRgFUS and Cardiovascular Imaging Unit, Sapienza Univ of
Rome, School of Medicine, Rome, Italy (A.N.); Institut Khuab for Interventional
Oncology, Comprehensive Tumor Ctr Barcelona, Barcelona, Spain (J.V.J.); Dept of
Interventional and Diagnostic Radiology, Univ of California Los Angeles, Los
Angeles, Calif (S.S.R.); Abdominal and Cross-Sectional Interventional Radiology,
Dept of Radiology, Univ of Michigan School of Medicine, Ann Arbor, Mich
(M.M.L.); Dept of Medical Imaging, Univ Health Network–Mount Sinai
Hosp–Women’s College Hosp, Univ of Toronto, Toronto, Canada
(S.G.); Inst of Urology, Univ of Southern California–USC School of
Medicine, Los Angeles, Calif (A.A.); and Dept of Radiology, Hosp of the Univ of
Pennsylvania, Philadelphia, Pa (K.M.S.)
| | - Alessandro Napoli
- From the Section of Interventional Radiology, Dept of Radiology and
Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, Room
TE-2, New Haven, CT 06520 (A.S., S.A.); Dept of Rad/Body MRI, Dept of Radiology,
Stanford Univ, Lucas Ctr, Stanford, Calif (P.G.); Dept of Urology, Univ of
Washington School of Medicine, Seattle, Wash (G.R.S., A.W.); Dept of
Radiological Sciences, MRgFUS and Cardiovascular Imaging Unit, Sapienza Univ of
Rome, School of Medicine, Rome, Italy (A.N.); Institut Khuab for Interventional
Oncology, Comprehensive Tumor Ctr Barcelona, Barcelona, Spain (J.V.J.); Dept of
Interventional and Diagnostic Radiology, Univ of California Los Angeles, Los
Angeles, Calif (S.S.R.); Abdominal and Cross-Sectional Interventional Radiology,
Dept of Radiology, Univ of Michigan School of Medicine, Ann Arbor, Mich
(M.M.L.); Dept of Medical Imaging, Univ Health Network–Mount Sinai
Hosp–Women’s College Hosp, Univ of Toronto, Toronto, Canada
(S.G.); Inst of Urology, Univ of Southern California–USC School of
Medicine, Los Angeles, Calif (A.A.); and Dept of Radiology, Hosp of the Univ of
Pennsylvania, Philadelphia, Pa (K.M.S.)
| | - Joan Vidal-Jove
- From the Section of Interventional Radiology, Dept of Radiology and
Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, Room
TE-2, New Haven, CT 06520 (A.S., S.A.); Dept of Rad/Body MRI, Dept of Radiology,
Stanford Univ, Lucas Ctr, Stanford, Calif (P.G.); Dept of Urology, Univ of
Washington School of Medicine, Seattle, Wash (G.R.S., A.W.); Dept of
Radiological Sciences, MRgFUS and Cardiovascular Imaging Unit, Sapienza Univ of
Rome, School of Medicine, Rome, Italy (A.N.); Institut Khuab for Interventional
Oncology, Comprehensive Tumor Ctr Barcelona, Barcelona, Spain (J.V.J.); Dept of
Interventional and Diagnostic Radiology, Univ of California Los Angeles, Los
Angeles, Calif (S.S.R.); Abdominal and Cross-Sectional Interventional Radiology,
Dept of Radiology, Univ of Michigan School of Medicine, Ann Arbor, Mich
(M.M.L.); Dept of Medical Imaging, Univ Health Network–Mount Sinai
Hosp–Women’s College Hosp, Univ of Toronto, Toronto, Canada
(S.G.); Inst of Urology, Univ of Southern California–USC School of
Medicine, Los Angeles, Calif (A.A.); and Dept of Radiology, Hosp of the Univ of
Pennsylvania, Philadelphia, Pa (K.M.S.)
| | - Steven S. Raman
- From the Section of Interventional Radiology, Dept of Radiology and
Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, Room
TE-2, New Haven, CT 06520 (A.S., S.A.); Dept of Rad/Body MRI, Dept of Radiology,
Stanford Univ, Lucas Ctr, Stanford, Calif (P.G.); Dept of Urology, Univ of
Washington School of Medicine, Seattle, Wash (G.R.S., A.W.); Dept of
Radiological Sciences, MRgFUS and Cardiovascular Imaging Unit, Sapienza Univ of
Rome, School of Medicine, Rome, Italy (A.N.); Institut Khuab for Interventional
Oncology, Comprehensive Tumor Ctr Barcelona, Barcelona, Spain (J.V.J.); Dept of
Interventional and Diagnostic Radiology, Univ of California Los Angeles, Los
Angeles, Calif (S.S.R.); Abdominal and Cross-Sectional Interventional Radiology,
Dept of Radiology, Univ of Michigan School of Medicine, Ann Arbor, Mich
(M.M.L.); Dept of Medical Imaging, Univ Health Network–Mount Sinai
Hosp–Women’s College Hosp, Univ of Toronto, Toronto, Canada
(S.G.); Inst of Urology, Univ of Southern California–USC School of
Medicine, Los Angeles, Calif (A.A.); and Dept of Radiology, Hosp of the Univ of
Pennsylvania, Philadelphia, Pa (K.M.S.)
| | - Mishal Mendiratta-Lala
- From the Section of Interventional Radiology, Dept of Radiology and
Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, Room
TE-2, New Haven, CT 06520 (A.S., S.A.); Dept of Rad/Body MRI, Dept of Radiology,
Stanford Univ, Lucas Ctr, Stanford, Calif (P.G.); Dept of Urology, Univ of
Washington School of Medicine, Seattle, Wash (G.R.S., A.W.); Dept of
Radiological Sciences, MRgFUS and Cardiovascular Imaging Unit, Sapienza Univ of
Rome, School of Medicine, Rome, Italy (A.N.); Institut Khuab for Interventional
Oncology, Comprehensive Tumor Ctr Barcelona, Barcelona, Spain (J.V.J.); Dept of
Interventional and Diagnostic Radiology, Univ of California Los Angeles, Los
Angeles, Calif (S.S.R.); Abdominal and Cross-Sectional Interventional Radiology,
Dept of Radiology, Univ of Michigan School of Medicine, Ann Arbor, Mich
(M.M.L.); Dept of Medical Imaging, Univ Health Network–Mount Sinai
Hosp–Women’s College Hosp, Univ of Toronto, Toronto, Canada
(S.G.); Inst of Urology, Univ of Southern California–USC School of
Medicine, Los Angeles, Calif (A.A.); and Dept of Radiology, Hosp of the Univ of
Pennsylvania, Philadelphia, Pa (K.M.S.)
| | - Sangeet Ghai
- From the Section of Interventional Radiology, Dept of Radiology and
Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, Room
TE-2, New Haven, CT 06520 (A.S., S.A.); Dept of Rad/Body MRI, Dept of Radiology,
Stanford Univ, Lucas Ctr, Stanford, Calif (P.G.); Dept of Urology, Univ of
Washington School of Medicine, Seattle, Wash (G.R.S., A.W.); Dept of
Radiological Sciences, MRgFUS and Cardiovascular Imaging Unit, Sapienza Univ of
Rome, School of Medicine, Rome, Italy (A.N.); Institut Khuab for Interventional
Oncology, Comprehensive Tumor Ctr Barcelona, Barcelona, Spain (J.V.J.); Dept of
Interventional and Diagnostic Radiology, Univ of California Los Angeles, Los
Angeles, Calif (S.S.R.); Abdominal and Cross-Sectional Interventional Radiology,
Dept of Radiology, Univ of Michigan School of Medicine, Ann Arbor, Mich
(M.M.L.); Dept of Medical Imaging, Univ Health Network–Mount Sinai
Hosp–Women’s College Hosp, Univ of Toronto, Toronto, Canada
(S.G.); Inst of Urology, Univ of Southern California–USC School of
Medicine, Los Angeles, Calif (A.A.); and Dept of Radiology, Hosp of the Univ of
Pennsylvania, Philadelphia, Pa (K.M.S.)
| | - Andre Abreu
- From the Section of Interventional Radiology, Dept of Radiology and
Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, Room
TE-2, New Haven, CT 06520 (A.S., S.A.); Dept of Rad/Body MRI, Dept of Radiology,
Stanford Univ, Lucas Ctr, Stanford, Calif (P.G.); Dept of Urology, Univ of
Washington School of Medicine, Seattle, Wash (G.R.S., A.W.); Dept of
Radiological Sciences, MRgFUS and Cardiovascular Imaging Unit, Sapienza Univ of
Rome, School of Medicine, Rome, Italy (A.N.); Institut Khuab for Interventional
Oncology, Comprehensive Tumor Ctr Barcelona, Barcelona, Spain (J.V.J.); Dept of
Interventional and Diagnostic Radiology, Univ of California Los Angeles, Los
Angeles, Calif (S.S.R.); Abdominal and Cross-Sectional Interventional Radiology,
Dept of Radiology, Univ of Michigan School of Medicine, Ann Arbor, Mich
(M.M.L.); Dept of Medical Imaging, Univ Health Network–Mount Sinai
Hosp–Women’s College Hosp, Univ of Toronto, Toronto, Canada
(S.G.); Inst of Urology, Univ of Southern California–USC School of
Medicine, Los Angeles, Calif (A.A.); and Dept of Radiology, Hosp of the Univ of
Pennsylvania, Philadelphia, Pa (K.M.S.)
| | - Karthik M. Sundaram
- From the Section of Interventional Radiology, Dept of Radiology and
Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, Room
TE-2, New Haven, CT 06520 (A.S., S.A.); Dept of Rad/Body MRI, Dept of Radiology,
Stanford Univ, Lucas Ctr, Stanford, Calif (P.G.); Dept of Urology, Univ of
Washington School of Medicine, Seattle, Wash (G.R.S., A.W.); Dept of
Radiological Sciences, MRgFUS and Cardiovascular Imaging Unit, Sapienza Univ of
Rome, School of Medicine, Rome, Italy (A.N.); Institut Khuab for Interventional
Oncology, Comprehensive Tumor Ctr Barcelona, Barcelona, Spain (J.V.J.); Dept of
Interventional and Diagnostic Radiology, Univ of California Los Angeles, Los
Angeles, Calif (S.S.R.); Abdominal and Cross-Sectional Interventional Radiology,
Dept of Radiology, Univ of Michigan School of Medicine, Ann Arbor, Mich
(M.M.L.); Dept of Medical Imaging, Univ Health Network–Mount Sinai
Hosp–Women’s College Hosp, Univ of Toronto, Toronto, Canada
(S.G.); Inst of Urology, Univ of Southern California–USC School of
Medicine, Los Angeles, Calif (A.A.); and Dept of Radiology, Hosp of the Univ of
Pennsylvania, Philadelphia, Pa (K.M.S.)
| | - Antonio Westphalen
- From the Section of Interventional Radiology, Dept of Radiology and
Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, Room
TE-2, New Haven, CT 06520 (A.S., S.A.); Dept of Rad/Body MRI, Dept of Radiology,
Stanford Univ, Lucas Ctr, Stanford, Calif (P.G.); Dept of Urology, Univ of
Washington School of Medicine, Seattle, Wash (G.R.S., A.W.); Dept of
Radiological Sciences, MRgFUS and Cardiovascular Imaging Unit, Sapienza Univ of
Rome, School of Medicine, Rome, Italy (A.N.); Institut Khuab for Interventional
Oncology, Comprehensive Tumor Ctr Barcelona, Barcelona, Spain (J.V.J.); Dept of
Interventional and Diagnostic Radiology, Univ of California Los Angeles, Los
Angeles, Calif (S.S.R.); Abdominal and Cross-Sectional Interventional Radiology,
Dept of Radiology, Univ of Michigan School of Medicine, Ann Arbor, Mich
(M.M.L.); Dept of Medical Imaging, Univ Health Network–Mount Sinai
Hosp–Women’s College Hosp, Univ of Toronto, Toronto, Canada
(S.G.); Inst of Urology, Univ of Southern California–USC School of
Medicine, Los Angeles, Calif (A.A.); and Dept of Radiology, Hosp of the Univ of
Pennsylvania, Philadelphia, Pa (K.M.S.)
| | - Sandeep Arora
- From the Section of Interventional Radiology, Dept of Radiology and
Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, Room
TE-2, New Haven, CT 06520 (A.S., S.A.); Dept of Rad/Body MRI, Dept of Radiology,
Stanford Univ, Lucas Ctr, Stanford, Calif (P.G.); Dept of Urology, Univ of
Washington School of Medicine, Seattle, Wash (G.R.S., A.W.); Dept of
Radiological Sciences, MRgFUS and Cardiovascular Imaging Unit, Sapienza Univ of
Rome, School of Medicine, Rome, Italy (A.N.); Institut Khuab for Interventional
Oncology, Comprehensive Tumor Ctr Barcelona, Barcelona, Spain (J.V.J.); Dept of
Interventional and Diagnostic Radiology, Univ of California Los Angeles, Los
Angeles, Calif (S.S.R.); Abdominal and Cross-Sectional Interventional Radiology,
Dept of Radiology, Univ of Michigan School of Medicine, Ann Arbor, Mich
(M.M.L.); Dept of Medical Imaging, Univ Health Network–Mount Sinai
Hosp–Women’s College Hosp, Univ of Toronto, Toronto, Canada
(S.G.); Inst of Urology, Univ of Southern California–USC School of
Medicine, Los Angeles, Calif (A.A.); and Dept of Radiology, Hosp of the Univ of
Pennsylvania, Philadelphia, Pa (K.M.S.)
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Psilopatis I, Fleckenstein FN, Collettini F, Can E, Frisch A, Gebauer B, Fehrenbach U, Torsello GF, Schnapauff D, David M, Wieners G. Short- and long-term evaluation of disease-specific symptoms and quality of life following uterine artery embolization of fibroids. Insights Imaging 2022; 13:106. [PMID: 35727408 PMCID: PMC9213618 DOI: 10.1186/s13244-022-01244-1] [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: 03/15/2022] [Accepted: 05/28/2022] [Indexed: 11/21/2022] Open
Abstract
Background The purpose of this study is to evaluate uterine artery embolization (UAE) for the management of symptomatic uterine leiomyomas regarding changes in quality of life after treatment in a large patient collective. This study retrospectively analyzed prospectively acquired standardized questionnaires of patients treated with UAE. Clinical success was evaluated before and after embolization. Patients were stratified into short- (≤ 7 months) and long-term (> 7 months) follow-up groups depending on the time of completion of the post-interventional questionnaire. Uterine leiomyomas were furthermore divided into small (< 10 cm) and large (≥ 10 cm) tumors based on the diameter of the dominant fibroid.
Results A total of 245 patients were included into the final data analysis. The Kaplan–Meier analysis showed a cumulative clinical success rate of 75.8% after 70 months until the end of follow-up (9.9 years). All questionnaire subscales showed a highly significant clinical improvement from baseline to short- and long-term follow-up (p < 0.001). Patients with small fibroids showed a significantly better response to UAE in multiple subcategories of the questionnaire than patients with fibroids ≥ 10 cm who had a twofold higher probability of re-intervention in the Cox-regression model. Conclusions UAE is an effective treatment method for symptomatic fibroids that leads to quick relief of fibroid-related symptoms with marked improvement of quality of life and is associated with a low risk for re-interventions. Patients with small fibroids tend to show a better response to UAE compared to patients with large fibroids. Trial registration Charité institutional review board, EA4/167/20. Registered 27 November 2020—Retrospectively registered. https://ethikkommission.charite.de/ Supplementary Information The online version contains supplementary material available at 10.1186/s13244-022-01244-1.
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Affiliation(s)
- Iason Psilopatis
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,Department of Gynecology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Florian Nima Fleckenstein
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. .,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin, Germany.
| | - Federico Collettini
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin, Germany
| | - Elif Can
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Anne Frisch
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Bernhard Gebauer
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Uli Fehrenbach
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Giovanni Federico Torsello
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | | | - Matthias David
- Department of Gynecology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Gero Wieners
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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Torres-de la Roche LA, Rafiq S, Devassy R, Verhoeven HC, Becker S, De Wilde RL. Should Ultrasound-Guided High Frequency Focused Ultrasound Be Considered as an Alternative Non-Surgical Treatment of Uterine Fibroids in Non-Asiatic Countries? An Opinion Paper. J Clin Med 2022; 11:839. [PMID: 35160290 PMCID: PMC8836878 DOI: 10.3390/jcm11030839] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 11/16/2022] Open
Abstract
Minimally invasive interventions for myomata treatment have gained acceptance due to the possibility of preserving fertility with reduced trauma induced by laparotomy as way of entrance. There are insufficient data regarding outcomes of high intensity focused ultrasound (HIFU) in non-Asiatic women. Therefore, we revised the available evidence to present an expert opinion that could support physicians, patients and policy-makers for considering this approach in other populations. We revisited systematic reviews, randomized controlled trials and cohort studies from January 2018 to August 2021 using PubMed and Google scholar, regarding short and long term outcomes after ablation with focused ultrasound waves. In total, 33 studies, including 114,810 adult patients showed that outcomes of this approach depend on several parameters directly related with resistance to thermal ablation, especially fibroid size and vascularization. Two studies report satisfactory outcomes in Afro-American women. In accordance to the technique used, fibroid volume reduction showed to be higher in fibroids <300 cm3 after ultrasound guided HIFU than after MRI guided. Compared to myomectomy and uterine artery embolization, HIFU seems to have shorter hospital stay, higher pregnancy rates and similar adverse events rates, with skin burn being the most reported. Symptoms and quality of life improvement is similar to myomectomy but lower than embolization, however reintervention rate is higher after HIFU. Lacks evidence about long-term sarcoma risk after ablation. Available evidence shows that HIFU can be considered as a uterine sparing treatment for women of different ethnicities suffering of uterine myomatosis, especially for those wishing to preserve their fertility.
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Affiliation(s)
- Luz Angela Torres-de la Roche
- University Hospital for Gynecology, Pius Hospital, University Medicine Oldenburg, 26121 Oldenburg, Germany; (L.A.T.-d.l.R.); (S.R.)
| | - Sarah Rafiq
- University Hospital for Gynecology, Pius Hospital, University Medicine Oldenburg, 26121 Oldenburg, Germany; (L.A.T.-d.l.R.); (S.R.)
| | - Rajesh Devassy
- Centre of Excellence in Gynecological Minimal Access Surgery and Oncology, Dubai London Clinic and Speciality Hospital, Dubai 3371500, United Arab Emirates;
| | - Hugo Christian Verhoeven
- Center for Endocrinology, Preventive Medicine, Reproductive Medicine and Gynecology, 40211 Düsseldorf, Germany;
| | - Sven Becker
- University Hospital for Gynecology and Obstetrics, University Hospital Frankfurt, 60590 Frankfurt, Germany;
| | - Rudy Leon De Wilde
- University Hospital for Gynecology, Pius Hospital, University Medicine Oldenburg, 26121 Oldenburg, Germany; (L.A.T.-d.l.R.); (S.R.)
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