Ultrasound-guided Microwave Ablation in the Management of Symptomatic Uterine Myomas: A Systematic Review and Meta-analysis

OBJECTIVE

This systematic review and meta-analysis aimed to evaluate the clinical effects and safety of ultrasound-guided microwave ablation (MWA) for the treatment of symptomatic uterine myomas.

DATA SOURCES

We searched PubMed, Web of Science Core Collection, Cochrane Library, Embase, Scopus, and Google Scholar for studies from January 2000 to January 2021.

METHODS OF STUDY SELECTION

We included all studies that reported the clinical outcomes of ultrasound-guided MWA in women with symptomatic uterine myomas. Two researchers conducted the study selection according to the screening criteria.

TABULATION, INTEGRATION, AND RESULTS

We evaluated the risk of bias and evidence quality using the Newcastle-Ottawa scale. Two researchers independently extracted information from the included studies. We extracted the standardized mean difference (SMD) and pooled proportion with a 95% confidence interval (CI) for the outcome measures of interest. A total of 10 studies representing 671 patients were included. The Uterine Fibroid Symptom and Quality of Life (UFS-QoL) questionnaire was used to assess the clinical effects. Compared with baseline, the UFS scores decreased significantly (SMD 3.37; 95% CI, 2.27-4.47; p <.001; reduction rate 65.9%), QoL scores increased significantly (SMD -3.12; 95% CI, -3.93 to -2.30; p <.001; rate of increase 72.0%), and hemoglobin concentration increased significantly (SMD -2.13; 95% CI, -3.44 to -0.81; p = .002; rate of increase 30.3%) at follow-up. The mean operation time was 34.48 minutes (95% CI, 22.82-46.13; p <.001). The rate of reduction in myoma volume after MWA was 85.3% (95% CI, 82.7%-88.0%, p <.001). No major adverse event was reported, and the incidence of minor adverse events was 21.1% (95% CI, 15.1%-27.0%, p <.001).

CONCLUSION

Ultrasound-guided MWA is an effective and safe minimally invasive therapy for symptomatic uterine myomas.

Uterine Artery Embolization Compared with High-intensity Focused Ultrasound Ablation for the Treatment of Symptomatic Uterine Myomas: A Systematic Review and Meta-analysis

OBJECTIVE

This study aimed to compare the clinical effects of uterine artery embolization (UAE) with those of high-intensity focused ultrasound (HIFU) ablation for the treatment of symptomatic uterine myomas.

DATA SOURCES

We searched PubMed, EMBASE, Web of Science, Cochrane Library, Google Scholar, and ClinicalTrials.gov for studies from January 2000 to August 2020. Related articles and relevant references of the included studies were also searched.

METHODS OF STUDY SELECTION

Two researchers independently performed the data selection. We included comparative studies that compared the clinical outcomes of UAE with those of HIFU ablation in women with myomas.

TABULATION, INTEGRATION, AND RESULTS

We assessed the study quality using the Cochrane Handbook for Systematic Reviews of Interventions for evaluating the risk of bias. Two independent researchers performed the article selection according to the screening criteria and rated the quality of evidence for each article. We calculated pooled mean difference with 95% confidence interval (CI) for continuous data and relative risk (RR) with 95% CI for dichotomous data. The systematic review registration number is CRD42020199630 on the International Prospective Register of Systematic Reviews. A total of 7 articles (5 trials), involving 4592 women with symptomatic uterine myomas, were included in the meta-analysis. Compared with the HIFU ablation group, the decrease in "uterine fibroid symptom" scores as well as the increase in quality-of-life scores at the time of follow-up were higher in the UAE group, with overall mean difference 19.54 (95% CI, 15.21-23.87; p <.001) and 15.72 (95% CI, 8.30-23.13; p <.001), respectively. The women in the UAE group had a significantly lower reintervention rate (RR 0.25; 95% CI, 0.15-0.42; p <.001). The women undergoing UAE had a significantly lower pregnancy rate than those undergoing HIFU ablation (RR 0.06; 95% CI, 0.01-0.45; p = .006). The difference in the incidence of adverse events between the 2 groups was not statistically significant (p = .53).

CONCLUSION

Compared with HIFU ablation, UAE provided more significant alleviation of symptoms and improvement in quality of life, lower postoperative reintervention rate, and lower pregnancy rate for women with uterine myomas. However, we cannot conclude that HIFU ablation is more favorable for desired pregnancy than UAE because of the confounding factors.

Impact of uterine fibroid symptoms on health-related quality of life of US women: evidence from a cross-sectional survey

BACKGROUND

Uterine fibroids (UF) are associated with significant health-related quality of life (HRQL) impact. This study examined the impact of UF symptoms on HRQL.

METHODS

An online cross-sectional survey of 18 to 49 year old US women was conducted and collected demographics, UF prevalence, symptoms, and HRQL using the UFS-QOL. Descriptive statistics were used to examine the impact of symptom presence, severity, bothersomeness, and number of UF symptoms on HRQL. Analyses were weighted to match the US female population distribution. Multivariate regressions were performed with each subscale as a dependent variable to examine the impact of individual UF symptoms on HRQL.

RESULTS

A total of 59,411 (15.5%) panel members completed the prevalence screener; 4848 met inclusion criteria; 955 had UF and no hysterectomy. Mean age was 40.3; 58% were white; 63% were married/civil union. Common UF symptoms were: lower back pain (65%), fatigue/weariness (63%), bloating (61%), pelvic pain/cramping during menses (63%), and heavy bleeding during menses (54%). Mean UFS-QoL subscale scores were significantly (p < .05) worse among women with a UF symptom versus women without the symptom. Women who rated their UF symptoms as severe had significantly (p < .001) worse UFS-QoL scores than women with mild or moderate symptoms. UFS-QoL subscale scores worsened as the number of symptoms increased. In the regressions, the presence of bleeding and non-bleeding symptoms were related to worse UFS-QoL subscale scores.

CONCLUSION

HRQL among women with UF was significantly impacted by UF-related symptoms. Greater impact was observed as the number and severity of symptoms increased.

Validation of the 4 week recall version of the Uterine Fibroid Symptom and Health-related Quality of Life (UFS-QOL) Questionnaire

OBJECTIVE

To assess the psychometric performance of the 4 week recall version of the Uterine Fibroid Symptom and Health-related Quality of Life Questionnaire (UFS-QoL), a patient measure of the severity of uterine fibroid (UF) symptoms and their impact on health-related quality of life (HRQL).

METHODS

This was a retrospective analysis of phase 2a data from pre-menopausal women with heavy menstrual bleeding associated with UF. Participants completed the UFS-QoL at Baseline, Treatment Month 3, and Follow-up Month 3 and a daily diary with a Menstrual Bleeding Scale and the UF Daily Symptom Scale throughout the study duration. Descriptive statistics were performed on patient demographic characteristics; analyses were conducted to assess the internal consistency reliability, validity, and responsiveness of the UFS-QoL 4 week recall version.

RESULTS

A total of 271 women were enrolled with a mean age of 41.8 years; 74% were black. The UFS-QoL demonstrated excellent internal consistency reliability, with Cronbach's alpha coefficient values >0.70 for each subscale at each study visit. Results indicated good concurrent validity with the UF Daily Symptom Scale items. The women with amenorrhea at Treatment Month 3 had significantly better scores on all UFS-QoL subscales and HRQL Total than women with menstrual bleeding, indicating acceptable discriminant validity. Mean subscale change scores from Baseline to Treatment Month 3 were 19.2 to 39.8. Effect sizes were moderate to large (0.53 to 1.86), demonstrating responsiveness to change.

LIMITATIONS

As this study is a post hoc validation of the 4 week recall UFS-QOL, it is limited to the clinical trial data available and does not include a direct comparison to the 3 month recall version of UFS-QOL.

CONCLUSIONS

The 4 week recall version of the UFS-QoL demonstrated good internal consistency reliability, concurrent validity, and responsiveness and is psychometrically comparable to the original 3 month recall UFS-QoL.

CLINICAL TRIAL REGISTRATION

Data from a phase 2a, cohort design proof of concept study (trial M12-663); ClinicalTrials.gov identifier NCT01441635. Date of Registration: 6 September 2011.