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Clinical Predictors of Long-term Success in Ultrasound-guided High-intensity Focused Ultrasound Ablation Treatment for Adenomyosis

View Article: PubMed Central - PubMed

ABSTRACT

The long-term outcomes of ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation treatment for adenomyosis and the relevant factors affecting the durability of symptom relief were assessed in this study.

A total of 230 women with adenomyosis who were treated with USgHIFU ablation between January 2007 and December 2013 were retrospectively analyzed. The contrast-enhanced ultrasonography (CEUS) was performed immediately after the treatment to evaluate the ablation effect, and the nonperfused volume (NPV) ratio was then calculated. Regular follow-up was conducted and the visual analog scale (VAS) score was used to assess the changes in dysmenorrhea. The effect of treatment was evaluated after an average follow-up length of 3 months and the factors affecting clinical success and symptom relapse were identified.

Of the 230 treated patients, 208 (90.4%) were followed up regularly, with a median follow-up length of 40 months (range, 18–94 months). Mean value of the NPV ratio calculated immediately after the treatment was 57.4 ± 24.4%. Varying degrees of symptomatic relief of dysmenorrhea based on the VAS scores were observed in 173 (83.2%) patients and 71.0% of the patients were asymptomatic during follow-up. Women with higher NPV ratio (OR = 0.964, 95% CI = 0.947–0.982, P = 0.000) and older age (OR = 0.342, 95% CI = 0.143–0.819, P = 0.016) were more likely to achieve clinical success. Dysmenorrhea recurred in 45 (26%) out of 173 cases; the median recurrence time was 12 months after treatment. The lower BMI (OR = 1.221, 95% CI = 1.079–1.381, P = 0.001) and the higher acoustic power (OR = 0.992, 95% CI = 0.986–0.998, P = 0.007) were associated with less risk of relapse. Twelve of the 14 patients who were retreated by USgHIFU ablation after experiencing dysmenorrhea recurrence achieved clinical success.

USgHIFU ablation is an effective uterus-conserving treatment for symptomatic adenomyosis with an acceptable long-term success rate. Higher chance of clinical success can be achieved in patients with larger NPV ratio and older age, whereas higher BMI and lower acoustic power may result in a higher chance of recurrence. These factors are helpful in selecting suitable patients for USgHIFU and in predicting the durability of symptom relief.

No MeSH data available.


Related in: MedlinePlus

Cumulative rate of freedom from recurrence after USgHIFU for symptomatic adenomyosis. USgHIFU = ultrasound-guided high-intensity focused ultrasound.
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Figure 2: Cumulative rate of freedom from recurrence after USgHIFU for symptomatic adenomyosis. USgHIFU = ultrasound-guided high-intensity focused ultrasound.

Mentions: Dysmenorrhea recurred in 45 (26%) patients. The age of these patients were 38.7 ± 5.3 years (range, 24–49 years). The median recurrence time was 12 months (range, 3–74 months). Of the 45 patients, 42 (93.3%) experienced dysmenorrhea recurrence within 3 years, whereas only 3 patients recurred after 3 years. The cumulative rate of freedom from recurrence according to Kaplan–Meier analysis was 72.9% after 36 months (Figure 2). Results of univariate analysis are shown in Table 3. A multivariate analysis was performed and 2 independent predictive factors were identified: the BMI (OR = 1.222, 95% CI = 1.079–1.381, P = 0.001) and the mean acoustic intensity (OR = 0.992, 95% CI = 0.986–0.998, P = 0.007). As for symptom recurrence, BMI is a risk factor, whereas the mean acoustic intensity showed a protective effect.


Clinical Predictors of Long-term Success in Ultrasound-guided High-intensity Focused Ultrasound Ablation Treatment for Adenomyosis
Cumulative rate of freedom from recurrence after USgHIFU for symptomatic adenomyosis. USgHIFU = ultrasound-guided high-intensity focused ultrasound.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998251&req=5

Figure 2: Cumulative rate of freedom from recurrence after USgHIFU for symptomatic adenomyosis. USgHIFU = ultrasound-guided high-intensity focused ultrasound.
Mentions: Dysmenorrhea recurred in 45 (26%) patients. The age of these patients were 38.7 ± 5.3 years (range, 24–49 years). The median recurrence time was 12 months (range, 3–74 months). Of the 45 patients, 42 (93.3%) experienced dysmenorrhea recurrence within 3 years, whereas only 3 patients recurred after 3 years. The cumulative rate of freedom from recurrence according to Kaplan–Meier analysis was 72.9% after 36 months (Figure 2). Results of univariate analysis are shown in Table 3. A multivariate analysis was performed and 2 independent predictive factors were identified: the BMI (OR = 1.222, 95% CI = 1.079–1.381, P = 0.001) and the mean acoustic intensity (OR = 0.992, 95% CI = 0.986–0.998, P = 0.007). As for symptom recurrence, BMI is a risk factor, whereas the mean acoustic intensity showed a protective effect.

View Article: PubMed Central - PubMed

ABSTRACT

The long-term outcomes of ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation treatment for adenomyosis and the relevant factors affecting the durability of symptom relief were assessed in this study.

A total of 230 women with adenomyosis who were treated with USgHIFU ablation between January 2007 and December 2013 were retrospectively analyzed. The contrast-enhanced ultrasonography (CEUS) was performed immediately after the treatment to evaluate the ablation effect, and the nonperfused volume (NPV) ratio was then calculated. Regular follow-up was conducted and the visual analog scale (VAS) score was used to assess the changes in dysmenorrhea. The effect of treatment was evaluated after an average follow-up length of 3 months and the factors affecting clinical success and symptom relapse were identified.

Of the 230 treated patients, 208 (90.4%) were followed up regularly, with a median follow-up length of 40 months (range, 18–94 months). Mean value of the NPV ratio calculated immediately after the treatment was 57.4 ± 24.4%. Varying degrees of symptomatic relief of dysmenorrhea based on the VAS scores were observed in 173 (83.2%) patients and 71.0% of the patients were asymptomatic during follow-up. Women with higher NPV ratio (OR = 0.964, 95% CI = 0.947–0.982, P = 0.000) and older age (OR = 0.342, 95% CI = 0.143–0.819, P = 0.016) were more likely to achieve clinical success. Dysmenorrhea recurred in 45 (26%) out of 173 cases; the median recurrence time was 12 months after treatment. The lower BMI (OR = 1.221, 95% CI = 1.079–1.381, P = 0.001) and the higher acoustic power (OR = 0.992, 95% CI = 0.986–0.998, P = 0.007) were associated with less risk of relapse. Twelve of the 14 patients who were retreated by USgHIFU ablation after experiencing dysmenorrhea recurrence achieved clinical success.

USgHIFU ablation is an effective uterus-conserving treatment for symptomatic adenomyosis with an acceptable long-term success rate. Higher chance of clinical success can be achieved in patients with larger NPV ratio and older age, whereas higher BMI and lower acoustic power may result in a higher chance of recurrence. These factors are helpful in selecting suitable patients for USgHIFU and in predicting the durability of symptom relief.

No MeSH data available.


Related in: MedlinePlus