Exvivo And Clinical Study On The Treatment Of Uterine Myoma By Suprapubic Ultrasound-Guided Transvaginal Puncture Radiofrequency Ablation

To evaluate the feasibility and therapeutic efficacy of Suprapubic ultrasound-guided transvaginal puncture radiofrequency ablation (RF A) for the treatment of uterine myoma.Exvivo study RFA were applied in exvivo liver tissue by using radiofrequency electrode with1.0cm and1.5cm tip exposure and powers output at10w,20w,30w and40w respectively. The shape, size, and temperature of ablation zone were evaluated. From March2010to Junary2011,43patients with52uterine myomas were treated with the suprapubic ultrsound-guided transvaginal puncture radiofrequency ablation. All patients were treated by contrast-enhanced ultrasound(CEUS) one week before and after RFA treatment. Enhacement patterns were evaluated after administration of2.4mL SonoVuet. Therapeutic effects were assessed by using ultrasound. Leiomyoma’s diameters, volumes and reduction rates at month1,3,6and12after RFA treatment were calculated and compared with those of pre-treatment improvement in myoma-related symptoms and impaction quality of life were assessed by using a validated questionnaire(UFS-QOL).The ablation shape by using radiofrequency electrode with tip exposure (1.0cm and1.5cm) were all elliptical in all power levels. The ablation volume increased with the increase of length exposed tip.The temperature in ablation zone gradually rose to85℃and the pathologic appearances of the ablation zone were coagulative necrosis. H&E staining and microscopic examination after RFA showed cell debris and hyalinization were distorted, cytoplasm was overflowed, cells shrinkage of nuclei. After the administration of SonoVue,52uterine myomas before RFA treatment showed peripheral globular enhancement pattern and centripetal filling immediately. There was a clear border between the tumor and the adjacent uterine parenchyma. After RFA treatment, on the CEUS complete tumor ablation was observed in48(84.61%) of the52uterine leiomyomas and residual tumors were found in three leiomyomas(5.7%). One leiomyomas(1.8%)showed diffuse enhancement indicating failed treatment. All patients were followed up at month1,3,6and12after RFA treatment.Results showed that the mean volume began to decrease three month after RFA. There were statistically significant difference between pre-treatment and post-treatment (P<0.05). Follow-up ultrasound revealed that median reductions in tumor size as a percentage of initial tumor volume at month1,3,6, and12after RFA treatment were41.41%,56.48%,64.3%, and73.25%, respectively. All patients in our study express significant relief from previous symptoms12months after RFA treatment. Quality-of-life measurement showed more significant and durable improvement compared with the baseline.Conclusions:1. In the exvivo study power output at30w or20w is the most suitable for radiofrequency ablation of the device. RFA can induce tissue necrosis in uterine leiomyomas. The histopathologic confirmed validity of RFA as an effective treatment method of uterine leiomyomas.2. CEUS can evaluate different ablation tissues and intact tissues. It proves to be a feasible method in guiding RFA treatment and post-treatment savillance. Ultrasound-guided transvaginal RFA for uterine leiomyoma is a safe, effective and minimally invasive modality for uterine leiomyoma treatment both for outpatients and inpatients.