Clinical Study On The Intermediate And Long-term Outcomes Of Ultrasound-guided High-intensity Focused Ultrasound Ablation Treatment For Adenomyosis

Background:Adenomyosis is a common gynecological disease often found in women of childbearing age, reducing patients' quality of life significantly by causing dysmenorrhea and menorrhagia. Historically, hysterectomy is considered as the definitive treatment for adenomyosis. However, for women who wish to preserve uterus, there is an increasing array of conservative therapies such as oral hormonal medications, uterine-sparing surgery, uterine artery embolization (UAE) and high-intensity focused ultrasound (HIFU) ablation which are alternatives to hysterectomy for the relief of adenomyosis symptoms. HIFU ablation is a tissue ablation technique for the treatment of solid tumors which is characterized by noninvasive, no radiation and conformal. Previous studies showed that HIFU ablation is a safe and effective treatment for adenomyosis, however, little studies have focused on the long-term value of the HIFU ablation treatment. In addition, relevant factors affecting the durability of symptom relief are still undefined.Objectives:1. To assess the long-term outcomes of USgHIFU ablation for adenomyosis;2. To define the parameters associated with the clinical success and symptom relapse.Methods: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. Regular follow-up was conducted after 3,6,12 months and yearly to evaluate the changes of dysmenorrhea and menorrhagia. In addition, the recurrence of symptoms is recorded. The factors affecting clinical success and symptom relapse were then identified.Results:1. A total of 208 (90.4%) patients were followed up regularly, with a median follow-up length of 40 months (range,12-92 months). Mean value of the NPV ratio calculated immediately after the treatment was 57.4±24.4%(1-100%). 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.2. NPV ratio and age were associated with clinical success. Women with higher NPV ratio and older age were more likely to achieve clinical success. The extent of adenomyotic lesions, treated adenomyotic lesions volume had a negative correlation with the NPV ratio, whereas NPV and mean acoustic intensity had a positive correlation with the NPV ratio.3. Dysmenorrhea recurred in 45 (26%) out of 173 cases, the median recurrence time was 12 months after treatment. The lower BMI and the higher acoustic power were associated with less risk of relapse.Conclusions: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.