A Two-year Follow-up Evaluation Of High Intensity Focused Ultrasound Treatment For Uterine Fibroids

Objective To evaluate the safety,efficacy and reintervention rate of ultrasound-guided high intensity focused ultrasound(HIFU)for the treatment of uterine fibroids.Determine whether the patient can achieve sustained and stable improvement of symptoms and a good quality of life.Methods Four hundred and fifty patients with 655 fibroids who underwent HIFU in Suining Central Hospital from December 2010 to June 2014 and completed 2-year follow-up were retrospectively investigated.The follow-up results,the treatment parameters,the non-perfusion volume ratio(NPVR),adverse effects and complications were analyzed.Results(1)Treatment data:The median treatment time was 74(interquartile range:47,119)min,the median sonication time was 652(interquartile range:399,1128)s,the median treatment intensity was 557(interquartile range:454,652)s/h.Four hundred patients with580 fibroids had contrast enhanced ultrasound immediately after HIFU and the results showed that the median NPVR was 83%(interquartile range:65%,100%).Among them,the NPVR of larger than 80%was observed in 325(56.0%of)fibroids,greater than 90%was seen in 230(40%of)fibroids.(2)Adverse effects:The adverse events included lower abdominal pain(100/450,22.2%),sciatic/buttock pain(45/450,10.0%),leg pain(3/450,0.07%),abnormal vaginal bleeding(4/450,0.09%),abnormal vaginal discharge(16/450,0.36%),skin burn(2/450,0.04%),nausea and stomach discomfort(6/450,0.13%),Anal pendant expasion(1/450,0.02%),fever(1/450,0.02%),urinary retention(1/450,0.02%),intrauterine infection(1/450,0.02%).These adverse effects were mild and no other severe adverse effects or complications occurred.(3)Volume changes of uterine fibroids and uterus:the median volume of uterine fibroids before and 6-,12-,24-month after HIFU treatment was 15.5(interquartile range:4.7,52.3)cm~3,6.8(interquartile range:2.3,21.7)cm~3,4.7(interquartile range:1.5,17.1)cm~3,3.6(0.7,13.5)cm~3,respectively.The median volumes of uterine before the and 6-,12-,24-month after HIFU treatment was 165.8(interquartile range:122.5,226.2)cm~3,144.4(interquartile range:108.0,191.2)cm~3,137.7(interquartile range:104.9,179.1)cm~3,124.1(interquartile range:90.5,167.6)cm~3,respectively.The volume of uterine fibroid and uterus significantly decreased after HIFU(P<0.01).(4)Follow-up of the uterine fibroid symptom and quality of life(UFS�QOL):the median symptom severity score(SSS)before and 6-,12-,24-month after HIFU treatment was 13(interquartile range:6,22),3(interquartile range:0,7.5),0(interquartile range:0,3),0(interquartile range:0,3),respectively.The score significantly decreased after HIFU treatment(P<0.01).The median score of health-related quality of life(HRQL)before and 6-,12-,24-month after HIFU treatment was 77(interquartile range:69,81),87(interquartile range:80,91),91(interquartile range:85,95),93(interquartile range:86,97),respectively.Significant difference was observed between before and after HIFU treatment in scores(P<0.01).(5)The reintervention rate:six(1.3%of)patients were treated either by myomectomy or hysterectomy within 12months afterv HIFU.Thirteen(2.9%of)patients had myomectomy or hysterectomy within24 months afterv HIFU.Only 2(0.04%)patients were treated with HIFU again.Conclusion USgHIFU treatment of uterine fibroids is safe and effective without severe adverse effects and long-term complications,and the reintervention rate is low.The long-term symptom relief is sustained and a better quality of life can be achieved.