Factosr Affecting Uterine Fibroid Recurrence After High Intensity Focused Ultrasound Treatment

High intensity focused ultrasound(HIFU)has been widely used in effective clinical treatment of solid tumors.As a non-invasive treatment,HIFU has been selected and accepted by more and more patients.Compared with the traditional way of treating uterine fibroids,HIFU has unique advantages.However,a long-term follow-up found that some patients may have local recurrence after treatment.Therefore,to investigate the factors affecting local recurrence after uterine fibroids treated with HIFU,it is of great significance to optimize the indication of HIFU treatment and improve the treatment plan.Objective:To investigate factors affecting recurrence of uterine fibroids after high intensity focused ultrasound(HIFU)ablation.Materials and methods:1.Eighty-three patients with solitary uterine fibroids who were treated with HIFU in Chongqing Haifu Hospital,the Fifth Hospital of Xinjiang Medical University,and Three Gorges Hospital in Chongqing between January 2011 and January 2016 showed local recurrence in follow-up magnetic resonance imaging(MRI)one year after HIFU treatment.These patients,along with 83 patients with solitary uterine fibroids who were treated with HIFU and showed no recurrence in the follow-up MRI at the same hospitals,were enrolled for a comparative study of baseline characteristics and treatment results,exploring independent factors associated with local recurrence of uterine fibroids to predict recurrence.2.Criteria for local recurrence:Local regeneration after complete fibroid ablation,regardless of fibroid size;or increased fibroid volume or tissue proliferation in the residual site after partial HIFU ablation.3.Criteria for fibroid non-recurrence:Complete ablation of fibroids with the absence of local recurrence and no increase in fibroid size,or the absence of increased fibroid volume and a lack of regeneration in the residual site after partial HIFU ablation.Results:1.The median ages of patients in the local recurrent group and non-recurrent groups were 39(Interquartile range:34-42)years and 40(Interquartile range:35-44)years,respectively.Patients in the local recurrence group had diameter,fibroid volume,and uterine volume medians of 65mm,106.29cm~3,and 259.98cm~3,respectively,while those without local recurrence were 52mm,59.77cm~3,and 198.90cm~3,respectively.2.It was observed that significant differences occurred in uterine volume,fibroid volume,maximum fibroid diameter,minimum distance between the ventral surface of the fibroid and the skin,maximum distance between the dorsal surface of the fibroid and the skin,distance between the dorsal surface of the fibroid and the sacrum,fibroid enhancement type and signal intensity,treatment time,sonication time and therapeutic energy.3.Multivariate analysis showed that NPV(non-perfused volume)ratio,maximum fibroid diameter and fibroid enhancement type were the independent factors affecting the recurrence of fibroids after HIFU treatment.The equation S=NPV ratio-0.655D+48.828X1+32.621X2was obtained and can be used to predict the probability of recurrence.Conclusions:NPV ratio,maximum fibroid diameter and fibroid enhancement type were the independent factors affecting the recurrence of fibroids after HIFU treatment.The establishment of a scoring system to optimize indicators that can predict recurrence of fibroids after HIFU treatment can be used in the future.