Nonresective treatments for uterine fibroids: a systematic review of uterine and fibroid volume reductions

Patients are increasingly seeking uterus-preserving, minimally invasive treatments for symptomatic uterine fibroids. This has led to a greater use of nonresective treatments such as uterine artery embolization (UAE), focused ultrasound (FUS) and more recently, radiofrequency ablation (RFA) of fibroids. This systematic review, following PRISMA guidelines, examines the change in uterine and fibroid volumes associated with UAE, FUS, and RFA. Pubmed and MedlinePlus databases were searched from 1956 to 2016. The keywords used were ‘radiofrequency ablation,’ ‘magnetic resonance guided focused ultrasound,’ ‘ultrasound guided focused ultrasound’, ‘uterine artery embolization,’ ‘uterine fibroid embolization,’ and ‘leiomyoma’ or ‘fibroid’. Publications with at least 20 patients were included. Data were collected and analyzed using Microsoft Excel^® (Microsoft Corporation, Redmond, WA) software. Eighty-one relevant papers were identified: 52 related to UAE, 11 to RFA, 17 to FUS, 1 compared UAE and FUS. We report the published uterine volume and fibroid volume changes seen in these studies at 1 to 36?months. The pooled fibroid volume reductions at six months seen with RFA were 70%, UAE 54% and FUS 32%. All three types of nonresective treatment result in fibroid volume reduction. However, fibroid volume reduction is most marked with RFA, with UAE resulting in the next most volume reduction. Additional larger cohort studies, including those that are randomized and/or comparative, would enable definitive conclusions. This is the first systematic review comparing uterine and fibroid volume reduction after RFA, UAE and MRgFUS.     

Ultra-structure changes and survivin expression in uterine fibroids after radiofrequency ablation

Abstract

Purpose: To explore the reliability and validity of radiofrequency (RF) ablation in treating uterine fibroids. Materials and methods: We evaluated 63 patients who underwent hysterectomy to treat multiple fibroids. Thirty patients immediately underwent abdominal hysterectomy after the fibroids were ablated under direct vision. Thirty-three patients first experienced trans-vaginal ablation with the guidance of a baseline ultrasound. We performed abdominal or trans-vaginal hysterectomy 72?h later. The tissues in the centre of the ablated lesion (group A), at the edge of the ablated lesion (group B), 1?cm away from the ablated edge (group C) and the control group were sampled. We observed ultra-structure changes by transmission electron microscopy and detected survivin expression with Western blot analysis. Results: According to transmission electron microscopy, the ultra-structure of fibroid cells in groups A and B was damaged. However, in group C, the ultra-structure was normal. Compared with the control group, survivin expression was significantly decreased. Meanwhile survivin expression was significantly increased with the distance to the ablated centre (p?<?0.05). Conclusions: Radiofrequency ablation caused permanent and irreversible damage to fibroid cells and decreased survivin expression, which provided reliable clinical evidence for the success of radiofrequency ablation treating uterine fibroids.     

MMP－9、E GF水平对子宫肌瘤诊断特异性及准确性作用分析

目的：探讨子宫肌瘤患者血清基质金属蛋白酶9（MMP－9）、表皮生长因子（EGF）水平变化及诊断子宫肌瘤的临床价值。方法：选取84例经病理学确诊的子宫肌瘤患者（病例组）、84例健康妇女作为对照组，分别对比两组血清MMP－9、E GF水平，并根据肌瘤生长位置、肌瘤大小对病例组进行亚组分析。结果：病例组患者的血清MMP－9、EGF水平均高于对照组，差异具有统计学意义（P＜0．05）；MMP－9鉴别诊断子宫肌瘤与健康人群的最佳临界值为1．40μg／ml，EGF鉴别诊断子宫肌瘤与健康人群的最佳临界值为288．5pg／ml，对应的ROC曲线下面积AUC值分别为0．816、0．739。黏膜下肌瘤患者的血清MMP－9、EGF水平均高于肌壁间肌瘤患者，差异具有统计学意义（P＜0．05）；肌瘤最大径＞5．0cm 和肌瘤最大径≤5．0cm患者的血清MMP－9、EGF水平差异不具有统计学意义（P＞0．05）。结论：检测血清MMP－9、EGF水平有利于鉴别诊断子宫肌瘤患者。     

A comparison of ultrasound-guided high intensity focused ultrasound for the treatment of uterine fibroids in patients with an anteverted uterus and a retroverted uterus

Objective: The aim of this study was to compare the treatment outcomes of ultrasound-guided high-intensity focused ultrasound (USgHIFU) for uterine fibroids in patients with an anteverted uterus versus a retroverted uterus.

Materials and methods: Based on the principles of statistics we enrolled 221patients with an anteverted uterus and 221 with a retroverted uterus. All patients had a solitary uterine fibroid and every fibroid was identified as hypointense on the T2 weighted images (T2WI) on magnetic resonance. The baseline characteristics of the patients, treatment results and adverse events were compared between the two groups.

Results: There were no significant differences in baseline characteristics between the two groups. The average non-perfused volume ratio of fibroids was 85.2?±?18.7% in the group of patients with a retroverted uterus, while it was 87.7?±?11.8% in patients with an anteverted uterus (P?Conclusion: The results of this study indicated that uterine fibroids with hypointensity on T2WI in a retroverted uterus can be safely and effectively treated with USgHIFU. However, the fibroids in an anteverted uterus are easier to treat with USgHIFU.     

A retrospective study of ultrasound-guided high intensity focussed ultrasound ablation for multiple uterine fibroids in South Africa

Objective: To evaluate the shrinkage rate, symptom relief and improvement of the quality of life following ultrasound-guided high intensity focussed ultrasound (USgHIFU) for multiple uterine fibroids.

Methods: From October 2015 to November 2016, 81 black women with multiple symptomatic fibroids underwent USgHIFU. The number of the fibroids ranged from 3 to 9. The shrinkage rate of fibroids, symptom severity score and quality of life were evaluated following USgHIFU. Magnetic resonance imaging (MRI), the uterine fibroid symptom and quality of life (UFS-QOL) questionnaire were used for evaluation.

Results: The mean age of patients was 35.3?±?5.9 years. The average weight of these patients was 68.4?±?11.4?kg, with the median abdominal subcutaneous fat thickness of 38.0?±?11.4?mm. The median fibroid volume was 36.0 (range: 1.8–1220.1) cm³. During HIFU, 60.5% of the patients reported lower abdominal pain, 43.2% sciatic/buttock pain, 60.5% skin “burning” sensation, 6.2% abnormal vaginal discharge and 13.6% transient leg pain. No severe complications were observed. The average volume reduction rate of fibroids in 21 patients who completed the follow-up was 32.5?±?24.0, 42.3?±?32.2 and 52.5?±?36.3% 1, 3 and 6 months after HIFU, respectively. The UFS score decreased and the QOL values significantly increased during the follow-up period. Re-intervention treatment occurred in two of the 21 patients 6 months after HIFU. One patient conceived 3 months after HIFU, and she had a term vaginal delivery without any obstetrical complications.

Conclusions: Based on our results, USgHIFU is safe and effective in treating patients with multiple uterine fibroids.     

CT-Monitored Percutaneous Cryoablation of Uterine Fibroids after Uterine Artery Embolization

OBJECTIVE To investigate the effects of percutaneous cryoablation on uterine fibroids using computed tomographic (CT) guidance after uterine artery embolization. METHODS Twelve patients who failed to respond to uterine artery em- bolization were treated using percutaneous cryoablation. All patients had undergone previous uterine artery embolization an average of 1.2 years (0.7~1.6 years) ago. Two cases had abnormal bleeding, and the other 10 suf- fered from pressure and/or pelvic pain. Myoma diameters were 4 cm to 16.5 cm. By using CT guidance, 2.0, 2.4, 3.0 or 3.8 mm cryoprobes were placed into the fibroid, and two 15~20 min freezing processes were performed. He- mostasis was achieved only by pressing the incisions for several minutes. MR-imaging was performed before the procedure to measure the size and number of fibroid tumors, and follow- up MR-imaging determined the reduc- tion of the lesions. RESULTS All patients were discharged within 48 h of treatment. Almost no hemorrhage was found in all of the cases. No bladder or bowel injury or significant postsurgery pain was reported. Ice spheres were readily visual- ized at CT. Beam-hardening artifact from the metal probes was present, but did not interfere with the procedure. Myomas regressed up to 76.3% after 12 months of treatment, and the primary symptoms improved in all treated women. CONCLUSION CT-monitored percutaneous cryoablation is an effective and minimally invasive therapy for symptom relief and fibroid shrinkage after the failure of uterine artery embolization.     

Lidamycin Induces Apoptosis of B-Cell Lymphoma Cells and Inhibits Xenograft Growth in Nude Mice

OBJECTIVE To study the cytotoxicity of Lidamycin (LDM) and its induction of apoptosis in Raji and Daudi cells of B-cell lymphoma, and the inhibition of growth of the lymphoma Raji xenograft in nude mice.METHODS MTT assay was used to observe the inhibition by LDM on the proliferation of the Raji and Daudi cells. Annexin V-FITC/PI double-stain, in combination with flow cytometry (FCM), was used to determine the induction of apoptosis by LDM in Raji cells. The B-cell lymphoma Raji xenograft model in nude mice was set up to detect the in vivo antitumor activity of LDM.RESULTS LDM markedly inhibited the proliferation of the Raji and Daudi cells in vitro, with IC50 values of 7.13×10-11 mol/L and 2.91×10-10 mol/L, respectively. The apoptotic rates of Raji cells were respectively 77.98% and 67.63% at 0.5 nmol/L and 0.25 nmol/L of LDM, indicating an obvious induction of apoptosis in Raji cells. LDM inhibited the formation and growth of human B-cell lymphoma Raji xenograft in nude mice. The inhibition rates of tumor growth were respectively 74.9% and 65.2% in LDM at dosage group of 0.05 mg/kg and 0.025 mg/kg, suggesting an apparent prolongation of survival time in the nude mouse bearing lymphoma.CONCLUSION LDM can effectively induce apoptosis of the B-cell lymphoma cells and inhibit the xenograft growth in nude mice.     

Neutrophil-to-Lymphocyte Ratio (NLR) for Preoperative Differentiation between Uterine Leiomyosarcoma (LMS) and Uterine Leiomyoma: A Case-Controlled Study

Background: Differentiating uterine LMS from uterine leiomyoma is difficult. Therefore, this study aimed to compare preoperative NLR of uterine leiomyosarcoma (LMS) with leiomyoma and secondary objective aimed to identify the clinical characteristics to distinguish between uterine LMS and uterine leiomyoma including the appropriate NLR cut off value to differentiate LMS from leiomyoma. Methods: This was a matched case-controlled study with 1:4 ratio. We collected data of patients with uterine LMS and leiomyoma from 2011 to 2020 at King Chulalongkorn Memorial Hospital. Patients with uterine LMS (case group) and leiomyoma (control group) were matched in terms of year of the surgery and size of the uterine mass. Statistical analysis was conducted using SPSS version 22.0 and STATA version 17. Conditional logistic regression analysis with a p-value of <0.05 was used. Results: Twenty-seven patients who were diagnosed with uterine LMS met the inclusion criteria; 13 patients who had incomplete data and one patient who was had concurrent breast cancer were excluded. Thirteen patients were included in the final analysis. From 2,587 patients in control group; 52 patients were matched. The baseline characteristics in both groups were comparable except for menopausal status Women with uterine LMS had a higher NLR than those with leiomyoma (mean, 4.56 ± 2.5 and 2.4 ± 1.15 in the case and control groups, respectively). Conditional logistic regression determined that the NLR cut-off value of 2.8 was a statistically significant factor for determining uterine LMS (OR = 3.24; 95% CI 1.01–10.43). No significant difference was found in the other factors. Conclusions: Patients who were diagnosed with uterine LMS had a significantly higher NLR than those diagnosed with leiomyoma. The NLR is a simple and effective method for predicting the presence of a uterine LMS in patients who are pre-operatively diagnosed with a uterine mass.     

BRM释介素抗肿瘤作用研究

 目的　研究中药复方胶囊BRM释介素的抗癌活性及诱导人神经胶质瘤细胞SHG 4 4凋亡。方法　运用MTT法检测BRM对体外人癌细胞株的抑制作用 ;运用小鼠移植瘤模型观察BRM体内抑瘤活性 ;应用电镜、流式细胞仪分析、琼脂糖凝胶电泳观察BRM诱导SHG 4 4。结果　BRM释介素体外对SHG 4 4、MCF 7具有明显的抑制作用 ;体内对小鼠移植性肿瘤表现出较显著的抗癌活性 ;SHG 4 4在BRM水提液作用下发生细胞凋亡。结论　BRM释介素的抗肿瘤活性与诱导细胞凋亡有关     

腹腔镜下分碎器误用于子宫肉瘤病例的回顾性分析

目的:回顾性分析因子宫肌瘤行腹腔镜手术的病例,探讨分碎器误用于子宫肉瘤的比率以及对其预后的影响。方法:选取2004年11月至2014年11月以诊断为子宫肌瘤入院并行腹腔镜下子宫切除术或子宫肌瘤切除术的患者,统计术后病理确诊或高度怀疑为子宫肉瘤的患者,分析其临床资料并随访其预后。结果:以诊断为子宫肌瘤入院并行腹腔镜子宫切除术或子宫肌瘤切除术的患者,共计2 278例,经术后病理确诊或高度怀疑为子宫肉瘤患者共8例,约占0.35%（8/2278）;术后2例病理经上级医院再次复核后考虑为良性,另有一例术后8个月复发行二次手术治疗,术中发现大网膜、肠系膜、腹膜已有多发转移病灶。其余无复发或死亡病例。结论:腹腔镜下分碎器误用于子宫肉瘤的机会非常小,其在腹腔镜子宫肌瘤手术中的应用仍是可行的,但同时应重视分碎器所带来的不良后果并采取措施规避之。     

Establishment of a scoring system for predicting the difficulty level of high-intensity focussed ultrasound ablation of uterine fibroids

Purpose: To establish a scoring system that predicts the difficulty level of high-intensity focussed ultrasound (HIFU) ablation of uterine fibroids.

Materials and methods: Four hundred and twenty-two patients with fibroids were enrolled. The energy efficiency factor (EEF) and sonication time were set as dependent variables, with factors possibly affecting EEF and sonication time including age, body mass index (BMI), the volume of fibroids, the location of the uterus, the type of fibroids, the signal intensity on the T2-weighted imaging (T2WI), the enhancement type, the thickness of the rectus abdominis and the subcutaneous fat layer, the distance from the anterior/posterior surface of the fibroid to the skin, and the abdominal wall scars were set as predictors for building optimal scaling regression models.

Results: The volume of the fibroids, the location of the uterus, the signal intensity on T2WI, enhancement type, rectus abdominis thickness, subcutaneous fat thickness, and distance from the anterior surface of fibroid to the skin were related to EEF. Signal intensity on T2WI, the volume of fibroids, distance from the posterior surface of fibroid to the skin, and enhancement type were related to sonication time. Models that can predict the difficulty level of HIFU for fibroids have been established: for EEF, y?′?=?0.338X?′₁???0.231X?′₂+0.156X?′₃+0.167X?′₄?; for sonication time, y?=?0.227X₁+0.321X₂+0.157X₃+0.194X₄.

Conclusions: A scoring system for predicting the difficulty level of HIFU treatment for uterine fibroids has been established and it can be used to help select patients and to predict the sonication time for a given fibroid.     

腹腔镜推结器经阴道套扎巨大子宫黏膜下肌瘤的临床应用

目的探讨应用腹腔镜推结器经阴道套扎巨大子宫黏膜下肌瘤的临床疗效。方法巨大子宫黏膜下肌瘤患者27例,根据临床表现、妇科检查和B超检查确诊,均为单发带蒂肌瘤,采用腹腔镜推结器经阴道套扎后切除肌瘤,观察手术时间、出血量和并发症发生率。手术后1个月、3个月随访患者的月经恢复情况、血红蛋白水平等。结果肌瘤摘除率为100%,平均手术时间为(61.4±5.8)min,平均出血量为(92.5±8.3)ml。所有患者术中生命体征平稳,术后无一例发生感染及严重并发症。手术后1个月随访,92.6%的患者月经恢复正常;手术后3个月随访,100%的患者月经恢复正常。结论应用腹腔镜推结器经阴道套扎是治疗巨大子宫黏膜下肌瘤的有效方法,操作简单,并发症少,值得推广应用。     

Radix Tetrastigma Extracts Enhance the Chemosensitivity in Triple-Negative Breast Cancer Via Inhibiting PI3K/Akt/mTOR-Mediated Autophagy

ObjectiveDrug resistance in tumors is one of the major factors that leads to chemotherapy failure. This study aims to investigate the effect of Radix Tetrastigma extracts (RTEs) on Taxol-induced autophagy and the chemosensitivity against drug resistance in triple-negative breast cancer (TNBC).MethodsTaxol-resistant MDA-MB-468 (MDA-MB-468/Taxol) cells were induced and treated with RTEs and/or Taxol. Mice were subcutaneously inoculated with MDA-MB- 468/Taxol cells to establish xenograft models. The associated protein levels were measured by western blotting. Flow cytometry, CCK-8 and EdU assay were performed to detect cell apoptosis, viability, and proliferation, respectively.ResultsIn MDA-MB-468/Taxol cells, RTEs & Taxol treatment increased cell apoptosis, reduced cell viability and proliferation, up-regulated anti-autophagy marker LC3I/LC3II ratio, and enhanced mTOR level. With RTEs & Taxol treatment, mTOR silencing downregulated LC3I/LC3II ratio, increased cell viability and proliferation, and reduced cell apoptosis, while mTOR overexpression showed the opposite results. PI3K inhibitor reduced AKT and mTOR levels, and the effects on cell activities were similar to the results of mTOR silencing. After RTEs & Taxol injection, xenograft tumor was smaller, and AKT, mTOR, LC3I/LC3II ratio and apoptotic marker cleaved caspase-3 were increased.ConclusionRTEs enhanced the chemosensitivity of resistant TNBC cells to Taxol through inhibiting PI3K/Akt/mTOR-mediated autophagy.MicroRTEs exerted anti-tumor effects in various cancers, and this study determined its role in TNBC. Taxol-resistant MDA-MB-468 cells were induced and xenograft models were established. We found that RTEs inhibited autophagy of MDA-MB-468/Taxol cells and reduced tumor growth. Inhibition of PI3K/Akt/mTOR pathway promoted autophagy of MDA-MB-468/Taxol cells. We may provide a new potential strategy for TNBC treatment.     

子宫肌瘤栓塞治疗后闭经的临床分析

背景与目的:子宫肌瘤的栓塞治疗是子宫肌瘤的治疗方法之一,但存在治疗后闭经的问题.本研究探讨子宫肌瘤栓塞治疗后发生闭经的原因.方法:对在中山大学附属第一医院行子宫肌瘤栓塞治疗的487例患者追踪随访1年观察闭经的发生情况.所有病例均采用双侧子宫动脉插管经导管注入栓塞剂方法,其中104例以超液化碘油加平阳霉素作为栓塞剂,栓塞剂用量超液化碘油8～15 mL(平均10 mL)、平阳霉素6～16 mg(平均8 mg);158例以聚乙烯醇作为栓塞剂,用量80～150 ms(平均100 mg);225例以明胶海绵作为栓塞剂,用量1-2 g(平均1.5g).结果:栓塞后临床有效率为98.97%(482/487):栓塞失败率1.03%(5/487).栓塞后共有6(1.23%)例出现闭经,其中碘油组3例.碘油在卵巢区沉积;聚乙烯醇组1例;明胶海绵组2例.除明胶海绵组1例外.其余5例均出现雌二醇下降,促卵泡生成素上升.另外1例经多次超声检查发现子宫内膜仅3 mm,而雌二醇和促卵泡生成素正常,宫腔镜证实为内膜萎缩.结论:常用的栓塞材料均有可能导致子宫肌瘤柃塞后闭经,子宫肌瘤栓塞后闭经发生率为1.23%,其原凶与卵巢受损和子宫内膜受损萎缩有关.     

亮丙瑞林微球蛋白对子宫肌瘤术后患者ER、Bcl-2蛋白表达及预后的影响

目的:探究亮丙瑞林微球蛋白对子宫肌瘤术后患者ER、Bcl-2蛋白表达及预后的影响。方法:选择2015年1月至2016年12月我院妇科收治的160例子宫肌瘤患者，按随机数表法将患者分为观察组（80例）和对照组（80例），患者经妇科彩超检查确定肿瘤部位后行腹腔镜治疗，观察组患者术前辅助用药亮丙瑞林微球蛋白，对照组患者不作处理，观察术后患者临床效果，并检测患者体内激素受体及肿瘤细胞因子的表达情况。结果:两组患者病情均有改善，且观察组患者临床症状改善及子宫、肿瘤体积减小程度更显著，治疗有效率高于对照组（P＜0.05），激素受体ER、PR的阳性表达率降低更明显（P＜0.05），肿瘤细胞因子Bcl-2、Bax的阳性表达均改善更佳（P＜0.05）。治疗后对照组患者日常生活及社会行动能力得到改善（P＜0.05），抑郁及焦虑状态未得到明显改善（P＞0.05），观察组患者4个测评因子均得到明显改善（P＜0.05）。结论:亮丙瑞林微球蛋白应用于子宫肌瘤患者能显著提高治疗效果，患者激素受体及肿瘤细胞因子的阳性表达情况得到明显控制，生活质量显著提高，治疗方法值得临床推广使用。     

Factors influencing MR changes associated with sacral injury after high-intensity focused ultrasound ablation of uterine fibroids

Purpose: We investigated the risk factors influencing MR changes associated with sacral injury from ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation for uterine fibroids.

Methods: We retrospectively analyzed a total of 346 patients with symptomatic uterine fibroids who received USgHIFU ablation. All of the patients underwent contrast-enhanced magnetic resonance imaging (CE-MRI) before and after treatment. Injury to the sacrum was set as the dependent variable, while fibroid features and the treatment parameters were set as independent variables. These variables were used to assess respectively their correlation with sacral injury by using univariate and multivariate analyses.

Results: The results of univariate analysis revealed that the volume, distance from the fibroid to the skin, maximal diameter, distance from the fibroid to the sacrum, fibroid types, degree of enhancement, therapeutic dosimetry (TD), energy efficiency factor (EEF) and non-perfused volume (NPV) ratio manifested significant correlations with the sacral injury (p?<?.05). Multivariate analysis showed that the degree of enhancement, TD and EEF were independent risk factors for sacral injury (p?<?.05), while the distance from fibroid to sacrum and intramural or subserosal types were protective factors (p?<?.05). The incidence of sacral tail pain and leg pain showed a significant positive correlation with sacral injury (p?<?.05).

Conclusion: As important affecting factors, the degree of enhancement, distance from fibroid to sacrum and fibroid types all possess significant correlations with MR changes associated with sacral injury.     

Effects of a microbubble ultrasound contrast agent on high-intensity focused ultrasound for uterine fibroids: a randomised controlled trial

Objective: To investigate the effects of a microbubble ultrasound contrast agent on high-intensity focused ultrasound (HIFU) treatment of uterine fibroids.

Methods: A total of 120 patients with solitary uterine fibroid were randomly assigned into Groups A, B, C and D. Patients in Groups A and B received 1.5?ml of SonoVue, Groups C and D received 1.5?ml of saline before HIFU ablation. HIFU sonication started at 6?min after administration of SonoVue or saline in Groups A and C, whereas it started at 10?min in Groups B and D. On day 1 after HIFU, magnetic resonance imaging was performed. Patients were followed up via phone or clinic visit during the first week after HIFU.

Results: No significant difference was observed in terms of age, fibroid location, diameter of fibroids, signal intensity on T2-weighted imaging, or tumour volume among the four groups (p?>?0.05). The use of SonoVue significantly shortened the treatment time and sonication time. The sonication start time of 6?min, relative to 10?min, had significant effects on the treatment time and sonication time. The use of intravenous SonoVue followed by HIFU ablation 6?min later significantly increased the rate of significant grey-scale changes (55.9%) and the non-perfused volume ratio (94.2%?±?10.6%). No significant differences were observed in the incidence of intra-procedure and post-HIFU adverse effects among the four groups (p?>?0.05).

Conclusions: SonoVue could be safely used to enhance the ablation effects of HIFU treatment of uterine fibroids.     

Factors influencing thermal injury to skin and abdominal wall structures in HIFU ablation of uterine fibroids

Objective: To investigate the factors which may cause thermal injury of abdominal wall structures in ultrasound-guided high-intensity focussed ultrasound (USgHIFU) ablation of uterine fibroids.

Method: A total of 892 patients with uterine fibroids diagnosed on contrast-enhanced magnetic resonance imaging (MRI) scans received HIFU ablation and follow-up MRI scanning. After therapy, thermal injury to the skin was assessed via measurement of skin redness, blisters, subcutaneous nodules and to the abdominal wall structures via measurement of signal intensity on T2-weighted MRI images. A total of 151 patients were assigned to the injury group, 741 patients were assigned to the non-injury group. The relationship between patient and treatment parameters and injury were analysed using univariate and multiple logistic regression analyses.

Results: Univariate logistic regression revealed that sonication time, sonication time per hour, total energy deposited, distance from uterine fibroid ventral side to skin, volume of uterine fibroids, abdominal wall scar, abdominal wall thickness and body mass index (BMI) all affected whether thermal injury occurred (p?p?=?0.000, OR?=?2.228, 95% CI 1.831–2.712), abdominal wall scar (p?=?0.019, OR?=?1.639, 95% CI 1.085–2.477) and abdominal wall thickness (p?=?0.000, OR?=?1.562, 95% CI 1.313–1.857) were significantly correlated with thermal injury.

Conclusion: Multiple logistic regression analysis revealed that abdominal wall thickness, total energy and abdominal wall scar were the most significant influencing factors that influenced minimal thermal injury of abdominal wall structures in USgHIFU ablation of uterine fibroids.     

Clinical 24 month experience of the first MRgFUS Unit for treatment of uterine fibroids in Australia

Aim: To describe and evaluate treatment of uterine fibroids using Magnetic Resonance Guided Focused Ultrasound (MRgFUS) during its first 24 months of use at The Royal Women's Hospital Melbourne. Methods: One hundred Victorian women were treated with MRgFUS using the ExAblate 2000 system. Treatment outcomes based on fibroid volume shrinkage measured at 4 and 12 months post‐treatment and symptom severity score assessment (Symptom Severity Score Quality of Life – SSS‐QOL) pre‐ and post‐ (4–6 weeks, 4, 6 and 12 months) treatment. Results: Mean non‐perfused volume of the treated fibroids were 67% ± 25% (n = 100) immediately post‐treatment. At 4 months post‐treatment, the treated fibroids demonstrated an average volume reduction of 29% ± 32% (n = 74) and at 12 months 38% ± 45% (n = 32). Mean symptom severity scores (SSS‐QOL) improved by 51% from 59 ± 21 (n = 97) at baseline to 29 ± 17 (n = 36) by 12 months. Conclusion: From our experience, we believe there is a role for MRgFUS in the treatment of uterine fibroids in selected women.