The sonographic features of follicular adenoma and follicular carcinoma are very similar, but larger lesion size, lack of a sonographic halo, hypoechoic appearance, and absence of cystic change favored a follicular carcinoma diagnosis. Increased patient age and male sex are associated with malignancy. Within the follicular carcinoma subgroup, Hürthle-cell variant of follicular carcinoma is more often seen in older patients with nodules having a heterogeneous appearance and lacking internal calcifications.
The results of this study suggest that DBT can replace conventional diagnostic mammography views for the evaluation of noncalcified findings recalled from screening mammography and achieve similar sensitivity and specificity. Two-view DBT was considered adequate mammographic evaluation for more than 90% of the findings. There was minimal change in the use of ultrasound with DBT compared with diagnostic mammography.
Purpose
To assess 12-month outcomes and safety of clinical magnetic resonance (MR)–guided focused ultrasound (US) treatments of uterine leiomyomas.
Materials and Methods
Between March 2005 and December 2009, 150 women with symptomatic uterine leiomyomas were clinically treated with MR-guided focused US at a single institution; 130 patients completed treatment and agreed to have their data used for research purposes. Patients were followed through retrospective review of medical records and phone interviews conducted at 3-, 6-, and 12-month intervals after treatment to assess additional procedures and symptom relief. Outcome measures and treatment complications were analyzed for possible correlations with the appearance of the tumors on T2-weighted imaging.
Results
The cumulative incidence of additional tumor-related treatments 12 months after MR-guided focused US was 7.4% by the Kaplan–Meier method. At 3-, 6-, and 12-month follow-up, 86% (90 of 105), 93% (92 of 99), and 88% (78 of 89) of patients reported relief of symptoms, respectively. No statistically significant correlation between tumor appearance on T2-weighted imaging and 12-month outcome was found. Treatment-related complications were observed in 17 patients (13.1%): 16 patients had minor complications and one had a major complication (deep vein thrombosis). All complications were resolved within the 12-month follow-up period.
Conclusions
MR-guided focused US is a noninvasive treatment option that can be used to effectively and safely treat uterine leiomyomas and delivers significant and lasting symptom relief for at least 12 months. The incidence of additional treatment during this time period is comparable with those in previous reports of uterine artery embolization.
Uterine fibroids are common smooth muscle tumors, which can result in substantial symptoms affecting the quality of life of women. Whereas patients have several options available for treatment, focused ultrasound ablation is one of the least invasive treatment options outside medical therapy. Magnetic resonance-guided focused ultrasound (MRgFUS) ablation combines therapy delivered by an ultrasound transducer with imaging, guidance for therapy, and thermal feedback provided by magnetic resonance imaging. In 2004, the MRgFUS system ExAblate 2000 (InSightec, Haifa, Israel) was approved by the United States Food and Drug Administration for clinical treatments of uterine fibroids. Since its approval, our institution has performed more than 140 treatments. This paper provides an overview of our site's clinical experience with MRgFUS, including a brief description of the treatment system, pertinent features to review on screening magnetic resonance imaging, how the procedure is performed, and risks and benefits of the treatment. Some potential clinical applications of the technology are also briefly reviewed.
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