Image-guided thermal ablation in the management of symptomatic adenomyosis: a systematic review and meta-analysis

Abstract

Objective: To evaluate the clinical effects of image-guided thermal ablation for the treatment of symptomatic adenomyosis (AD). Data sources: We searched PubMed, Web of Science, Cochrane Library, EMBASE, ClinicalTrials.gov and Google Scholar for literature from January 2000 to September 2020. Methods of study selection: We included all studies reporting clinical outcomes of image-guided thermal ablation for AD, involving high-intensity focused ultrasound (HIFU), percutaneous microwave ablation (PMWA) and radiofrequency ablation (RFA). Two independent researchers performed study selection according to the screening criteria. Results: A total of 38 studies representing 15,908 women were included. Compared with those at baseline, the visual analog scale scores, the symptom severity scores and the menorrhagia severity scores decreased significantly after these thermal ablation therapies. The mean ablation time was 92.18 min, 24.15 min and 31.93 min during HIFU, PMWA and RFA, respectively. The non-perfused volume ratio of AD was 68.3% for HIFU, 82.5% for PMWA and 79.2% for RFA. The reduction rates of uterine volume were 33.6% (HIFU), 46.8% (PMWA) and 44.0% (RFA). The reduction rates of AD volume were 45.1% (HIFU), 74.9% (PMWA) and 61.3% (RFA). The relief rates of dysmenorrhea were 84.2% (HIFU), 89.7% (PMWA) and 89.2% (RFA). The incidence of minor adverse events was 39.0% (HIFU), 51.3% (PMWA) and 3.6% (RFA). The re-intervention rates were 4.0% (HIFU) and 28.7% (RFA). The recurrence rate was 10.2% after HIFU. The pregnancy rates were 16.7% (HIFU), 4.93% (PMWA) and 35.8% (RFA). Conclusion: Image-guided HIFU, PMWA and RFA may be effective and safe minimally invasive therapies for symptomatic AD.

A review of high-intensity focused ultrasound as a novel and non-invasive interventional radiology technique

“…Patients with uterine fibroids or adenomyosis usually experience menorrhagia, abnormal vaginal discharge, increase in bloody discharge, and dysmenorrhea, accompanied with subfertility. 41 The goal of HIFU treatment for uterine fibroids and adenomyosis is to alleviate symptoms, induce necrosis, and decrease its volume. 42 MRI is used for the assessment of remission of clinical symptoms.…”

Literature Review on the Modern Management of Adenomyosis

“…There are newer minimally invasive techniques which use thermal energy sources on adenomyotic lesions to improve symptoms. There are three types: High intensity focus ultrasound (HIFU), percutaneous microwave ablation (PWMA) and radiofrequency ablation (RA) [8].…”

“…HIFU although its less invasive and doesn't use an electrode, there is a limitation of penetration of ultrasound for lesions that are deep. MWA and RFA, was identified to be more advantageous in comparison to HIFU due to shorter operator times, reduction in uterine and adenomyosis volume [8].…”

Adenomyosis and fertility: does adenomyosis impact fertility and does treatment improve outcomes

“…Reproductive outcomes for each technique are limited. A recent systematic review and meta-analysis documented pregnancy rates following thermal ablation of 17% (HIFU), 5% (microwave ablation), and 36% (radiofrequency ablation); however, the primary outcomes of most studies included impact on bleeding and pain rather than the impact on pregnancy outcomes [40 ▪ ]. A retrospective cohort of 81 patients who underwent radiofrequency ablation for adenomyosis and desired future fertility noted that 36% of the cohort achieved pregnancy with a live birth rate among women who conceived of 67% [41].…”