Influence of Ulipristal Acetate Therapy on Uterine Fibroid‐Related Symptoms and on Uterine and Fibroid Volumes and Vascularity Indices Assessed by Ultrasound

Baggio, Silvia; Pomini, Paola; Galeone, F.; Presti, F.; Santi, Lorenza; Raffaelli, Ricciarda; Franchi, Massimo Piergiuseppe

doi:10.1002/jum.14573

Cited by 15 publications

(13 citation statements)

References 26 publications

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“…4). The treatment outcome of this study is also comparable to that of the previous studies (LeBlang et al 2010;Soliman et al 2017;Baggio et al 2018;Hu et al 2020), in which more than 90% of patients had symptom alleviation and fibroid shrinkage. In addition to fibroid shrinkage and USF-QOL, NPV is often used to evaluate HIFU efficacy, and NPVR is recommended to be at least 0.50 (LeBlang et al 2010).…”

Section: Feasibility Of Devascularization and Treatment Outcomesupporting

confidence: 86%

Ultrasound-Guided High-Intensity Focused Ultrasound for Devascularization of Uterine Fibroid: A Feasibility Study

Zhou

Niu

et al. 2021

Ultrasound in Medicine & Biology

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This study aimed to establish the feasibility of ultrasound-guided high-intensity focused ultrasound (USgHIFU) for devascularization of uterine fibroids. Ultrasound color Doppler flow imaging (CDFI) and B-mode imaging were used to target fibroid vascularity. The vessels were covered and ablated by high-intensity focused ultrasound spots. In this study, 42 fibroids with a volume of 66.98 § 4.00 cm 3 were treated. No blood flow was detected by post-treatment CDFI in 40 fibroids. The 6-mo non-perfusion volume rate was 75.23% § 34.77% (n = 40). The mean shrinkage in fibroid volume was 38.20% and 43.89%, respectively, at 1 and 6 mo after treatment (p < 0.001). The uterine fibroid symptom and quality of life scores were reduced by 9.43% at 1 mo and 26.66% at 6-mo after treatment (p < 0.001). No serious adverse event was observed. This study demonstrates the feasibility of USgHIFU-induced fibroid devascularization, and more studies are required for the evaluation of safety and efficacy.

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Section: Feasibility Of Devascularization and Treatment Outcomesupporting

confidence: 86%

Ultrasound-Guided High-Intensity Focused Ultrasound for Devascularization of Uterine Fibroid: A Feasibility Study

Zhou

Niu

et al. 2021

Ultrasound in Medicine & Biology

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“…Continuous variables were presented as mean ± SD, and categorical variables were presented as frequency and percent. The relationship between the nonperfused volume ratio and continuous variables, including age, body mass index, abdominal wall thickness, and fibroid size and volume, and perfusion parameters were evaluated by an independent Student t test, whereas the association between the nonperfused volume ratio and categorical variables, including fibroid location in the uterus and location of the uterus, was analyzed by a χ test or Fisher exact test. The correlation of perfusion parameters with the nonperfused volume ratio was evaluated by a Spearman analysis.…”

Section: Methodsmentioning

confidence: 99%

“…A uterine fibroid is the most common benign tumor in women of reproductive age, which has a substantial adverse impact on the physical and psychological well‐being of patients as well as quality of life . Surgical treatments, including hysterectomy and myomectomy, have been considered the preferred treatments for uterine fibroids over decades .…”

mentioning

confidence: 99%

“…A uterine fibroid is the most common benign tumor in women of reproductive age, which has a substantial adverse impact on the physical and psychological well-being of patients as well as quality of life. [1][2][3] Surgical treatments, including hysterectomy and myomectomy, have been considered the preferred treatments for uterine fibroids over decades. 4,5 However, surgery is invasive and not suitable for patients with a fertility desire because of the risk of postoperative recurrence, uterine scarring, and uterine rupture during pregnancy.…”

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confidence: 99%

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Predictive Value of Quantitative Uterine Fibroid Perfusion Parameters From Contrast‐Enhanced Ultrasound for the Therapeutic Effect of High‐Intensity Focused Ultrasound Ablation

Wang

Zhang

et al. 2018

J of Ultrasound Medicine

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Objectives To assess the predictive significance of quantitative perfusion parameters from contrast‐enhanced ultrasound (CEUS) for the therapeutic response to high‐intensity focused ultrasound (HIFU) ablation in patients with uterine fibroids. Methods A total of 263 patients with single uterine fibroids were treated with HIFU ablation under ultrasound guidance. The arrival time, peak time, enhancement time, enhancement intensity, and enhancement rate were evaluated with pretreatment CEUS. According to a nonperfused volume ratio evaluation by posttreatment magnetic resonance imaging, all patients were assigned to groups with volume ratios of 70% or higher and lower than 70%. Then the predictive performances of different parameters for ablation efficacy were studied. Results The arrival time, peak time, and enhancement time in the group with a nonperfused volume ratio of 70% or higher were longer than those in the group with a volume ratio lower than 70% (mean ± SD, 16.7 ± 3.5, 26.5 ± 4.9, and 10.2 ± 2.6 seconds, respectively, versus 13.3 ± 4.2, 20.8 ± 5.4, and 7.6 ± 2.3 seconds), whereas patients with a volume ratio of 70% or higher had a lower mean enhancement intensity and enhancement rate than those with a volume ratio lower than 70% (29.7 ± 16.7 dB and 3.2 ± 1.5 dB/s versus 63.2 ± 26.3 dB and 8.6 ± 4.3 dB/s; P < .05). The nonperfused volume ratio was negatively correlated with the enhancement intensity and enhancement rate (r = –0.631 and –0.712) but positively correlated with the arrival time, peak time, and enhancement time (r = 0.322, 0.456, and 0.477; P < .05). The areas under the receiver operating characteristic curve for the enhancement time, enhancement intensity, and enhancement rate were 0.73, 0.79, and 0.81 (P < .05). Conclusions Quantitative parameters from CEUS are potentially useful for evaluating the therapeutic effect of HIFU ablation for uterine fibroids.

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“…1 Twenty to 40% of women are affected by uterine fibroids at this stage. 2,3 Most cases are asymptomatic, but patients can exhibit pelvic pain, abnormal uterine bleeding, and infertility when the fibroids are large either in size or number, or if they affect specific locations such as the endometrial cavity. 4 Fibroids may also alter implantation potential by promoting abnormal uterine contractility, altering endometrial blood supply, or altering endometrial receptivity, for instance.…”

Section: Introductionmentioning

confidence: 99%

Series of 55 pregnancies following ulipristal acetate treatment of symptomatic uterine fibroids

Costa

Carvalho

Martins

et al. 2020

Journal of Endometriosis and Pelvic Pain Disorders

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Introduction: Treatment with ulipristal acetate effectively controls excessive bleeding due to uterine fibroids and reduces their size. Uterine fibroid size reduction is expected to improve the results of the myomectomy and the reproductive prospects of the patient. Methods: Retrospective and descriptive analysis of a series of 53 patients who achieved pregnancy after being treated for symptomatic uterine fibroids. The primary endpoints were pregnancy and birth outcomes in women with symptomatic uterine fibroids that conceived following at least one course of therapy with ulipristal acetate 5 mg/day. The secondary endpoints were time until pregnancy, reasons for ulipristal acetate treatment, number of treatment courses completed, hemorrhagic control achievement, hemoglobin levels, fibroid FIGO classification, largest fibroid diameter, and type of myomectomy (if any). Results: Fifty-five pregnancies were registered in 53 patients following ulipristal acetate therapy (43 live births, 9 miscarriages, and 3 ongoing pregnancies). Half of the patients became pregnant without interval surgery. Bleeding control was achieved in 96% of the cases. A significant increase (p < 0.001) in hemoglobin levels and a reduction (p < 0.001) in uterine fibroid size was observed after treatment. No malformations were reported among newborns after ulipristal acetate therapy. Conclusion: So far, this is the largest case series reporting both pregnancy and birth outcomes following ulipristal acetate therapy for uterine fibroids. Our data support favorable outcomes after therapy for this population subset.

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Influence of Ulipristal Acetate Therapy on Uterine Fibroid‐Related Symptoms and on Uterine and Fibroid Volumes and Vascularity Indices Assessed by Ultrasound

Abstract: Fibroid treatment with ulipristal acetate resulted in a significant improvement of fibroid-related symptoms; moreover, it proved to be effective in decreasing both uterine and fibroid volumes and fibroid vascularization. Type 5 fibroids seem to have the most major response to treatment.

Cited by 15 publications

References 26 publications

Ultrasound-Guided High-Intensity Focused Ultrasound for Devascularization of Uterine Fibroid: A Feasibility Study

Ultrasound-Guided High-Intensity Focused Ultrasound for Devascularization of Uterine Fibroid: A Feasibility Study

Predictive Value of Quantitative Uterine Fibroid Perfusion Parameters From Contrast‐Enhanced Ultrasound for the Therapeutic Effect of High‐Intensity Focused Ultrasound Ablation

Series of 55 pregnancies following ulipristal acetate treatment of symptomatic uterine fibroids

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