The efficacy and safety of MR-HIFU and US-HIFU in treating uterine fibroids with the volume <300 cm³: a meta-analysis

Abstract

Background: High-intensity focused ultrasound (HIFU) is a promising and non-invasive therapy for symptomatic uterine fibroids. Currently, the main image-guided methods for HIFU include magnetic resonance-guided (MR-HIFU) and ultrasound-guided (US-HIFU). However, there are few comparative studies on the therapeutic efficacy and safety of MR-HIFU and US-HIFU in treating symptomatic uterine fibroids with a volume <300 cm 3 . Objective: We performed this meta-analysis to evaluate the efficacy and safety of MR-HIFU and US-HIFU in treating symptomatic uterine fibroids with a volume <300 cm 3 . Methods: We searched relevant literature in PubMed, EMBASE, Cochrane Library CNKI from inception until 2021. The mean value, the proportion, and their 95% confidence intervals (CIs) were measured by random-effects models. Publication bias was assessed using funnel plots. Results: 48 studies met our inclusion criteria-28 describing MR-HIFU and 20 describing US-HIFU. The mean non-perfused volume rate (NPVR) was 81.07% in the US-HIFU group and 58.92% in the MR-HIFU group, respectively. The mean volume reduction rates at month-3, month-6, and month-12 were 42.42, 58.72, and 65.55% in the US-HIFU group, while 34.79, 37.39, and 36.44% in the MR-HIFU group. The incidence of post-operative abdominal pain and abnormal vaginal discharge in the US-HIFU group was lower than that of MRI-HIFU. However, post-operative skin burn and sciatic nerve pain were more common in the US-HIFU group compared with MRI-HIFU. The one-year reintervention rate after MR-HIFU was 13.4%, which was higher than 5.2% in the US-HIFU group. Conclusion: US-HIFU may show better efficiency and safety than MR-HIFU in treating symptomatic fibroids with a volume <300 cm 3 .

Should Ultrasound-Guided High Frequency Focused Ultrasound Be Considered as an Alternative Non-Surgical Treatment of Uterine Fibroids in Non-Asiatic Countries? An Opinion Paper

“…Several studies showed lower frequency of major complications and treatable minor complications, in which skin redness, abdominal pain or discomfort and sciatic nerve paresthesia or simply leg pain are the most common. SAE occur in less than 0.5% of cases including second degree skin burn, lesions to bowel, ureter and bladder [29]. These complications occur when organs are in acoustic pathway or when the thermal effect induces inflammatory response and edema [21].…”

“…Outcomes of HIFU depend on different matters. According to myoma localization, it is observed that intramural fibroids [11] with volume under 300 cm 3 [29] show higher volume reduction results due to less deep tissue and scared blood supply, as compared to transmural and submucosal uterine fibroids. Regarding signal intensity of fibroids, two retrospective studies reported contradictory results about fibroid shrinkage.…”

“…The reduction depends on the initial fibroid volume and that there is a positive relationship between fibroid shrinkage and NPV ratio; the more the NPV, the higher the volume reduction [19]. Yu L, et al [29] found in his meta-analysis higher reduction rates after USgHIFU (65.55%) than in MRgHIFU 36.44% for patients having <300 cm 3 fibroid volume. He M, et al [17] observed no significant difference in reduction rate between hypointense, isointense and hyperintense fibroids at one, three and six months (32.5% ± 24.0, 42.3 ± 32.2% and 52.5 ± 36.3%, respectively).…”

“…The meta-analysis from Jeng CJ et al [28] reports that abdominal pain and abnormal vaginal discharge are more prevalent in MRgHIFU (mean 37.0% and 20.3%, respectively) as compared to USgHIFU (mean 31.2% and 11.3%, respectively), as timely adjustments could be made according to patient's pain feedback during USgHIFU. In contrast, sciatic nerve pain and thermal skin injury was found to be less frequent in MRgHIFU, according to the meta-analysis of Yu L et al [29].…”

“…Ten papers estimated reintervention rates after HIFU (Table 7), and report that MRgHIFU has higher reintervention rates than other ablation methods. In the meta-analysis from Yu L et al [29] evaluating 11 studies for fibroids <300 cm 3 , the summarized reintervention rate was 8.1% (I 2 = 8.1%; π 2 = 0.0015; p < 0.01), with MRgHIFU presenting higher rates than USgHIFU (mean 13.4%; 95% CI: 5.4-21.4 vs. 5.2%; 95% CI: 2.0-8.4). In another metaanalysis, Wang Y et al [22] reported that reintervention rate is higher in HIFU as compared to UAE (pooled OR: 11.99, 95% CI: 5.17-27.83, p < 0.01) and myomectomy (pooled OR: 4.05, 95% CI: 1.82-8.9).…”