Ratio of directly necrotized volume to total volume of a submucosal myoma predicts shrinkage after microwave endometrial ablation

Combined transabdominal and transvaginal ultrasound-guided percutaneous microwave ablation of uterine myomas: an effective monitoring technique

OBJECTIVE

This study compared the feasibility and efficacy of transabdominal ultrasound (TAU) and combined transabdominal and transvaginal ultrasound (TA/TV US)-guided percutaneous microwave ablation (PMWA) for uterine myoma (UM).

METHOD

This study enrolled 73 patients with UM who underwent PMWA via the transabdominal ultrasound-guided (TA group) or the combined transabdominal and transvaginal ultrasound-guided (TA/TV group) approaches. The intraoperative supplementary ablation rates, postoperative immediate ablation rates, lesion reduction rates and other indicators three months postoperatively were compared between the groups. The display of the needle tip, endometrium, uterine serosa, rectum and myoma feeding vessels under the guidance of TAU, transvaginal ultrasound (TVU) and TA/TV US were evaluated in the TA/TV group.

RESULTS

In the TA/TV group, the real-time position of the needle tip and the endometrium complete display rate of the same lesions with TVU guidance were significantly higher than those using TAU. TA/TV US guidance significantly improved the complete display rate of each indicator. The intraoperative supplementary ablation rate in the TA/TV group was lower than that in the TA group. Similarly, the postoperative immediate ablation and volume reduction rates of the lesions three months postoperatively were higher than those in the TA group, especially for lesions with a maximum diameter ≥6 cm.

CONCLUSION

TA/TV US is an effective monitoring method that can be used to improve imaging display. Its use is recommended in patients with obesity, poor transabdominal ultrasound image quality and large myoma volumes.

A retrospective comparison of microwave ablation and high intensity focused ultrasound for treating symptomatic uterine fibroids

OBJECTIVES

To retrospectively compare the effectiveness and safety of percutaneous microwave ablation (PMWA) and ultrasound-guided high-intensity focused ultrasound (USgHIFU) for treating symptomatic uterine fibroids.

METHODS

Seventy-three women with symptomatic uterine fibroids who met the inclusion criteria were enrolled in our study from September 2012 to December 2013. Thirty-one patients with forty uterine fibroids underwent PMWA, and forty-two patients with fifty-one uterine fibroids underwent USgHIFU. A contrast-enhanced MRI was performed before and after treatment, and all patients were followed up for 6 months. Assessment endpoints included symptom severity scores (SSS), treatment time, ablation rate, fibroid regression rate and adverse events.

RESULTS

The mean age of the patients in our study was 35.4±6.2 years (range, 21-49 years), and the median volume of uterine fibroids was 95.7cm(3) (60.3-131.5cm(3)). The ablation rate of uterine fibroids was 79.8±18.2% and 77.1±14.9% in the PMWA group and the USgHIFU group, respectively, and showed no significant difference between the groups. Changes in SSS after PMWA were similar in the PMWA group (47.7 pre-treatment vs. 29.9 post-treatment) and USgHIFU group (42.1 pre-treatment vs. 24.6 post-treatment). The regression rate of uterine fibroids also showed no marked difference between the two groups (PMWA, 50.3%; USgHIFU, 52.4%). The median treatment time of the PMWA group was 46.2min, which was demonstrably superior to USgHIFU. Finally, the occurrence rate of adverse events was the same in the two groups.

CONCLUSIONS

The safety and effectiveness of PMWA and USgHIFU in the treatment of uterine fibroids were similar; however, the median treatment time of PMWA was shorter than that of USgHIFU.

Thermal ablation

Image-guided tumor ablation refers to a group of treatment modalities that have emerged during the past 2 decades as important tools in the treatment of a wide range of tumors throughout the body. Although most widely recognized in the treatment of hepatic and renal malignancies, the role of thermal ablation has expanded to include lesions of the lung, breast, prostate, bone, as well as other organs and its clinical applications continue to increase. In the following article, we discuss the major thermal ablation modalities, their respective strengths and weaknesses, potential complications and how to avoid them, as well as possible future applications.