Dataset Information

High-Intensity Focused Ultrasound Ablation of Uterine Fibroids - Potential Impact on Fertility and Pregnancy Outcome.

ABSTRACT: Laparoscopic myomectomy is regarded as the gold standard for women with symptomatic fibroids who wish to become pregnant. High-intensity focused ultrasound (HIFU or MRgFUS) ablation of uterine fibroids is also being discussed as a non-surgical, minimally invasive, therapeutic option. This review examines the available data on the impact of HIFU/MRgFUS on fertility and pregnancy, focusing particularly on potential direct side-effects of this type of intervention on ovaries, fallopian tubes and uterus and potential late effects on pregnancy and birth, based on the current literature. All pregnancies after HIFU/MRgFUS published to date (around 100 cases) were evaluated. The published case series suggest that HIFU/MRgFUS ablation has no impact on the rate of miscarriages or other obstetrical outcome parameters. Because no prospective studies exist which permit firm conclusions to be drawn on the impact of HIFU/MRgFUS on fertility and pregnancy outcome in women with symptomatic fibroids, this approach is currently only recommended for women with suspected fertility problems due to uterine fibroids who either decline surgery or who have an unacceptably high surgical risk.

SUBMITTER: Bohlmann MK

PROVIDER: S-EPMC3973937 | biostudies-literature | 2014 Feb

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

High-Intensity Focused Ultrasound Ablation of Uterine Fibroids - Potential Impact on Fertility and Pregnancy Outcome.

Bohlmann M K MK Hoellen F F Hunold P P David M M

Geburtshilfe und Frauenheilkunde 20140201 2

Laparoscopic myomectomy is regarded as the gold standard for women with symptomatic fibroids who wish to become pregnant. High-intensity focused ultrasound (HIFU or MRgFUS) ablation of uterine fibroids is also being discussed as a non-surgical, minimally invasive, therapeutic option. This review examines the available data on the impact of HIFU/MRgFUS on fertility and pregnancy, focusing particularly on potential direct side-effects of this type of intervention on ovaries, fallopian tubes and ut ...[more]

PMID: 24741124

Similar Datasets

Project description:BackgroundMagnetic resonance-guided high-intensity focused ultrasound (MRgHIFU) is a noninvasive uterine-preserving treatment alternative to hysterectomy for women with symptomatic uterine leiomyomas (fibroids). Uterine fibroids commonly occur, have a broad impact on women's health and lifestyle, continue to be the main indication for hysterectomy, and represent a costly public health burden.ObjectivesThe objectives of the analysis were to evaluate patients' eligibility for MRgHIFU treatment of symptomatic uterine fibroids and the technical success, safety, effectiveness, and durability of this treatment. The review also compared the safety and effectiveness of MRgHIFU with other minimally invasive uterine-preserving treatments and surgeries for uterine fibroids.MethodsA literature search was performed on March 27, 2014, using Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid EMBASE, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), and EBM Reviews, for studies published from January 1, 2000, to March 27, 2014.ResultsThe evidence review identified 2 systematic reviews, 2 RCTs, 45 cohort study reports, and 19 case reports involving HIFU treatment of symptomatic uterine fibroids. Eligibility for MRgHIFU treatment was variable, ranging from 14% to 74%. In clinical cohort studies involving 1,594 patients, 26 major complications (1.6%) were reported. MRgHIFU resulted in statistically and clinically significant reductions in fibroid-related symptoms in studies conducted in 10 countries, although few involved follow-up longer than 1 year. Retreatment rates following MRgHIFU were higher in early clinical studies involving regulated restrictions in the extent of fibroid ablation than in later reports involving near-complete ablation. Emergent interventions, however, were rare. Although a desire for fertility was an exclusion criteria for treatment, spontaneous term pregnancies did occur following HIFU. There were no randomized trials comparing MRgHIFU and other guidance methods, other minimally invasive treatments, or surgeries for symptomatic uterine fibroids. Limitations with MRgHIFU included restricted eligibility, requirement for a dedicated MR device to guide the treatment, lengthy procedure time, and loss of MR opportunity time.ConclusionsFor women failing medical therapy and seeking alternatives to hysterectomy for symptomatic uterine fibroids, MRgHIFU provides a safe and effective, noninvasive, uterine-preserving treatment from which they rapidly recover. The treatment advantages of MRgHIFU are potentially offset by restrictive eligibility, lengthy procedure time, and dependence on availability of an MR device. The lack of comparative evidence between MRgHIFU and other, more established uterine-preserving treatments limits informed decision making among treatment options.

Project description:BackgroundThe heterogeneity of uterine fibroids in magnetic resonance imaging (MRI) is complex for a subjective visual evaluation, therefore it is difficult for an accurate prediction of the efficacy of high intensity focused ultrasound (HIFU) ablation in fibroids before the treatment. The purpose of this study was to set up a radiomics model based on MRI T2-weighted imaging (T2WI) for predicting the efficacy of HIFU ablation in uterine fibroids, and it would be used in preoperative screening of the fibroids for achieving high non-perfused volume ratio (NPVR).MethodsA total of 178 patients with uterine fibroids were consecutively enrolled and treated with ultrasound-guided HIFU under conscious sedation between February 2017 and December 2021. Among them, 96 patients with 108 uterine fibroids with high ablation efficacy (NPVR ≥80%, h_NPVR) and 82 patients with 92 fibroids with lower ablation efficacy (NPVR <80%, l_NPVR) were retrospectively analyzed. The transverse T2WI images of fibroids were selected, and the fibroids were delineated slice by slice using ITK-SNAP software. The radiomics analysis was performed to find the imaging biomarker for the construction of a predicting model for the evaluation of the ablation efficacy, including the feature extraction, feature selection and model construction. The prediction model was built by logistic regression and assessed by receiver operating characteristic (ROC) curve, and the prediction efficiency of the two models was compared by Delong test. The ratio of the training set to the testing set was 8:2.ResultsThe logistic regression model showed that the mean area under the curve (AUC) of the training set was 0.817 [95% confidence interval (CI): 0.755-0.882], and the testing set was 0.805 (95% CI: 0.670-0.941), respectively, which indicated a strong classification ability. The Delong test showed that there was no significant difference in the area under the ROC curve between the training set and testing set (P>0.05).ConclusionsThe radiomics model based on T2WI is feasible and effective for predicting the efficacy of HIFU ablation in treatment of uterine fibroids.

Dataset Information

High-Intensity Focused Ultrasound Ablation of Uterine Fibroids - Potential Impact on Fertility and Pregnancy Outcome.

Publications

High-Intensity Focused Ultrasound Ablation of Uterine Fibroids - Potential Impact on Fertility and Pregnancy Outcome.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets