04:21 PM Abstract No. 140 Uterine artery embolization for adenomyosis: a single-center experience

Abstract

To examine the outcomes of UAE for patients with adenomyosis to determine efficacy and possible subgroups with superior outcomes. At a single-center, records of patients who underwent UAE for adenomyosis were identified. Patients with concurrent fibroids were included in this study; patients without complete records were excluded. Chart review, pelvic MRI, and procedure records were utilized to determine and classify the type of adenomyosis, primary symptom improvement, and embolic type/size. 183 patients with adenomyosis underwent embolization from 1999 to 2018. Of these, 74 patients had complete records and comprise our study. Five patients (6%) underwent UAE for pure adenomyosis. Average age was 45.5 years. Median time to follow-up was 3 months (range: 2- to 10-months). Overall, 63 patients (85%) reported symptom improvement and 11 (15%) reported inadequate symptom improvement. Seventeen patients were treated with smaller particles (300-500 um) than typically used for UAE for treatment of fibroids alone. Although this subset had greater symptom improvement when compared to the larger embolic group, it was without significance (p=0.14). Subgroups of adenomyosis were classified as focal (n=34), regional (n=17), and diffuse (n=19). An ANOVA analysis of adenomyosis types and symptom improvement demonstrated no statistically significant difference between these groups (p=0.52). Though UAE is increasingly utilized to treat symptomatic adenomyosis, there is not yet a standard embolization protocol or classification system for adenomyosis. This retrospective analysis supports UAE efficacy for the treatment of adenomyosis with an overall clinical improvement of 85%. There is continued lack of understanding regarding particular subtypes of adenomyosis in response to UAE, which may be due to the lack of a thorough classification of the varieties of adenomyosis. A staging system similar to the Figo classification for fibroids may be needed for adenomyosis. This analysis calls for further classification of adenomyosis and suggests that size of embolic used should be studied in a prospective fashion.Table 1Type of Adenomyosis and Clinical OutcomeType of Adenomyosisn =# Symptom Improvement% Symptom Improvement# No Symptom Improvement% No Symptom ImprovementFocal342882%618%Regional171694%16%Diffuse191684%211% Open table in a new tab