Abstract
Objective: To evaluate factors in predicting the treatment outcome of ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation for uterine fibroids with a non-perfused volume ratio (NPVR) of at least 80%.Methods: One thousand patients with uterine fibroids who received USgHIFU were enrolled. Thirty-two independent variables of four dimensions of data set, including general information of patients, clinical symptoms, laboratory tests, and fibroid imaging characteristics, were used to investigate the potential predictors of the NPVR of at least 80% by multivariate logistic regression. NPVR was the gold standard for evaluating the efficiency of HIFU ablation, and a NPVR of at least 80% was considered sufficient ablation, while partial ablation was defined as having an NPVR of <80%.Results: Out of 1,000 fibroids, 758 obtained sufficient ablation and 242 obtained partial ablation, and the median NPVR was 88.3% (interquartile range: 80.3–94.8%). The probability of NPVR reaching 80% fibroids with a signal intensity of T2WI of hypointense, isointense, and hyperintense was 86.4, 76.5, and 62.6%, respectively; fibroids with an enhancement type of T1WI of slight, irregular, and regular was 81.5, 73.6, and 63.7%, respectively; and fibroids with uterine anteroposterior of 30–130 mm was 57.7–78.3%, respectively. In patients with a platelet count of 50 × 109/L−550 × 109/L, the probability of NPVR reaching 80% is from 53.4 to 80.1%, respectively.Conclusions: In predicting NPVR ≥ 80%, the signal intensity on T2WI was the most important factor affecting ablative efficiency, followed by enhancement type on T1WI, uterine anteroposterior, and platelet count.
Highlights
Uterine fibroid is the most common benign tumor in women of childbearing age
Previous studies have shown that when the non-perfused volume ratio (NPVR) of uterine fibroids is up to 70%, the 2-year clinical effect of ultrasound ablation is considered to be equivalent to myomectomy [16, 17]
Fan et al used multiple linear regression to find that the factors influencing the NPVR of HIFU ablation of uterine fibroids were as follows: distance from UFs ventral side to skin, hypointense and hyperintense signal of T2WI, enhancement type of T1WI, posterior and anterior location of UFs, transmural type of UFs, and anteverted uterine position [26]
Summary
Uterine fibroid is the most common benign tumor in women of childbearing age. Up to 25% of women and up to 30– 40% of women older than 40 years have clinical symptoms of uterine fibroids [1,2,3]. Previous studies have focused on assessing the ablation efficacy based on tissue in the acoustic pathways, MRI signal intensity, structure, and blood supply [22, 25]. Other clinical information, such as clinical symptom data and laboratory test data of uterine fibroids, was ignored. This study intends to incorporate the multidimensional clinical data obtained from a large sample, to further explore the factors affecting the ablative efficiency of HIFU ablation and analyze the relative importance of its contribution to the efficiency, and that provided a more accurate ablative efficiency prediction and the factors influencing ablative efficiency could optimize patient screening for HIFU ablation of uterine fibroids
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