Abstract
A variety of novel endometrial ablation technologies are now in routine use. A subset of uteri that had previously undergone these treatments will ultimately be evaluated by the pathologist. However, the full spectrum of histologic changes that may result from these treatments has received only sporadic attention. The NovaSure™ [Hologic Corporation, Marlborough, MA, USA] endometrial ablation system is one of several available second-generation technologies and its particular endometrial ablative power is based on the delivery of radiofrequency energy. The present analysis was designed to decipher any histologic changes (if any) associated with the NovaSure™ endometrial ablation system relative to benign smooth muscle tumors of the uterine corpus. Over a one-year period, 3 uteri that had previously undergone the NovaSure™ endometrial ablation and which also had leiomyomatous mass lesions were evaluated. The leiomyomatous mass lesions were extensively sampled and were evaluated for cellular shapes (epithelioid change, cellular rounding, extraordinary cytoplasmic eosinophilia, clear cell change, cytoplasmic vacuolation), nuclear changes (nucleomegaly, nucleolomegaly, multinucleation, hyperchromasia, symplastic changes), necrosis (coagulative and/or infarct), mitotic activity, apoptotic bodies or pyknotic cells, myxoid change, hyalinization. The three uteri were resected 61, 47 and 74 (mean 60.7) days post-ablation. After a detailed evaluation of multiple submucosal, intramural and subserosal leiomyomata from these 3 uteri, no noteworthy histologic changes were identified in the tumors. Since the presence or absence of tumor necrosis is one histologic criterion by which malignant potential is assigned to uterine smooth muscle neoplasms, defining any extrinsic processes that may establish, or contribute to this finding is clinically relevant. The findings reported herein suggests that if a leiomyoma that was obtained from a patient that had recently undergone the NovaSure™ endometrial ablation displays any degenerative changes such as necrosis, the changes are probably not attributable to the ablation.
Highlights
Some of the available endometrial ablation technologies include The NovaSureTM system [Hologic (Cytyc) Corporation, Marlborough, MA, USA, which ablates the endometrial surface via radiofrequency energy], the ThermaChoice UBT (Gynecare Inc, Somerville, NJ, USA) and Cavaterm (Wallsten Medical, Morges, Switzerland) systems, the HerOption system [American Medical Systems Inc, Minnetonka, MN, USA, which is based on freezing the endometrium surface], the HTA system [BEI Medical/Boston Scientific, Natick, MA, USA, which is based on the use of heated saline], and the Microsulis system [Microsulis Medical Ltd, Pampano Beach, FL, USA, which is based on microwave energy]
Increasing tissue depth of ablation causes an automatic cessation of power-delivery at a threshold of 50 ohms or at 120 seconds, and the maximum power requirements are predetermined [1,2] Recently, we encountered a distinctive uterus that was removed from a patient who had undergone the NovaSureTM endometrial ablation and received a gonadotropin-releasing hormone receptor agonist (Leuprolide acetate) within the 7 months that preceded her hysterectomy
Prospective studies with long-term follow-up have shown that the NovaSureTM endometrial ablation system is an effi
Summary
Http://www.diagnosticpathology.org/content/3/1/28 phologically recognizable changes in the smooth muscle tumors. Livengood et al reported the histologic changes associated with "treatment failures" of a variety of endometrial ablation technologies, NovaSureTM included [8] The authors found that for water-balloon and radiofrequency based modalities, persistent post-ablation bleeding is related to "treatmentrelated thermally-fixed vessels" [8]. It is concluded that the NovaSureTM endometrial ablation probably does not cause any morphologically recognizable changes to leiomyomata being evaluated at an average of 60.7 days after treatment. It is unclear if tumors removed within a shorter time-frame post-ablation will display any changes. The findings reported suggests that if a leiomyoma that was obtained from a patient that had recently undergone the NovaSureTM endometrial ablation displays any degenerative changes such as necrosis, the changes are probably not attributable to the ablation
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
