Abstract
ObjectiveTo evaluate the experience of the physician of the technical success in high-intensity focused ultrasound (HIFU) ablation of uterine fibroids with a nonperfused volume ratio (NPVR) of at least 80%.MethodsPatients from a 20-center prospective study were enrolled in this study. In this study, among the 20 clinical centers, five centers had physician with >3 years of HIFU experience, and the other 15 centers initiated HIFU therapy <3 years, were defined as the experienced group and the inexperienced group, respectively. Technical success was defined as achieving NPVR ≥ 80% of uterine fibroids with no major complications and it was defined as the successful group; otherwise, it was defined as the unsuccessful group.ResultsA total of 1,352 patients were included at the age of 41.32 ± 5.08 years. The mean NPVR (87.48 ± 14.91%) was obtained in the inexperienced group (86.50 ± 15.76%) and in the experienced group (89.21 ± 13.12%), respectively. The multivariate analysis showed that the volume of uterus, location of fibroids, and physician experience were significantly correlated with technical success (p < 0.05). In the experienced group, 82.20% of uterine fibroids obtained NPVR ≥ 80%, compared with 75.32% in the inexperienced group, and the difference was significant (p = 0.003). The technical success rate of the experienced group was 82.00% which was higher than 75.20% of the inexperienced group (p = 0.004).ConclusionIn technical success of achieving NPVR ≥ 80%, experience of the physician was positively correlated with technical success; NPVR and major complications for the inexperienced group were comparable to those of the experienced group from a clinical perspective; inexperienced physicians could reach NPVR ≥ 80% of sufficient ablation and were trustworthy in efficacy. Smaller uterus and fibroids of anterior wall were correlated with better technical success; experienced physicians still have better technical success when choosing patients with larger uterus, contributing to clinical decision-making and patient referral.
Highlights
Uterine fibroids are benign lesions or neoplasms of the uterus that can enlarge the uterus and it is estimated that 25% of the patients can develop clinical symptoms [1, 2]
There are reports of prenatal uterine rupture after laparoscopic myomectomy [7] and major complication rates in uterine artery embolization (UAE) were estimated that range from 1 to 17% [8, 9]
Eligibility criteria for patients [17] were as follows: [1] Premenopausal women with completed planned families, [2] Imagingconfirmed diagnosis of uterine fibroids had any of the following indications for hysterectomy: (a) enlarged uterus; (b) menorrhagia and/or secondary anemia; (c) pelvic pain, urinary frequency, or constipation, [3] For patients with multiple fibroids, no more than three fibroids with minimal diameters of 2 cm based on abdominal ultrasound present, [4] Fibroids clearly imaged by abdominal ultrasound, and [5] For patients with abdominal surgical scars, the width of image blurring due to acoustic attenuation had to be < 10 mm
Summary
Uterine fibroids are benign lesions or neoplasms of the uterus that can enlarge the uterus and it is estimated that 25% of the patients can develop clinical symptoms [1, 2]. Hysterectomy and myomectomy approaches are associated with a high rate of significant complications and weeks to recover [5, 6]. There are reports of prenatal uterine rupture after laparoscopic myomectomy [7] and major complication rates in UAE were estimated that range from 1 to 17% [8, 9]. High-intensity focused ultrasound (HIFU) has been used in noninvasive ablation of uterine fibroids, which was a uterus-preserving therapy proved to be safe and effective [11, 12]. We conducted a multicenter study to compare technical success in physician with different experience, in order to provide a basis for the clinical technical training, choices of physician, patient selection, and expanded application of HIFU technology
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