Abstract
Minimally invasive interventions for myomata treatment have gained acceptance due to the possibility of preserving fertility with reduced trauma induced by laparotomy as way of entrance. There are insufficient data regarding outcomes of high intensity focused ultrasound (HIFU) in non-Asiatic women. Therefore, we revised the available evidence to present an expert opinion that could support physicians, patients and policy-makers for considering this approach in other populations. We revisited systematic reviews, randomized controlled trials and cohort studies from January 2018 to August 2021 using PubMed and Google scholar, regarding short and long term outcomes after ablation with focused ultrasound waves. In total, 33 studies, including 114,810 adult patients showed that outcomes of this approach depend on several parameters directly related with resistance to thermal ablation, especially fibroid size and vascularization. Two studies report satisfactory outcomes in Afro-American women. In accordance to the technique used, fibroid volume reduction showed to be higher in fibroids <300 cm3 after ultrasound guided HIFU than after MRI guided. Compared to myomectomy and uterine artery embolization, HIFU seems to have shorter hospital stay, higher pregnancy rates and similar adverse events rates, with skin burn being the most reported. Symptoms and quality of life improvement is similar to myomectomy but lower than embolization, however reintervention rate is higher after HIFU. Lacks evidence about long-term sarcoma risk after ablation. Available evidence shows that HIFU can be considered as a uterine sparing treatment for women of different ethnicities suffering of uterine myomatosis, especially for those wishing to preserve their fertility.
Highlights
In clinical practice, non-invasive gynecological interventions have gained acceptance due to the possibility of preserving fertility and reducing the risks associated with invasive surgery but with similar results with respect to symptoms resolution [1]
Considering that gynecologists and patients are interested in having access to noninvasive alternatives for the management of uterine myomatosis, but having insufficient data on high intensity focused ultrasound (HIFU) long-term effects, we present an evidence-based expert opinion that could support physicians, patients and policy-makers for eventually considering the HIFU as an alternative to surgery and uterine artery embolization (UAE) to treat patients presenting with uterine myomatosis
adverse events (AE): I2 = 62.5%; Cochran Q = 5.3; p = 0.069 mean Non-perfused volume ratio (NPVR): MRI guided HIFU (MRgHIFU): 58.92%, USgHIFU: 81.07%
Summary
Non-invasive gynecological interventions have gained acceptance due to the possibility of preserving fertility and reducing the risks associated with invasive surgery but with similar results with respect to symptoms resolution [1]. The beam of high intensity focused ultrasound (HIFU) can be guided by MRI (MRgHIFU) or ultrasound (USgHIFU) to accurately localize and treat the lesion [3]. The waves pass through the tissues and arrive at the target lesion, raising the temperature of the focal point leading to irreversible coagulative necrosis by absorption of ultrasound energy (thermal effect) and thereby ultrasound-induced cavitation damage (mechanical effect) [5]. The blood perfusion of the lesion is reduced and a defined border between the treated area and surrounding tissue is created [2]. These changes are easy to recognize post-procedure by contrast–enhance MRI or ultrasound. Though several cohort studies report HIFU outcomes to be better than surgery, the use of this technology is not worldwide approved, available or used [7]
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