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Research paper
Published online: 2021-04-23
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Magnetic resonance-guided high-intensity ultrasound (MR-HIFU) in the treatment of symptomatic uterine fibroids — five-year experience

Tomasz Lozinski1, Justyna Filipowska12, Magdalena Pyka1, Monika Baczkowska3, Michal Ciebiera3
DOI: 10.5603/GP.a2021.0098
·
Pubmed: 33914323
Affiliations
  1. Department of Obstetrics and Gynaecology Pro-Familia Hospital, Rzeszow, Poland
  2. Faculty of Medicine, Institute of Nursing and Health Sciences, University of Rzeszow, Poland
  3. Second Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw, Poland

open access

Ahead of Print
ORIGINAL PAPERS Gynecology
Published online: 2021-04-23

Abstract

Objectives: Uterine fibroids (UF) are the most common benign tumors of the female reproductive organ. It is crucial to recognize that the appropriate treatment of UFs requires an individualized approach. The present paper aimed at the presentation of the five-year experience of our center in the treatment of UFs with the use of magnetic resonance-guided high-intensity ultrasound (MR-HIFU) therapy. Material and methods: The study enrolled a total of 1284 patients with symptomatic UFs. The Sonalleve MR-HIFU system (Philips Ingenia 3.0T System) was used for magnetic resonance imaging (MRI) qualification and treatment. Results: The group of patients qualified for thermal ablation included 356 (28%) women. No significant differences were observed between the group undergoing thermal ablation and patients who were disqualified. A complete procedure was performed in 22.6% of patients who presented at the center. Non-perfused volume (NPV) is one of the most important parameters assessed during MR-HIFU procedures. The mean NPV value in the present study was 71%. The average UF volumes decreased by 27% at three-month follow-up ultrasound, by 34% after six months and by 39% as shown by MRI measurements performed 6 months post-treatment. Conclusions: According to our data, MR-HIFU therapy is associated with good clinical outcomes in patients with symptomatic UFs. The method facilitates a marked symptom reduction and, in many cases, diminishing tumor volume. The presented five-year outcomes as regards our experience in the MR-HIFU therapy of patients with symptomatic UFs indicate that the method offers an attractive alternative to the traditional methods of UF treatment in selected cases.

Abstract

Objectives: Uterine fibroids (UF) are the most common benign tumors of the female reproductive organ. It is crucial to recognize that the appropriate treatment of UFs requires an individualized approach. The present paper aimed at the presentation of the five-year experience of our center in the treatment of UFs with the use of magnetic resonance-guided high-intensity ultrasound (MR-HIFU) therapy. Material and methods: The study enrolled a total of 1284 patients with symptomatic UFs. The Sonalleve MR-HIFU system (Philips Ingenia 3.0T System) was used for magnetic resonance imaging (MRI) qualification and treatment. Results: The group of patients qualified for thermal ablation included 356 (28%) women. No significant differences were observed between the group undergoing thermal ablation and patients who were disqualified. A complete procedure was performed in 22.6% of patients who presented at the center. Non-perfused volume (NPV) is one of the most important parameters assessed during MR-HIFU procedures. The mean NPV value in the present study was 71%. The average UF volumes decreased by 27% at three-month follow-up ultrasound, by 34% after six months and by 39% as shown by MRI measurements performed 6 months post-treatment. Conclusions: According to our data, MR-HIFU therapy is associated with good clinical outcomes in patients with symptomatic UFs. The method facilitates a marked symptom reduction and, in many cases, diminishing tumor volume. The presented five-year outcomes as regards our experience in the MR-HIFU therapy of patients with symptomatic UFs indicate that the method offers an attractive alternative to the traditional methods of UF treatment in selected cases.

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Keywords

uterine fibroid; leiomyoma; non-invasive; magnetic resonance imaging; magnetic resonance-guided high-intensity ultrasound; MR-HIFU

About this article
Title

Magnetic resonance-guided high-intensity ultrasound (MR-HIFU) in the treatment of symptomatic uterine fibroids — five-year experience

Journal

Ginekologia Polska

Issue

Ahead of Print

Article type

Research paper

Published online

2021-04-23

DOI

10.5603/GP.a2021.0098

Pubmed

33914323

Keywords

uterine fibroid
leiomyoma
non-invasive
magnetic resonance imaging
magnetic resonance-guided high-intensity ultrasound
MR-HIFU

Authors

Tomasz Lozinski
Justyna Filipowska
Magdalena Pyka
Monika Baczkowska
Michal Ciebiera

References (55)
  1. Stewart EA, Laughlin-Tommaso SK, Catherino WH, et al. Uterine fibroids. Nat Rev Dis Primers. 2016; 2: 16043.
  2. Cardozo ER, Clark AD, Banks NK, et al. The estimated annual cost of uterine leiomyomata in the United States. Am J Obstet Gynecol. 2012; 206(3): 211.e1–211.e9.
  3. Soliman AM, Yang H, Du EX, et al. The direct and indirect costs of uterine fibroid tumors: a systematic review of the literature between 2000 and 2013. Am J Obstet Gynecol. 2015; 213(2): 141–160.
  4. Harrington A, Bonine NG, Banks E, et al. Direct Costs Incurred Among Women Undergoing Surgical Procedures to Treat Uterine Fibroids. J Manag Care Spec Pharm. 2020; 26(1-a Suppl): S2–SS10.
  5. Stewart EA, Cookson CL, Gandolfo RA, et al. Epidemiology of uterine fibroids: a systematic review. BJOG. 2017; 124(10): 1501–1512.
  6. Giuliani E, As-Sanie S, Marsh EE. Epidemiology and management of uterine fibroids. Int J Gynaecol Obstet. 2020; 149(1): 3–9.
  7. Yu O, Scholes D, Schulze-Rath R, et al. A US population-based study of uterine fibroid diagnosis incidence, trends, and prevalence: 2005 through 2014. Am J Obstet Gynecol. 2018; 219(6): 591.e1–591.e8.
  8. Bulun S. Uterine Fibroids. N Engl J Med. 2013; 369(14): 1344–1355.
  9. Cetin E, Al-Hendy A, Ciebiera M. Non-hormonal mediators of uterine fibroid growth. Curr Opin Obstet Gynecol. 2020; 32(5): 361–370.
  10. Ciebiera M, Włodarczyk M, Zgliczyńska M, et al. The Role of Tumor Necrosis Factor α in the Biology of Uterine Fibroids and the Related Symptoms. Int J Mol Sci. 2018; 19(12).
  11. Edwards TL, Giri A, Hellwege JN, et al. A -Ethnic Genome-Wide Association Study of Uterine Fibroids. Front Genet. 2019; 10: 511.
  12. Mehine M, Kaasinen E, Mäkinen N, et al. Characterization of uterine leiomyomas by whole-genome sequencing. N Engl J Med. 2013; 369(1): 43–53.
  13. Toprani SM, Kelkar Mane V. Role of DNA damage and repair mechanisms in uterine fibroid/leiomyomas: a review. Biol Reprod. 2021; 104(1): 58–70.
  14. Baird DD, Patchel SA, Saldana TM, et al. Uterine fibroid incidence and growth in an ultrasound-based, prospective study of young African Americans. Am J Obstet Gynecol. 2020; 223(3): 402.e1–402.e18.
  15. Lee M, Chung YJ, Kim HK, et al. Estimated Prevalence and Incidence of Uterine Leiomyoma, and Its Treatment Trend in South Korean Women for 12 years: A National Population-Based Study. J Womens Health (Larchmt). 2020 [Epub ahead of print].
  16. Harmon QE, Brasky TM. Risk factors for uterine fibroids: time to build on what we have learned. Fertil Steril. 2020; 114(4): 755–756.
  17. Bariani MV, Rangaswamy R, Siblini H, et al. The role of endocrine-disrupting chemicals in uterine fibroid pathogenesis. Curr Opin Endocrinol Diabetes Obes. 2020; 27(6): 380–387.
  18. Chwalisz K, Taylor H. Current and Emerging Medical Treatments for Uterine Fibroids. Semin Reprod Med. 2017; 35(6): 510–522.
  19. Al-Hendy A, Myers ER, Stewart E. Uterine Fibroids: Burden and Unmet Medical Need. Semin Reprod Med. 2017; 35(6): 473–480.
  20. Vitale SG, Riemma G, Ciebiera M, et al. Hysteroscopic treatment of submucosal fibroids in perimenopausal women: when, why, and how? Climacteric. 2020; 23(4): 355–359.
  21. Laberge PY, Murji A, Vilos GA, et al. SPECIAL CONTRIBUTORS. The management of uterine leiomyomas. J Obstet Gynaecol Can. 2015; 37(2): 157–178.
  22. Strand T, Kives S, Leyland N, et al. Treatment Choices in a National Cohort of Canadian Women With Symptomatic Uterine Fibroids. J Obstet Gynaecol Can. 2020; 42(12): 1475–1482.e2.
  23. Czuczwar P, Stepniak A, Milart P, et al. Comparison of the influence of three fibroid treatment options: supracervical hysterectomy, ulipristal acetate and uterine artery embolization on ovarian reserve - an observational study. J Ovarian Res. 2018; 11(1): 45.
  24. Giarrè G, Franchini M, Castellacci E, et al. Ulipristal acetate in symptomatic uterine fibroids. A real-world experience in a multicentric Italian study. Gynecol Endocrinol. 2020; 36(2): 171–174.
  25. Ali M, Chaudhry ZT, Al-Hendy A. Successes and failures of uterine leiomyoma drug discovery. Expert Opin Drug Discov. 2018; 13(2): 169–177.
  26. Letterie GS, Coddington CC, Winkel CA, et al. Efficacy of a gonadotropin-releasing hormone agonist in the treatment of uterine leiomyomata: long-term follow-up. Fertil Steril. 1989; 51(6): 951–956.
  27. Schlaff WD, Ackerman RT, Al-Hendy A, et al. Elagolix for Heavy Menstrual Bleeding in Women with Uterine Fibroids. N Engl J Med. 2020; 382(4): 328–340.
  28. Kang S, Brinker A, Jones SC, et al. An Evaluation of Postmarketing Reports of Serious Idiosyncratic Liver Injury Associated with Ulipristal Acetate for the Treatment of Uterine Fibroids. Drug Saf. 2020; 43(12): 1267–1276.
  29. Lethaby A, Puscasiu L, Vollenhoven B. Preoperative medical therapy before surgery for uterine fibroids. Cochrane Database Syst Rev. 2017; 11: CD000547.
  30. Cope AG, Young RJ, Stewart EA. Non-extirpative Treatments for Uterine Myomas: Measuring Success. J Minim Invasive Gynecol. 2021; 28(3): 442–452.e4.
  31. Stępniak A. Uterine artery embolization in the treatment of symptomatic fibroids - state of the art 2018. Prz Menopauzalny. 2018; 17(4): 141–143.
  32. Czuczwar P, Woźniak S, Szkodziak P, et al. Predicting the results of uterine artery embolization: correlation between initial intramural fibroid volume and percentage volume decrease. Prz Menopauzalny. 2014; 13(4): 247–252.
  33. Szkodziak P, Pyra K, Szkodziak F, et al. The Lublin Protocol of the Uterine Arteries Embolization in the Treatment of Symptomatic Uterine Fibroids. J Vis Exp. 2020(163).
  34. Sieroń D, Wiggermann P, Skupiński J, et al. Uterine artery embolisation and magnetic resonance-guided focused ultrasound treatment of uterine fibroids. Pol J Radiol. 2011; 76(2): 37–39.
  35. Li S, Wu PH. Magnetic resonance image-guided versus ultrasound-guided high-intensity focused ultrasound in the treatment of breast cancer. Chin J Cancer. 2013; 32(8): 441–452.
  36. Funaki K, Fukunishi H, Funaki T, et al. Magnetic resonance-guided focused ultrasound surgery for uterine fibroids: relationship between the therapeutic effects and signal intensity of preexisting T2-weighted magnetic resonance images. Am J Obstet Gynecol. 2007; 196(2): 184.e1–184.e6.
  37. Lozinski T, Filipowska J, Krol P, et al. Oxytocin Administration in High-Intensity Focused Ultrasound Treatment of Myomata. Biomed Res Int. 2018; 2018: 7518026.
  38. Lozinski T, Filipowska J, Gurynowicz G, et al. The effect of high-intensity focused ultrasound guided by magnetic resonance therapy on obstetrical outcomes in patients with uterine fibroids - experiences from the main Polish center and a review of current data. Int J Hyperthermia. 2019; 36(1): 582–590.
  39. Focused Ultrasound Foundation. Focused Ultrasound Reimbursement Landscape in Europe 2020 [Updated 8.10.2020]. https://www.fusfoundation.org/news/focused-ultrasound-reimbursement-landscape-in-europe (16.01.2021).
  40. Rabinovici J, David M, Fukunishi H, et al. MRgFUS Study Group. Pregnancy outcome after magnetic resonance-guided focused ultrasound surgery (MRgFUS) for conservative treatment of uterine fibroids. Fertil Steril. 2010; 93(1): 199–209.
  41. Liu X, Xue L, Wang Y, et al. Vaginal delivery outcomes of pregnancies following ultrasound-guided high-intensity focused ultrasound ablation treatment for uterine fibroids. Int J Hyperthermia. 2018; 35(1): 510–517.
  42. Practice Committee of the American Society for Reproductive Medicine. Electronic address: ASRM@asrm.org, Practice Committee of the American Society for Reproductive Medicine. Removal of myomas in asymptomatic patients to improve fertility and/or reduce miscarriage rate: a guideline. Fertil Steril. 2017; 108(3): 416–425.
  43. Purohit P, Vigneswaran K. Fibroids and Infertility. Curr Obstet Gynecol Rep. 2016; 5: 81–8.
  44. Chen J, Chen W, Zhang L, et al. Safety of ultrasound-guided ultrasound ablation for uterine fibroids and adenomyosis: A review of 9988 cases. Ultrason Sonochem. 2015; 27: 671–676.
  45. Liu Y, Zhang WW, He M, et al. Adverse effect analysis of high-intensity focused ultrasound in the treatment of benign uterine diseases. Int J Hyperthermia. 2018; 35(1): 56–61.
  46. Kroncke T, David M. participants of the Consensus M. Magnetic Resonance Guided Focused Ultrasound for Fibroid Treatment - Results of the Second Radiological Gynecological Expert Meeting. Geburtshilfe Frauenheilkd. 2015; 75(5): 436–8.
  47. Ciebiera M, Łoziński T. The role of magnetic resonance-guided focused ultrasound in fertility-sparing treatment of uterine fibroids-current perspectives. Ecancermedicalscience. 2020; 14: 1034.
  48. Pandey S, Bhattacharya S. Impact of obesity on gynecology. Womens Health (Lond). 2010; 6(1): 107–117.
  49. Ilaria S, Marci R. From obesity to uterine fibroids: an intricate network. Curr Med Res Opin. 2018; 34(11): 1877–1879.
  50. Filipowska J, Loziński T. Magnetic Resonance-Guided High-Intensity Focused Ultrasound (MR-HIFU) in Treatment of Symptomatic Uterine Myomas. Pol J Radiol. 2014; 79: 439–443.
  51. Yang S, Kong F, Hou R, et al. Ultrasound guided high-intensity focused ultrasound combined with gonadotropin releasing hormone analogue (GnRHa) ablating uterine leiomyoma with homogeneous hyperintensity on T weighted MR imaging. Br J Radiol. 2017; 90(1073): 20160760.
  52. Ikink ME, Voogt MJ, Verkooijen HM, et al. Mid-term clinical efficacy of a volumetric magnetic resonance-guided high-intensity focused ultrasound technique for treatment of symptomatic uterine fibroids. Eur Radiol. 2013; 23(11): 3054–3061.
  53. Verpalen IM, Anneveldt KJ, Nijholt IM, et al. Magnetic resonance-high intensity focused ultrasound (MR-HIFU) therapy of symptomatic uterine fibroids with unrestrictive treatment protocols: A systematic review and meta-analysis. Eur J Radiol. 2019; 120: 108700.
  54. Kröncke T, David M, Kröncke T, et al. MR-Guided Focused Ultrasound in Fibroid Treatment - Results of the 4th Radiological-Gynecological Expert Meeting. Rofo. 2019; 191(7): 626–629.
  55. Spies JB, Coyne K, Guaou Guaou N, et al. The UFS-QOL, a new disease-specific symptom and health-related quality of life questionnaire for leiomyomata. Obstet Gynecol. 2002; 99(2): 290–300.

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