Search

Objectives: To verify the stability of high‐intensity focused ultrasound (HIFU) technology and the feasibility of training programs with learning curve cumulative summation (LC‐CUSUM). Methods: A total of 12 physicians and 720 cases were equally assigned to the learning group and the control group, with 6 physicians and 360 cases per group. The learning group was treated by physicians without HIFU experience and the control group was treated by experienced physicians. Nonperfused volume (NPV) ratio was assessed by contrast‐enhanced magnetic resonance imaging. Technical failure was defined as NPV ratio of uterine fibroids <70% and/or major complication, while <80% was set as a stricter standard of training qualification. LC‐CUSUM was used to analyze the learning curve. Results: Physicians with or without HIFU experience in both groups achieved matchable NPV ratios, where a NPV ratio of 92.52% (16.06) was achieved by experienced physicians and 93.82% (16.95) by inexperienced physicians. No major complication was observed. The results of LC‐CUSUM analysis showed that, with the standards of the NPV ratio of 70% or 80%, the learning group mastered the technique on the 11th case and the 16th case, respectively, while the control group was stable. Conclusions: HIFU technology stayed stable in operation, with good safety and sound effectiveness, and was easy to learn. NPV ratio of 70% was considered as an appropriate indicator of training qualification. HIFU has remarkable prospects in achieving a NPV ratio of ≥80% without safety being compromised. [ABSTRACT FROM AUTHOR]

Objective To evaluate the incidence and severity of adverse reactions to ultrasound-guided ultrasound ablation of uterine fibroids through a multicenter, large-scale retrospective study. Methods Between July 2006 and June 2007, 9988 patients with uterine fibroids or adenomyosis were enrolled and received ultrasound ablation treatment under conscious sedation. Forty-two doctors administrated the treatment following a standardized clinical protocol. In-treatment and post-treatment side effects and complications were monitored and each patient was followed up for at least 6 months after the treatment. Complications were classified and graded according to the SIR classification system. The technical success and safety of the treatment were evaluated. Results The mean age of the 9988 patients was 40.4 ± 5.8 years (range, 20–56 years). Among them, 7438 had uterine fibroids and 2549 had adenomyosis. Specifically, 6545 patients had solitary uterine fibroid, 818 had multiple uterine fibroids, and 76 had fibroids complicated with adenomyosis. There were mainly three types of fibroids: submucous myoma in 89 patients (12.0%), intramural myoma in 5059 patients (68.0%) and subserosal myoma in 1478 patients (20.0%). In terms of fibroid location, 3496 fibroids were found in the anterior wall (47.0%), 2306 in the posterior wall (31.0%), 447 in the lateral wall (6.0%), and 1190 in fundus (16.0%). The length of treatment for uterine fibroids and adenomyosis averaged 84.2 ± 38.8 min (range, 30.0–240.0 min) and 93.3 ± 55.4 min (range, 15.0–240.0 min), respectively; and the lengths of sonication were 1243.8 ± 725.2 s (range, 506.0–2658.0 s) and 1169.7 ± 707.7 s (range, 185.0–3600.0 s), respectively. Of the uterine fibroids patients, 98.38% (7319/7439) underwent successful ablation with a mean volume ablation rate of 83.1% ± 15.6% (range, 25–100%). Of the adenomyosis patients, 94.59% (2411/2549) underwent successful ablation with a mean volume ablation rate of 73.2% ± 23.6% (range, 21–100%). A total of 1062 patients (10.6%) presented with 1305 events of adverse reactions. According to the SIR classification system, 1228 (94.1%) of these reactions fell under Class A; 45 (3.4%) fell under Class B; 24 (1.8%) fell under Class C; and the rest 8 (0.6%) fell under Class D. Adverse reactions included 874 cases (8.67%) of vaginal secretion, 225 cases (2.23%) of lower abdominal pain 24 h after the treatment but requiring no painkillers, 76 cases (0.76%) of melosalgia or buttock pain, 52 cases (0.52%) of odynuria, 20 cases (0.20%) of menstruation-like vaginal bleeding, 2 cases (0.2%) of temporary blurred vision, 26 cases (0.26%) of blisters or tangerine pericarp-like burns in the abdominal skin, 16 cases (0.16%) of urinary retention, 4 cases (0.4%) of fever of 38.5 °C, 3 cases (0.3%) of acute renal insufficiency, 2 cases (0.2%) of intestinal perforation, and 1 case (0.01%) of long-term lateral ventral syndrome. No permanent injury or fatal complication occurred. Conclusions Based on our observations from 9988 cases, ultrasound ablation treatment for uterine fibroid and adenomyosis is highly effective and safe. Adverse reactions to ultrasound ablation under conscious sedation are slight and temporary for both conditions. Hence, this clinically effective and safe treatment is an alternative treatment for women with uterine fibroids and adenomyosis. [ABSTRACT FROM AUTHOR]

As a non-surgical treatment, high intensity focused ultrasound (HIFU) has received increasing interest for the treatment of gynaecological diseases over the last 10 years. Many studies have shown that HIFU is safe and effective in treating patients with uterine fibroids, adenomyosis, cervicitis or vulvar diseases. Both magnetic resonance imaging-guided HIFU (MRgHIFU) and ultrasound-guided HIFU (USgHIFU) can offer gynaecologists non-invasive techniques to treat patients with uterine benign diseases. Focused ultrasound therapy can also be used effectively to treat cervicitis and vulvar diseases. As gynaecologists gain more experience with this technology, the rate of severe adverse effects has been lowered with the development of this non-invasive technique. In this paper we review the literature available regarding the utilisation of magnetic resonance imaging-guided focused ultrasound/MRgHIFU or USgHIFU and new findings from our group in the treatment of gynaecological diseases: uterine fibroids, adenomyosis, cervicitis, vulvar diseases, caesarean scar pregnancies, and abdominal wall endometriosis. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to investigate the effect of high-intensity focused ultrasound (HIFU) on immune function in patients with uterine fibroids, in a randomised comparison to conventional myomectomy. Methods: The patients were assigned (1:1) to the HIFU group or the myomectomy (MY) group. Venous blood samples were collected 24 h before and 24 h and 72 h after operation. The percentages of CD4+ and CD8+ T cells and natural killer (NK) cells were quantified by flow cytometry (FCM). Serum levels of interleukin-2 (IL-2), IL-6 and IL-10 were determined using enzyme-linked immunosorbent assay. Results: HIFU was associated with early ambulation, fewer post-operative complications, and shorter hospital stay ( p < 0.001). The percentages of CD4+ and CD8+ T cells and NK cells in the HIFU group were not significantly altered after treatment compared with before treatment. In contrast, the numbers of these cells in the MY group decreased significantly 24 h after conventional myomectomy ( p < 0.001). The CD4+/CD8+ T cell ratios were also decreased significantly 24 h and 72 h after conventional myomectomy ( p < 0.001). Serum levels of IL-6 and IL-10 increased after treatment in both groups. Peak IL-6 and IL-10 levels were significantly lower in the HIFU group than in the MY group ( p < 0.001). In contrast, IL-2 level decreased significantly in the MY group compared to the HIFU group at 24 h post-operation ( p < 0.001). Conclusions: Short-term post-operative immune function is better preserved after HIFU treatment. Better preserved immune function may reflect a reduction in tissue trauma after HIFU treatment and contribute to reduced post-operative complications. [ABSTRACT FROM AUTHOR]

Purpose To investigate the value of microbubble contrast-enhanced ultrasound (CEUS) in evaluating the treatment response of uterine fibroids to HIFU ablation. Materials and methods Sixty-eight patients with a solitary uterine fibroid from the First Affiliated Hospital of Chongqing Medical University were included and analyzed. All patients underwent pre- and post-treatment magnetic resonance imaging (MRI) with a standardized protocol, as well as pre-evaluation, intraprocedure, and immediate post-treatment CEUS. CEUS and MRI were compared by different radiologists. Results In comparison with MRI, CEUS showed that the size of fibroids, volume of fibroids, size of non-perfused regions, non-perfused volume (NPV) or fractional ablation (NPV ratio) was similar to that of MRI. In terms of CEUS examination results, the median volume of fibroids was 75.2 (interquartile range, 34.2–127.3) cm 3 , the median non-perfused volume was 54.9 (interquartile range, 28.0–98.1) cm 3 , the mean fractional ablation was 83.7 ± 13.6 (range, 30.0–100.0)%. In terms of MRI examination results, the median volume of fibroids was 74.1 (interquartile range, 33.4–116.2) cm 3 . On the basis of contrast-enhanced T1-weighted images immediately after HIFU treatment, the median non-perfused volume was 58.5 (interquartile range, 27.7–100.0) cm 3 , the average fractional ablation was 84.2 ± 14.2 (range, 40.0–100.0)%. Conclusions CEUS clearly showed the size of fibroids and the non-perfused areas of the fibroid. Results from CEUS correlated well with results obtained from MRI. [ABSTRACT FROM AUTHOR]