Obstet Gynecol Sci.  2019 Jul;62(4):258-263. 10.5468/ogs.2019.62.4.258.

Clinical characteristics of patients with leiomyoma who undergo surgery after high intensity focused ultrasound (HIFU)

• Choe YS
• Lee WM
• Choi JS
• Bae J
• Eom JM
• Choi E

• KMID: 2451655
• DOI: http://doi.org/10.5468/ogs.2019.62.4.258

Abstract

OBJECTIVE
We evaluated the clinical characteristics of patients who underwent surgery after high intensity focused ultrasound (HIFU) to treat uterine leiomyoma.
METHODS
From June 2016 to September 2017, patients at our hospital who underwent HIFU to treat uterine leiomyoma prior to surgery were enrolled. All patients underwent pelvic magnetic resonance imaging (MRI) before and after HIFU. If 6 months had passed since the last pelvic MRI was performed, imaging was performed again before the operation.
RESULTS
A total of 12 patients were analyzed. The median age was 45 (range, 28-51) years. The median body mass index was 24.9 (range, 18.1-29.2) kg/m2. The median size of the leiomyoma was 10.1 (range, 7.8-14.0) cm before HIFU, which changed to 8.75 (range, 5.9-14.8) cm after HIFU. The median size increased to 9.1 (range, 5.9-18.0) cm before the operation. Surgery was planned for several reasons, including an increase in the leiomyoma size (n=6), persistent symptoms (n=4), and newly developed lesion (n=2). The median interval between HIFU and surgery was 7 (range, 3-32) months. Ten of the 12 patients underwent laparoscopic surgery, while the others underwent laparotomy; 6 patients also underwent laparoscopic myomectomy, and 4 underwent hysterectomy. Histopathologic findings showed infarction-type necrosis surrounded by granulation tissue with the infiltration of lymphocytes and macrophages in all patients.
CONCLUSION
Treatment of leiomyoma with operative procedures should be considered in selected patients with tumor size greater than 10 cm, multiple tumors, and persistent symptoms after HIFU treatment.

Keyword

Leiomyoma; High-intensity focused ultrasound ablation; Myomectomy; Hysterectomy

MeSH Terms

Body Mass Index
Granulation Tissue
High-Intensity Focused Ultrasound Ablation
Humans
Hysterectomy
Laparoscopy
Laparotomy
Leiomyoma*
Lymphocytes
Macrophages
Magnetic Resonance Imaging
Necrosis
Surgical Procedures, Operative
Ultrasonography*

Figure

• 

  Fig. 1 (A) Post-operative gross appearance of leiomyoma after high intensity focused ultrasound (HIFU). (B) Histopathologic appearance of leiomyoma after HIFU (hematoxylin and eosin stain, ×100). Black triangle: leiomyoma with HIFU treatment, white triangle: leiomyoma without HIFU treatment.

Reference

1. Kim SH, Park HM. Uterine leiomyoma. Korean Society of Obstetrics and Gynecology. Obstetrics & Gynecology. 3rd ed. Seoul: Koonja;2014. p. 77–84.

2. Vilos GA, Allaire C, Laberge PY, Leyland N. SPECIAL CONTRIBUTORS. The management of uterine leiomyomas. J Obstet Gynaecol Can. 2015; 37:157–178.

3. Duhan N. Current and emerging treatments for uterine myoma - an update. Int J Womens Health. 2011; 3:231–241.

4. Cheung VY. Sonographically guided high-intensity focused ultrasound for the management of uterine fibroids. J Ultrasound Med. 2013; 32:1353–1358.

5. Mahmoud MZ, Alkhorayef M, Alzimami KS, Aljuhani MS, Sulieman A. High-intensity focused ultrasound (HIFU) in uterine fibroid treatment: review study. Pol J Radiol. 2014; 79:384–390.

6. Zhang L, Zhang W, Orsi F, Chen W, Wang Z. Ultrasound-guided high intensity focused ultrasound for the treatment of gynaecological diseases: a review of safety and efficacy. Int J Hyperthermia. 2015; 31:280–284.

7. Łoziński T, Filipowska J, Gurynowicz G, Gabriel I, Czekierdowski A. Non-invasive therapeutic use of high-intensity focused ultrasound (HIFU) with 3 tesla magnetic resonance imaging in women with symptomatic uterine fibroids. Ginekol Pol. 2017; 88:497–503.

8. Korean Society of Obstetrics and Gynecology. HIFU guidelines [Internet]. Seoul: Korean Society of Obstetrics and Gynecology;c2016. cited 2016 Jul 15. Available from: http://www.ksog.org/bbs/?code=notice&mode=view&number=3525.

9. Leung JH, Yu SC, Cheung EC, Wong AS, Tong MM, Ho SS, et al. Safety and efficacy of sonographically guided high-intensity focused ultrasound for symptomatic uterine fibroids. J Ultrasound Med. 2014; 33:1811–1818.

10. Sandberg EM, Tummers FH, Cohen SL, van den Haak L, Dekkers OM, Jansen FW. Reintervention risk and quality of life outcomes after uterine-sparing interventions for fibroids: a systematic review and meta-analysis. Fertil Steril. 2018; 109:698–707.e1.

11. Lee JS, Hong GY, Park BJ, Kim TE. Ultrasound-guided high-intensity focused ultrasound treatment for uterine fibroid & adenomyosis: a single center experience from the Republic of Korea. Ultrason Sonochem. 2015; 27:682–687.

12. Park J, Lee JS, Cho JH, Kim S. Effects of high-intensity-focused ultrasound treatment on benign uterine tumor. J Korean Med Sci. 2016; 31:1279–1283.

13. Yoon SW, Lee C, Cha SH, Yu JS, Na YJ, Kim KA, et al. Patient selection guidelines in MR-guided focused ultrasound surgery of uterine fibroids: a pictorial guide to relevant findings in screening pelvic MRI. Eur Radiol. 2008; 18:2997–3006.

14. Hou R, Wang L, Li S, Rong F, Wang Y, Qin X, et al. Pilot study: safety and effectiveness of simple ultrasound-guided high-intensity focused ultrasound ablating uterine leiomyoma with a diameter greater than 10 cm. Br J Radiol. 2018; 91:20160950.

15. Kim YS, Kim JH, Rhim H, Lim HK, Keserci B, Bae DS, et al. Volumetric MR-guided high-intensity focused ultrasound ablation with a one-layer strategy to treat large uterine fibroids: initial clinical outcomes. Radiology. 2012; 263:600–609.