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)

Affiliations
  • 1Division of Gynecologic Oncology and Gynecologic Minimally Invasive Surgery, Department of Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul, Korea. leewmoo@hanyang.ac.kr

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*
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