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

다국어 초록 (Multilingual Abstract)

ObjectiveWe evaluated the clinical characteristics of patients who underwent surgery after high intensity focused ultrasound(HIFU) to treat uterine leiomyoma.
MethodsFrom June 2016 to September 2017, patients at our hospital who underwent HIFU to treat uterine leiomyoma priorto surgery were enrolled. All patients underwent pelvic magnetic resonance imaging (MRI) before and after HIFU. If6 months had passed since the last pelvic MRI was performed, imaging was performed again before the operation.
ResultsA total of 12 patients were analyzed. The median age was 45 (range, 28–51) years. The median body mass index was24.9 (range, 18.1–29.2) kg/m2. The median size of the leiomyoma was 10.1 (range, 7.8–14.0) cm before HIFU, whichchanged 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 theoperation. Surgery was planned for several reasons, including an increase in the leiomyoma size (n=6), persistentsymptoms (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 findingsshowed infarction-type necrosis surrounded by granulation tissue with the infiltration of lymphocytes andmacrophages in all patients.
ConclusionTreatment of leiomyoma with operative procedures should be considered in selected patients with tumor size greaterthan 10 cm, multiple tumors, and persistent symptoms after HIFU treatment.

참고문헌 (Reference)

1 Kim YS, "Volumetric MR-guided high-intensity focused ultrasound ablation with a one-layer strategy to treat large uterine fibroids : initial clinical outcomes" 263 : 600-609, 2012

2 Zhang L, "Ultrasoundguided high intensity focused ultrasound for the treatment of gynaecological diseases : a review of safety and efficacy" 31 : 280-284, 2015

3 Lee JS, "Ultrasound-guided high-intensity focused ultrasound treatment for uterine fibroid & adenomyosis : a single center experience from the Republic of Korea" 27 : 682-687, 2015

4 Vilos GA, "The management of uterine leiomyomas" 37 : 157-178, 2015

5 Cheung VY, "Sonographically guided high-intensity focused ultrasound for the management of uterine fibroids" 32 : 1353-1358, 2013

6 Leung JH, "Safety and efficacy of sonographically guided high-intensity focused ultrasound for symptomatic uterine fibroids" 33 : 1811-1818, 2014

7 Sandberg EM, "Reintervention risk and quality of life outcomes after uterine-sparing interventions for fibroids : a systematic review and meta-analysis" 109 : 698-707, 2018

8 Hou R, "Pilot study : safety and effectiveness of simple ultrasoundguided high-intensity focused ultrasound ablating uterine leiomyoma with a diameter greater than 10 cm" 91 : 20160950-, 2018

9 Yoon SW, "Patient selection guidelines in MR-guided focused ultrasound surgery of uterine fibroids : a pictorial guide to relevant findings in screening pelvic MRI" 18 : 2997-3006, 2008

10 Kim SH, "Obstetrics & Gynecology" Koonja 77-84, 2014

11 Łoziński T, "Non-invasive therapeutic use of high-intensity focused ultrasound(HIFU)with 3 tesla magnetic resonance imaging in women with symptomatic uterine fibroids" 88 : 497-503, 2017

12 Mahmoud MZ, "High-intensity focused ultrasound(HIFU)in uterine fibroid treatment : review study" 79 : 384-390, 2014

13 Korean Society of Obstetrics and Gynecology, "HIFU guidelines" Korean Society of Obstetrics and Gynecology

14 박재윤, "Effects of High-Intensity-Focused Ultrasound Treatment on Benign Uterine Tumor" 대한의학회 31 (31): 1279-1283, 2016

15 Duhan N, "Current and emerging treatments for uterine myoma-an update" 3 : 231-241, 2011