About
The Journal "Obstetrics and Gynecology"Journal HistoryAims and ScopePolicies on Conflict of Interest, Human and Animal Rights, and Informed ConsentEditorial ProcessData sharing statementAdvertising PolicyThe Process for Handling Cases Requiring Corrections, Retractions, and Editorial Expressions of ConcernEditorial BoardEditorial CounsilInformation for ProfessionalsNewsContacts
ArchiveEthical StandardsSubscription
For authors
InstructionsInformed consent policyContract offerEASE GuidelinesICJME CriteriaWAME Recommendations on ChatGPT and Chatbots in Relation to Scholarly Publications
Reviewing
About
The Journal "Obstetrics and Gynecology"Journal HistoryAims and ScopePolicies on Conflict of Interest, Human and Animal Rights, and Informed ConsentEditorial ProcessData sharing statementAdvertising PolicyThe Process for Handling Cases Requiring Corrections, Retractions, and Editorial Expressions of ConcernEditorial BoardEditorial CounsilInformation for ProfessionalsNewsContacts
ArchiveEthical StandardsSubscription
For authors
InstructionsInformed consent policyContract offerEASE GuidelinesICJME CriteriaWAME Recommendations on ChatGPT and Chatbots in Relation to Scholarly Publications
Reviewing
Logout
Obstetrics and Gynegology2023№1
The role of high-intensity focused...

The role of high-intensity focused ultrasound treatment in patients with uterine myoma

DOI
https://dx.doi.org/10.18565/aig.2022.240

Moskvicheva L.I.

P.A. Herzen Moscow Oncology Research Institute, Branch, National Medical Radiology Research Center, Ministry of Health of the Russian Federation, Moscow, Russia
Uterine myoma is the most common benign tumor in gynecological practice and the leading cause of hysterectomy. This pathology has clinical manifestations in every three female patients, decreases quality of life and level of fertility in reproductive-aged women, and also substantially affects the human potential of any country. Uterine fibroids can be now treated with various medical, surgical, interventional, and ablative methods that differ in the nature of their impact, in the criteria for selecting female patients, in the required level of technical equipment, and in economic characteristics. In connection with to the active introduction of modern minimally traumatic local treatments into wide practice, high-intensity focused ultrasound therapy, a non-invasive thermal ablation technique for solid neoplasms at various sites, is of particular interest to patients with uterine myoma. The literature review presents the possibilities of using high-intensity focused ultrasound therapy in patients with uterine myoma; highlights the advantages and disadvantages of this type of local thermal effect in the treatment of a benign uterine tumor; determines indications for and contraindications to high-intensity focused ultrasound therapy; describes the main complications of ultrasound ablation and ways for their prevention; identifies criteria for the efficiency of treatment, as viewed from both the general somatic characteristics of a woman and the biological characteristics of a myomatous node and the parameters of the procedure; and demonstrates the clinical results of local treatment (the time course of changes in tumor sizes, pain syndrome level, menorrhagia volume) and its impact on female reproductive abilities.
Conclusion: The present study has shown that high-intensity focused ultrasound therapy can be considered as an affordable, effective, relatively safe method to treat patients with uterine myoma.

Conflicts of interest: The author declares that there are no conflicts of interest.
Funding: This investigation has not been sponsored.
For citation: Moskvicheva L.I. The role of high-intensity focused ultrasound treatment
in patients with uterine myoma.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2023; 1: 5-12 (in Russian)
https://dx.doi.org/10.18565/aig.2022.240

Keywords

infertility
high-intensity focused ultrasound therapy
dysmenorrhea
uterine myoma
thermal ablation
HIFU
Full text (in Russian)

References

  1. Ikhena D.E., Bulun S.E. Literature review on the role of uterine fibroids in endometrial function. Reprod. Sci. 2018; 25(5): 635-43. https://dx.doi.org/10.1177/1933719117725827.
  2. Stewart E.A., Cookson C.L., Gandolfo R.A., Schulze-Rath R. Epidemiology of uterine fibroids: a systematic review. BJOG. 2017; 124(10): 1501-12. https://dx.doi.org/10.1111/1471-0528.14640.
  3. Сидорова И.С., Агеев М.Б. Клинико-морфологические особенности простой и пролиферирующей миомы матки. Российский вестник акушера-гинеколога. 2013; 13(6): 34‑8. [Sidorova I.S., Ageev M.B. The clinical and morphological features of simple and proliferating uterine myoma. Russian Bulletin of Obstetrician-Gynecologist. 2013; 13(6): 34‑8. (in Russian)].
  4. Ierardi A.M., Savasi V., Angileri S.A., Petrillo M., Sbaraini S., Pinto A. et al. Percutaneous high frequency microwave ablation of uterine fibroids: systematic review. Biomed. Res. Int. 2018; 2018: 2360107. https://dx.doi.org/10.1155/2018/2360107.
  5. Al-Hendy A., Myers E.R., Stewart E. Uterine fibroids: burden and unmet medical need. Semin. Reprod. Med. 2017; 35(6): 473-80. 10.1055/s-0037-1607264.
  6. Zepiridis L.I., Grimbizis G.F., Tarlatzis B.C. Infertility and uterine fibroids. Best Pract. Res. Clin. Obstet. Gynaecol. 2016; 34: 66‐73. https://dx.doi.org/10.1016/j.bpobgyn.2015.12.001.
  7. Galliano D., Bellver J., Días-Garcia C., Simón C., Pellicer A. ART and uterine pathology: how revelant is the maternal side for implantation. Hum. Reprod. Update. 2015; 21: 13-38. https://dx.doi.org/10.1093/humupd/dmu047.
  8. Parazzini F., Tozzi L., Bianchi S. Pregnancy outcome and uterine fibroids. Best Pract. Res. Clin. Obstet. Gynaecol. 2016; 34: 74-84. https://dx.doi.org/10.1016/j.bpobgyn.2015.11.017.
  9. Blitz M.J., Rochelson B., Augustine S., Greenberg M., Sison C.P., Vohra N. Uterine fibroids at routine second-trimester ultrasound survey and risk of sonographic short cervix. J. Matern. Fetal Neonatal Med. 2016; 14: 1-7. https://dx.doi.org/10.3109/14767058.2015.1131261.
  10. Donnez J., Dolmans M.M. Uterine fibroid management: from the present to the future. Hum. Reprod. Update. 2016; 22(6): 665-86. https://dx.doi.org/10.1093/humupd/dmw023.
  11. Siedek F., Yeo S.Y., Heijman E., Grinstein O., Bratke G., Heneweer C. et al. Magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU): technical background and overview of current clinical applications (Part 1). Rofo. 2019; 191(6): 522-30. https://dx.doi.org/10.1055/a-0817-5645.
  12. Maresca D., Lakshmanan A., Abedi M., Bar-Zion A., Farhadi A., Lu G.J. et al. Biomolecular ultrasound and sonogenetics. Annu. Rev. Chem. Biomol. Eng. 2018; 9: 229-52. https://dx.doi.org/10.1146/annurev-chembioeng-060817-084034.
  13. van den Bijgaart R.J.E., Eikelenboom D.C., Hoogenboom M., Fütterer J.J., den Brok M.H., Adema G.J. Thermal and mechanical high-intensity focused ultrasound: perspectives on tumor ablation, immune effects and combination strategies. Cancer Immunol. Immunother. 2017; 66(2): 247-58. https://dx.doi.org/10.1007/s00262-016-1891-9.
  14. Deng Z., Xiao Y., Pan M., Li F., Duan W., Meng L. et al. Hyperthermia-triggered drug delivery from iRGD-modified temperature-sensitive liposomes enhances the anti-tumor efficacy using high intensity focused ultrasound. J. Control. Release. 2016; 243: 333-41. https://dx.doi.org/10.1016/j.jconrel.2016.10.030.
  15. Boissenot T., Bordat A., Fattal E., Tsapis N. Ultrasound-triggered drug delivery for cancer treatment using drug delivery systems: From theoretical considerations to practical applications. J. Control. Release. 2016; 241: 144-63. https://dx.doi.org/10.1016/j.jconrel.2016.09.026.
  16. Elhelf I.A.S., Albahar H., Shah U., Oto A., Cressman E., Almekkawy M. High intensity focused ultrasound: the fundamentals, clinical applications and research trends. Diagn. Interv. Imaging. 2018; 99(6): 349-59. https://dx.doi.org/10.1016/j.diii.2018.03.001.
  17. Москвичева Л.И. Высокоинтенсивная фокусированная ультразвуковая абляция злокачественных новообразований молочной железы. Исследования и практика в медицине. 2018; 5(3): 67-76. https://dx.doi.org/10.17709/2409-2231-2018-5-3-6. [Moskvicheva L.I. High-intensity focused ultrasonic ablation of breast cancer. Research and Practical Medicine Journal. 2018; 5(3): 67-76. (in Russian)]. https://dx.doi.org/10.17709/2409-2231-2018-5-3-6.
  18. Курашвили Ю.Б., Козловская С.Л., Назаренко Т.А., Дубницкая Л.В. Возможности реализации репродуктивной функции у пациенток с миомой матки после МРТкФУЗ (данные литературы, собственный опыт). Вестник РУДН. Серия: Медицина. 2009; 6: 57-62. [Kurashvili Yu.B., Kozlovskaya S.L., Nazarenko T.A., Dubnitskaya L.V. Reproductive outcome following MGR FUS therapy of uterine fibroids (literature review, own results). Vestnik RUDN. Series: Medicine. 2009; 6: 57-62. (in Russian)].
  19. Максутова Д.Ж., Самойлова Т.Е., Коков Л.С., Куринов С.Б., Сметник В.П., Волобуев А.И. Сравнительная клиническая эффективность и безопасность фокусированной ультразвуковой аблации и эмболизации маточных артерий при лейомиоме матки. Российский вестник акушера-гинеколога. 2008; 2: 44-9. [Maksutova D.Zh., Samoilova T.E., Kokov L.S. et al. Comparative clinical efficacy and safety of focused ultrasound ablation and embolization of uterine arteries in uterine leiomyoma. Russian Bulletin of Obstetrician-Gynecologist. 2008; 2: 44-9. (in Russian)].
  20. Министерство здравоохранения Российской Федерации. Клинические рекомендации. Миома матки. 2020. Доступно по: https://minzdrav.samregion.ru/wp-content/uploads/sites/28/2021/02/mioma-matki.pdf?ysclid=lb91x2ai3d287940916 Дата обращения: 04.12.2022. [Ministry of Health of the Russian Federation. Uterine fibroids. Clinical guidelines. 2020. Available at: https://minzdrav.samregion.ru/wp-content/uploads/sites/28/2021/02/mioma-matki.pdf?ysclid=lb91x2ai3d287940916 Date of application: 04.12.2022. (in Russian)].
  21. Park H., Yoon S.W., Kim K.A., Jung Kim D., Jung S.G. Magnetic resonance imaging-guided focused ultrasound treatment of pedunculated subserosal uterine fibroids: a preliminary report. J. Vasc. Interv. Radiol. 2012; 23(12): 1589-93. https://dx.doi.org/10.1016/j.jvir.2012.08.018.
  22. David M., Matzko M. MR-guided focused ultrasound in fibroid treatment–results of the 3rd radiological-gynecological expert meeting. Rofo. 2017; 189(6): 515-8. https://dx.doi.org/10.1055/s-0043-108994.
  23. Duc N.M., Keserci B. Review of influential clinical factors in reducing the risk of unsuccessful MRI-guided HIFU treatment outcome of uterine fibroids. Diagn. Interv. Radiol. 2018; 24(5): 283-91. https://dx.doi.org/10.5152/dir.2018.18111.
  24. Funaki K., Fukunishi H., Funaki T., Sawada K., Kaji Y., Maruo T. 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.e1846. https://dx.doi.org/10.1016/j.ajog.2006.08.030.
  25. Yeo S.Y., Kim Y.S., Lim H.K., Rhim H., Jung S.H., Hwang N.Y. Uterine fibroids: Influence of "T2-Rim sign" on immediate therapeutic responses to magnetic resonance imaging-guided high-intensity focused ultrasound ablation. Eur. J. Radiol. 2017; 97: 21-30. https://dx.doi.org/10.1016/j.ejrad.2017.10.006.
  26. Kröncke T., David M. MR-guided focused ultrasound in fibroid treatment - results of the 4th radiological-gynecological expert meeting. Geburtshilfe Frauenheilkd. 2019; 79(7): 693-6. https://dx.doi.org/10.1055/a-0893-4752.
  27. Peregrino P.F.M., de Lorenzo Messina M., Dos Santos Simões R., Soares-Júnior J.M., Baracat E.C. Review of magnetic resonance-guided focused ultrasound in the treatment of uterine fibroids. Clinics (SaoPaulo). 2017; 72(10): 637-41. https://dx.doi.org/10.6061/clinics/2017(10)08.
  28. Wang W., Wang Y., Wang T., Wang J., Wang L., Tang J. Safety and efficacy of US-guided high-intensity focused ultrasound for treatment of submucosal fibroids. Eur. Radiol. 2012; 22(11): 2553-8. https://dx.doi.org/10.1007/s00330-012-2517-z.
  29. Zhu Y., Keserci B., Viitala A., Wei J., Yang X., Wang X. Volumetric MR-guided high-intensity focused ultrasound ablation to treat uterine fibroids through the abdominal scars using scar patch: a case report. J. Ther. Ultrasound. 2016; 4: 20. https://dx.doi.org/10.1186/s40349-016-0064-9.
  30. Keserci B., Nguyen D. Volumetric magnetic resonance-guided high-intensity focused ultrasound ablation of uterine fibroids through abdominal scars: the impact of a scar patch on therapeutic efficacy and adverse effects. J. Ther. Ultrasound. 2017; 5: 22. https://dx.doi.org/10.1186/s40349-017-0100-4.
  31. Sridhar D., Kohi M.P. Updates on MR-guided focused ultrasound for symptomatic uterine fibroids. Semin. Intervent. Radiol. 2018; 35(1): 17-22. https://dx.doi.org/10.1055/s-0038-1636516.
  32. Lozinski T., Filipowska J., Krol P., Kubaty A., Wegrzyn P. Oxytocin administration in high-intensity focused ultrasound treatment of myomata. Biomed. Res. Int. 2018; 2018: 7518026. https://dx.doi.org/10.1155/2018/7518026.
  33. Mashiach R., Inbar Y., Rabinovici J., Mohr Sasson A., Alagem-Mizrachi A., Machtinger R. Outcome of magnetic resonance–guided focused ultrasound surgery (MRgFUS) for FIGO class 1 fibroids. Eur. J. Obstet. Gynecol. Reprod. Biol. 2018; 221: 119-22. https://dx.doi.org/10.1016/j.ejogrb.2017.12.025.
  34. Курашвили Ю.Б., Лядов К.В., Коган Е.А. Неинвазивная хирургия миом матки. Журнал акушерства и женских болезней. 2009; 58(5): 115-6. [Kurashvili Yu.B., Lyadov K.V., Kogan E.A. Noninvasive surgery of uterine fibroids. Zhurn. akush. i zhen. bol./ Journal of Obstetrics and Women's Diseases. 2009; 58(5): 115-6. (in Russian)].
  35. Mikami K., Murakami T., Okada A., Osuga K., Tomoda K., Nakamura H. Magnetic resonance imaging-guided focused ultrasound ablation of uterine fibroids: early clinical experience. Radiat. Med. 2008; 26(4): 198-205. https://dx.doi.org/10.1007/s11604-007-0215-6.
  36. Park M.J., Kim Y.S., Rhim H., Lim H.K. Safety and therapeutic efficacy of complete or near-complete ablation of symptomatic uterine fibroid tumors by MR imaging-guided high-intensity focused US therapy. J. Vasc. Interv. Radiol. 2014; 25(2): 231-9. https://dx.doi.org/10.1016/j.jvir.2013.11.011.
  37. Gorny K.R., Borah B.J., Brown D.L., Woodrum D.A., Stewart E.A., Hesley G.K. Incidence of additional treatments in women treated with MR-guided focused US for symptomatic uterine fibroids: review of 138 patients with an average follow-up of 2.8 years. J. Vasc. Interv. Radiol. 2014; 25(10): 1506-12. https://dx.doi.org/10.1016/j.jvir.2014.05.012.
  38. Napoli A., Alfieri G., Andrani F., Scipione R., Manganaro L., Pecorini F., Catalano C. Uterine Myomas: Focused Ultrasound Surgery. Semin. Ultrasound. CT MR. 2021; 42(1): 25-36. https://dx.doi.org/10.1053/j.sult.2020.08.001.
  39. Suomi V., Komar G., Sainio T., Joronen K., Perheentupa A., Blanco Sequeiros R. Comprehensive feature selection for classifying the treatment outcome of high-intensity ultrasound therapy in uterine fibroids. Sci. Rep. 2019; 9(1): 10907. https://dx.doi.org/10.1038/s41598-019-47484-y.
  40. Fan H.J., Zhang C., Lei H.T., Cun J.P., Zhao W., Huang J.Q., Zhai Y. Ultrasound-guided high-intensity focused ultrasound in the treatment of uterine fibroids. Medicine (Baltimore). 2019; 98(10): e14566. https://dx.doi.org/10.1097/MD.0000000000014566.
  41. Keserci B., Duc N.M. Magnetic resonance imaging parameters in predicting the treatment outcome of high-intensity focused ultrasound ablation of uterine fibroids with an immediate nonperfused volume ratio of at least 90. Acad. Radiol. 2018; 25(10): 1257-69. https://dx.doi.org/10.1016/j.acra.2018.01.022.
  42. Mindjuk I., Trumm C.G., Herzog P., Stahl R., Matzko M. MRI predictors of clinical success in MR-guided focused ultrasound (MRgFUS) treatments of uterine fibroids: results from a single centre. Eur. Radiol. 2015; 25(5): 1317-28. https://dx.doi.org/10.1007/s00330-014-3538-6.
  43. Funaki K., Fukunishi H., Sawada K. Clinical outcomes of magnetic resonance-guided focused ultrasound surgery for uterine myomas: 24-month follow-up. Ultrasound Obstet. Gynecol. 2009; 34(5): 584-9. https://dx.doi.org/10.1002/uog.7455.
  44. Froeling V., Meckelburg K., Schreiter N.F., Scheurig-Muenkler C., Kamp J., Maurer M.H. et al. Outcome of uterine artery embolization versus MR-guided high-intensity focused ultrasound treatment for uterine fibroids: long-term results. Eur. J, Radiol. 2013; 82(12): 2265-9. https://dx.doi.org/10.1016/j.ejrad.2013.08.045.
  45. Cui Y., Dong Y., Guo B., Xing C., Gao X., Su D. Effect of HIFU on endometrial receptivity and sex hormone level in uterine fibroid patients and analysis of influencing factors for its treatment rate. Exp. Ther. Med. 2019; 17(3): 2291-7. https://dx.doi.org/10.3892/etm.2019.7194.
  46. Wang Y., Wang Z.B., Xu Y.H. Efficacy, efficiency, and safety of magnetic resonance-guided high-intensity focused ultrasound for ablation of uterine fibroids: comparison with ultrasound-guided method. Korean J. Radiol. 2018; 19(4): 724-32. https://dx.doi.org/10.3348/kjr.2018.19.4.724.
  47. Rabinovici J., David M., Fukunishi H., Morita Y., Gostout B.S., Stewart E.A. Pregnancy outcome after magnetic resonance‐guided focused ultrasound surgery (MRgFUS) for conservative treatment of uterine fibroids. Fertil. Steril. 2010; 93(1): 199-209. https://dx.doi.org/10.1016/j.fertnstert.2008.10.001.
  48. Zou M., Chen L., Wu C., Hu C., Xiong Y. Pregnancy outcomes in patients with uterine fibroids treated with ultrasound-guided high-intensity focused ultrasound. BJOG. 2017; 124(Suppl. 3): 30-5. https://dx.doi.org/10.1111/1471-0528.14742.
  49. Li J.S., Wang Y., Chen J.Y., Chen W.Z. Pregnancy outcomes in nulliparous women after ultrasound ablation of uterine fibroids: A single-central retrospective study. Sci. Rep. 2017; 7(1): 3977. https://dx.doi.org/10.1038/s41598-017-04319-y.
  50. Babashov V., Palimaka S., Blackhouse G., O'Reilly D. Magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU) for treatment of symptomatic uterine fibroids: an economic analysis. Ont. Health Technol. Assess. Ser. 2015; 15(5): 1-61.
  51. O'Sullivan A.K., Thompson D., Chu P., Lee D.W., Stewart E.A., Weinstein M.C. Cost-effectiveness of magnetic resonance guided focused ultrasound for the treatment of uterine fibroids. Int. J. Technol. Assess. Health Care. 2009; 25(1): 14-25. https://dx.doi.org/10.1017/S0266462309090035.
  52. Borah B.J., Carls G.S., Moore B.J., Gibson T.B., Moriarty J.P., Stewart E.A. Cost comparison between uterine-sparing fibroid treatments one year following treatment. J. Ther. Ultrasound. 2014; 2: 7. https://dx.doi.org/10.1186/2050-5736-2-7.
  53. Cain-Nielsen A.H., Moriarty J.P., Stewart E.A., Borah B.J. Cost-effectiveness of uterine-preserving procedures for the treatment of uterine fibroid symptoms in the USA. J. Comp. Eff. Res. 2014; 3(5): 503-14. https://dx.doi.org/10.2217/cer.14.32
  54. Chen J., Li Y., Wang Z., McCulloch P., Hu L., Chen W. Evaluation of high-intensity focused ultrasound ablation for uterine fibroids: an IDEAL prospective exploration study. BJOG. 2018; 125(3): 354-64. https://dx.doi.org/10.1111/1471-0528.14689.

Received 07.10.2022

Accepted 05.12.2022

About the Authors

Liudmila I. Moskvicheva, oncologist at the Ultrasound Department, P. Hertsen Moscow Oncology Research Institute – branch of the National Medical Research Radiological Center, Ministry of Health of Russia, ludamed16@mail.ru, SPIN: 8321-3464, https://orcid.org/0000-0002-5750-8492, 125284, Russia, Moscow, 2nd Botkin passage, 3.

Similar Articles

№8 / 2023
Pshenisnova I.V., Yakovlev P.P.
Androgen priming in a poor ovarian stimulation response
№11 / 2023
Artymuk N.V., Zotova O.A.
The effect of the Cyclodynon drug on sexual function in patients with infertility and menstrual disorders
№5 / 2023
Chistyakova A.V., Makarova N.P., Nepsha O.S., Smolnikova V.Yu., Kalinina E.A.
The results of infertility treatment with assisted reproductive technology and sperm selection via cumulus‑oocyte complexes
№9 / 2023
Asfarova G.R., Smolnikova V.Yu., Makarova N.P., Zingerenko B.V., Kalinina E.A.
The effectiveness of infertility treatment involving transfer of cryopreserved embryos obtained after autologous embryo-cumulus cells co-culture in women with repeated inplantation failure
№3 / 2024
Mayasina E.N., Buev Yu.E., Askerov R.A., Yamalyeva N.Sh., Kichigina E.A., Kornilova A.S., Salimov D.F.
Comparative assessment of the efficacy of micronized progesterone medications in the IVF programs
By continuing to use our site, you consent to the processing of cookies that ensure the proper functioning of the site.