Ultrasound-guided Microwave Ablation in the Management of Symptomatic Uterine Myomas: A Systematic Review and Meta-analysis.

ABSTRACT

OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the clinical effects and safety of ultrasound-guided microwave ablation (MWA) for the treatment of symptomatic uterine myomas. DATA SOURCES We searched PubMed, Web of Science Core Collection, Cochrane Library, Embase, Scopus, and Google Scholar for studies from January 2000 to January 2021. METHODS OF STUDY SELECTION We included all studies that reported the clinical outcomes of ultrasound-guided MWA in women with symptomatic uterine myomas. Two researchers conducted the study selection according to the screening criteria. TABULATION, INTEGRATION, AND RESULTS: We evaluated the risk of bias and evidence quality using the Newcastle-Ottawa scale. Two researchers independently extracted information from the included studies. We extracted the standardized mean difference (SMD) and pooled proportion with a 95% confidence interval (CI) for the outcome measures of interest. A total of 10 studies representing 671 patients were included. The Uterine Fibroid Symptom and Quality of Life (UFS-QoL) questionnaire was used to assess the clinical effects. Compared with baseline, the UFS scores decreased significantly (SMD 3.37; 95% CI, 2.27-4.47; p <.001; reduction rate 65.9%), QoL scores increased significantly (SMD -3.12; 95% CI, -3.93 to -2.30; p <.001; rate of increase 72.0%), and hemoglobin concentration increased significantly (SMD -2.13; 95% CI, -3.44 to -0.81; p = .002; rate of increase 30.3%) at follow-up. The mean operation time was 34.48 minutes (95% CI, 22.82-46.13; p <.001). The rate of reduction in myoma volume after MWA was 85.3% (95% CI, 82.7%-88.0%, p <.001). No major adverse event was reported, and the incidence of minor adverse events was 21.1% (95% CI, 15.1%-27.0%, p <.001). CONCLUSION: Ultrasound-guided MWA is an effective and safe minimally invasive therapy for symptomatic uterine myomas.