Clinical analysis of high-intensity focussed ultrasound ablation for abdominal wall endometriosis: a 4-year experience at a specialty gynecological institution.

OBJECTIVE: To evaluate the long-term clinical effect of high-intensity focussed ultrasound (HIFU) as a non-invasive modality for ablation of abdominal wall endometriosis (AWE) foci. METHODS: All women who were diagnosed with cutaneous endometriosis and underwent HIFU ablation and 4-year follow-up were included. Patient symptoms, imaging performed, HIFU ablation, recurrence, lesion location, size and number were collected and analyzed. RESULTS: A total of 51 women with 57 painful abdominal wall masses with a median volume of 4.00 cm3 and a mean age of 30.5±2.12 years were treated with HIFU. The main symptoms were a palpable painful abdominal mass (93%), protrusion of the skin (28.1%, 16) or lack of protrusion of the skin (71.9%, 41). Ultrasound was initially performed in 100% (51) of women, whereas 6% (3) required MRI examinations to distinguish the features and range of the masses. Ablation was performed with a median 300 s of sonication time, 40 min treatment time, 150 W of power and 41800 J of total energy to treat lesions that were a median volume of 3.83 cm3. No severe complications occurred, except in one patient with a first-degree skin burn, during the 48-month follow-up period. The pooled recurrence of cutaneous endometriosis occurred in 3.9% (2) of women. CONCLUSION: The diagnosis of AWE should be confirmed with imaging of the lesion number, location, size and features before HIFU ablation. HIFU should be the first choice for the treatment of AWE as it is a non-invasive method, with high efficiency and safety and rapid postoperative recovery.

Effect of pre-treatment with gonadotropin-releasing hormone analogue GnRH-α on high-intensity focussed ultrasound ablation for diffuse adenomyosis: a preliminary study.

OBJECTIVES: To evaluate the efficacy and safety of GnRH-α pre-treatment with HIFU ablation for diffuse adenomyosis. METHODS: From January 2014 to December 2016, 61 patients were divided into two groups. Twenty-three patients with larger uteri received pre-treatment with GnRH-α and were then subjected to HIFU, and 38 patients underwent HIFU alone. The technical parameters included treatment time, sonication time, average sonication power, treatment intensity, total energy, non-perfusion volume (NPV) and NPV ratio. Intra-, post-procedural complaints, the relief rate of dysmenorrhoea and clinical effectiveness were followed up. RESULTS: Although the lesion volume in the HIFU + GnRH group was larger than in the HIFU-only group, higher NPV, NPVR%, treatment intensity and total energy with shorter treatment and sonication times in the HIFU + GnRH group were obtained than that in the HIFU-only group. Significant differences were evident for NPV, NPVR%, average power, and total intensity energy (p < 0.05), but not for other parameters between the two groups (p > 0.05). Although no differences in the intra-, post-procedural VAS scores, in the adverse effects and in the relief rate or clinical effectiveness were apparent between the two groups (p > 0.05), the relief rate was better in the HIFU + GnRH group than that in the HIFU group from 6 to 12 months after treatment. Self-comparison of differences occurred in the two groups before and after treatment (p < 0.05) and were between the two groups after only 6 months (p < 0.05). CONCLUSION: The combination of HIFU with GnRH-α is more effective than HIFU alone for ablation of diffuse adenomyosis. Moreover, the GnRH-α pre-treatment with HIFU is safe.