Comparison of Reintervention Rates for Type 1 and Type 2 Uterine Fibroids Treated With HIFU Ablation With Varying Non-Perfused Volume Ratios to That With TCRM.

OBJECTIVES

The objective of this study is to investigate the correlation between long-term reintervention rates following high-intensity focused ultrasound (HIFU) ablation with varying non-perfused volume ratios (NPVR) and hysteroscopic transcervical resection of myoma (TCRM) for type 1 and 2 fibroids. Additionally, the study aims to define the technical success criteria in this context.

METHODS

This retrospective study included patients with type 1 and 2 fibroids who underwent treatment with HIFU or TCRM between January 2012 and December 2019. Follow-up assessments were conducted to monitor reintervention rates. NPVR, assessed via magnetic resonance imaging (MRI) post-HIFU treatment, served as a technical indicator for comparing reintervention outcomes between HIFU and TCRM. Logistic regression analysis was employed to identify factors influencing reintervention in patients.

RESULTS

A total of 445 patients were enrolled, with successful follow-up on 325 cases, including 181 cases in the HIFU group and 144 cases in the TCRM group, resulting in a follow-up rate of 73%. When NPVR was ≥70% (n = 151), the long-term reintervention rate following HIFU was comparable to that of TCRM. Binary logistic regression analysis revealed age and long-term symptom relief as independent influencing factors influencing reintervention. The cut-off value of age in patients from the HIFU group was determined as 41.5 using receiver operating characteristic curve (ROC) analysis. The reintervention rate was found to be 10.1% (n = 79) for patients aged over 41.5 years, compared to 34.7% (n = 72) for those aged below it.

CONCLUSION

HIFU emerges as an effective and reliable treatment modality for large type 1 and type 2 uterine fibroids, providing a viable non-invasive alternative for their management. NPVR ≥70% can serve as a technical criterion for successful operation.