Effect of Ovarian Endometriotic Cyst on the Efficacy of High Intensity Focused Ultrasound for Adenomyosis.

OBJECTIVE

To assess the effect of ovarian endometriotic cysts on the efficacy of high intensity focused ultrasound (HIFU) in patients with adenomyosis.

METHODS

Based on magnetic resonance imaging (MRI) findings, patients were categorized into three groups according to the presence and type of adnexal cyst signal: group A (with endometriotic cyst signal), group B (with simple cyst signal), and group C (without cyst signal). The non-perfused volume ratio (NPVR), postoperative dysmenorrhea scores, and long-term recurrence of HIFU were compared among groups.

RESULTS

A total of 396 patients were enrolled, comprising group A (77 cases), group B (134 cases), and group C (185 cases), and the NPVR were 41.83, 44.99, and 50.79%, respectively (P = .021). The postoperative dysmenorrhea scores were 3 (2, 5), 2 (1, 4), and 2 (1, 4) (P = .012), while the pregnancy rates were 20.00%, 27.27%, and 43.59%, respectively (P = .072). Cumulative recurrence rates for patients with endometriotic cysts at 1, 2, 3, 5, and 10 years were 45.60, 56.10, 57.90, 61.90, and 67.30%, respectively (log-rank P < .001). Endometriotic cysts were significantly associated with higher dysmenorrhea scores and represented an independent risk factor for postoperative pregnancy (OR = 0.338, 95% CI: 0.129-0.886, P = .027) and long-term recurrence (HR = 1.865, 95% CI: 1.275-2.728, P = .001).

CONCLUSIONS

The signal of endometriotic cyst on MRI exhibits a negative correlation with the efficacy of HIFU in patients with adenomyosis. Preoperative MRI assessment of adnexal cyst signal in patients facilitates the development of a more tailored and comprehensive treatment plan for individuals suffering from adenomyosis.