ParticipantsNguyen Minh Duc, MD, Ho Chi Minh, Vietnam (Presenter) Nothing to Disclose
Chandran Nadarajan, MD, Kota Bharu, Malaysia (Abstract Co-Author) Nothing to Disclose
Mohd Shafie Abdullah, MMed,RT, Kota Bharu, Malaysia (Abstract Co-Author) Nothing to Disclose
Rajiv Chopra, PhD, Dallas, TX (Abstract Co-Author) Stockholder, Profound Medical Corporation; Stockholder, Solenic Medical Inc
Bilgin Keserci, PhD, Kota Bharu, Malaysia (Abstract Co-Author) Nothing to Disclose
bsnguyenminhduc@pnt.edu.vn
PURPOSETo assess whether HIFU ablation with the achievement of a non-perfused volume (NPV) ratio greater than 90% should be recommended for women in childbearing age with extensive fibroids or adenomyosis, or whether it should be restricted only to patients who do not wish to preserve their fertility.
METHOD AND MATERIALSOne hundred twenty women (39.5 ± 5.8 years) with symptomatic fibroids (group 1) and 66 women (40.6 ± 6.6 years) with symptomatic adenomyosis (group 2) underwent HIFU treatment. In group 1, the patients were subdivided into "group 1A, n = 72" comprised of patients with an NPV ratio > 90% and "group 1B, n = 48" comprised of patients with an NPV ratio < 90%. In group 2, the patients were subdivided into "group 2A, n = 26" comprised of patients with an NPV ratio > 90% and "group 2B, n = 40" comprised of patients with an NPV ratio < 90%. The Anti-Müllerian hormone (AMH) level (ng/mL) prior to treatment and at 6-month follow-up was assessed as a measure of ovarian reserve.
RESULTSThe AMH levels before and at 6-months follow-up were 1.98 ± 1.86 (0.03-9.23) and 1.97 ± 1.85 (0.02-9.2; p = 0.077) in group 1A and 1.81 ± 1.42 (0.21-7.1) and 1.79 ± 1.42 (0.21-7.1; p = 0.06) in group 1B, respectively. The AMH concentrations before and at 6 months after treatment were respectively 1.98 ± 1.15 (0.57-4.61) and 1.98 ± 1.15 (0.57-4.61; p = 0.327) in group 2A and 1.65 ± 0.94 (0.09-4.11) and 1.65 ± 0.95 (0.09-4.11; p = 0.160) in group 2B. There was no significant difference between the AMH levels before or at 6-months follow-up within groups 1 and 2. In group 1, five patients conceived (2 still conceiving while 3 delivered live-birth with mean weight of 3200g ± 120); meanwhile, in group II, 3 patients conceived (1 still conceiving while 2 delivered live-birth with mean weight of 3150g ± 110).
CONCLUSIONOur findings suggest that there was no significant change in AMH levels before and 6 months after HIFU treatment both in fibroids and adenomyosis patients, suggesting that the ovary and its vessels were not adversely affected even with the achievement of a nonperfused volume (NPV) ratio greater than 90%.
CLINICAL RELEVANCE/APPLICATIONMRI guided HIFU treatment of both uterine leiomyomas and adenomyosis with the targeted endpoint of nonperfused volume (NPV) ratio of at least 90% can be achieved safely for women who wish to preserve their fertility.