Image-guided thermal ablation in the management of symptomatic adenomyosis: a systematic review and meta-analysis

Objective To evaluate the clinical effects of image-guided thermal ablation for the treatment of symptomatic adenomyosis (AD). Data sources We searched PubMed, Web of Science, Cochrane Library, EMBASE, ClinicalTrials.gov and Google Scholar for literature from January 2000 to September 2020. Methods of study selection We included all studies reporting clinical outcomes of image-guided thermal ablation for AD, involving high-intensity focused ultrasound (HIFU), percutaneous microwave ablation (PMWA) and radiofrequency ablation (RFA). Two independent researchers performed study selection according to the screening criteria. Results A total of 38 studies representing 15,908 women were included. Compared with those at baseline, the visual analog scale scores, the symptom severity scores and the menorrhagia severity scores decreased significantly after these thermal ablation therapies. The mean ablation time was 92.18 min, 24.15 min and 31.93 min during HIFU, PMWA and RFA, respectively. The non-perfused volume ratio of AD was 68.3% for HIFU, 82.5% for PMWA and 79.2% for RFA. The reduction rates of uterine volume were 33.6% (HIFU), 46.8% (PMWA) and 44.0% (RFA). The reduction rates of AD volume were 45.1% (HIFU), 74.9% (PMWA) and 61.3% (RFA). The relief rates of dysmenorrhea were 84.2% (HIFU), 89.7% (PMWA) and 89.2% (RFA). The incidence of minor adverse events was 39.0% (HIFU), 51.3% (PMWA) and 3.6% (RFA). The re-intervention rates were 4.0% (HIFU) and 28.7% (RFA). The recurrence rate was 10.2% after HIFU. The pregnancy rates were 16.7% (HIFU), 4.93% (PMWA) and 35.8% (RFA). Conclusion Image-guided HIFU, PMWA and RFA may be effective and safe minimally invasive therapies for symptomatic AD.

Automated summary

Image-guided thermal ablation, including HIFU, PMWA, and RFA, showed promising clinical effects in treating symptomatic adenomyosis, with significant improvements in symptom severity and reduction in menorrhagia. The procedures had relatively short ablation times and good non-perfused volume ratio outcomes, with high relief rates of dysmenorrhea. However, there were notable rates of minor adverse events associated with the treatments. Overall, HIFU, PMWA, and RFA are effective and safe minimally invasive therapies for symptomatic AD.