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Extracorporeal Ablation of Uterine Fibroids With High-Intensity Focused Ultrasound

Imaging and Histopathologic Evaluation

Department of Ultrasonography, Xijing Hospital, Fourth Military Medical University, Xi’an, China.

Address correspondence to Xiao-Dong Zhou, MD, PhD, Department of Ultrasonography, Xijing Hospital, Fourth Military Medical University, 17 W Changle Rd, Xi’an, Shaanxi 710032, China. E-mail: zhouxd{at}fmmu.edu.cn

Objective. The purpose of this study was to evaluate the therapeutic efficacy of high-intensity focused ultrasound (HIFU) in the treatment of uterine fibroids by using imaging and histopathologic examination. Methods. From May 2004 to June 2005, 119 consecutive patients with 187 uterine fibroids were treated with HIFU. Sixty-two fibroids received ultrasonographically guided needle puncture biopsy 1 week before and after HIFU treatment, respectively, to confirm the diagnosis and to assess the early therapeutic efficacy. Hematoxylin-eosin staining and electron microscopy were performed to characterize more subtle phenotypic changes to determine treatment success. Immediate therapeutic effects were assessed at follow-up with Doppler ultrasonography and computed tomography or magnetic resonance imaging. All patients were followed for 6 to 12 months to observe long-term therapeutic effects. Fibroid mean diameters, volumes, and reduction rates 1, 3, 6, and 12 months after HIFU treatment were calculated and compared with 1-way analysis of variance and Student-Newman-Keuls tests. Results. No severe complications were observed after HIFU ablation. Fifty-one (82.3%) of 62 biopsy specimens revealed obvious signs of necrosis under light microscopy, and more subtle changes in cellular structure that indicated nonviability could be found in 60 specimens (96.8%) under electron microscopy. However, viable cells still could be found in 16 specimens (25.8%). Follow-up images showed absence or reduction of blood supply in the lesions after HIFU ablation. Median reductions in tumor size as a percentage of initial tumor volume at 1, 3, 6, and 12 months after HIFU treatment were 21.2%, 29.6%, 44.8%, and 48.7%, respectively. Conclusions. Imaging and histopathologic evidence directly validate HIFU ablation as an effective treatment of uterine fibroids.

Key Words: fibroid • high-intensity focused ultrasound • interventional therapy • ultrasonography • uterine disease

Abbreviations: CDFI, color Doppler flow imaging • CT, computed tomography • H&E, hematoxylin-eosin • HIFU, high-intensity focused ultrasound • MRI, magnetic resonance imaging • UAE, uterine artery embolization

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