Beermann Marie, Jonsdottir Gudny, Cronisoe Annika, Hasselrot Klara, Kopp Kallner Helena
Department of Radiology, Danderyd Hospital, Stockholm, Sweden.
Department of Clincial Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
Int J Hyperthermia. 2022;39(1):1158-1163. doi: 10.1080/02656736.2022.2109764.
To study long-term effects in patients treated with microwave ablation (MWA) for symptomatic uterine fibroids and investigate fibroid characteristics predictive of successful treatment.
Women who received MWA treatment for uterine fibroids in a previous study were included. A total of 16 patients underwent contrast enhanced MRI before treatment, postoperatively at 6 months and at long-term follow-up, to assess volumes of treated fibroids ( = 42). Long-term MRI was performed between 16 and 36 months after treatment [median 22 months, interquartile range (IQR) 18.5-27]. Validated questionnaires for evaluation of uterine fibroid symptoms and menstrual bleeding (UFS-QoL and PBAC) were used to assess long-term effects on symptoms. The degree of shrinkage was correlated to vascularization and T2 signal intensity (SI) at preoperative MRI and location of fibroids according to the FIGO classification, using the Mann-Whitney test.
Most patients (82%) reported improvement up to 3 years after treatment. Out of 42 treated fibroids, 35 (83%) continued to shrink over time with median relative volume reduction of 77% (IQR 39-95). For eight fibroids (19%) which showed low vascularization on the pretreatment MRI, there was less shrinkage compared to well-vascularized fibroids ( = 0.01). Most fibroids (79%) showed iso- to hyperintense T2 signal on preoperative MRI and showed a higher grade of shrinkage than hypointense fibroids ( = 0.02).
After microwave treatment improvement is maintained for most patients up to 36 months and most fibroids showed continuous shrinkage. Preoperative vascularization, high T2 SI and submucosal location predicted continuous volume reduction. However, to confirm this, larger studies are needed.
研究微波消融（MWA）治疗有症状子宫肌瘤患者的长期疗效，并探讨预测治疗成功的肌瘤特征。
纳入在先前研究中接受MWA治疗子宫肌瘤的女性。共有16例患者在治疗前、术后6个月及长期随访时接受了对比增强MRI检查，以评估治疗肌瘤的体积（n = 42）。长期MRI检查在治疗后16至36个月进行[中位数22个月，四分位间距（IQR）18.5 - 27]。使用经过验证的评估子宫肌瘤症状和月经出血的问卷（UFS - QoL和PBAC）来评估对症状的长期影响。根据FIGO分类，使用Mann - Whitney检验将缩小程度与术前MRI的血管化程度、T2信号强度（SI）以及肌瘤位置相关联。
大多数患者（82%）报告治疗后长达3年症状有所改善。在42个接受治疗的肌瘤中，35个（83%）随时间持续缩小，相对体积中位数减少77%（IQR 39 - 95）。对于8个（19%）在预处理MRI上显示血管化程度低的肌瘤，与血管化良好的肌瘤相比，缩小程度较小（P = 0.01）。大多数肌瘤（79%）在术前MRI上显示T2信号等强度至高信号，并且比低信号肌瘤显示出更高程度的缩小（P = 0.02）。
微波治疗后，大多数患者长达36个月症状持续改善，大多数肌瘤持续缩小。术前血管化程度高、T2 SI高以及黏膜下位置可预测体积持续缩小。然而，要证实这一点，需要更大规模的研究。
