Jing Zhang

Objective: To investigate the indications and techniques of microwave ablation for uterine fibroids in fertility-seeking patients, and to evaluate its safety and pregnancy outcomes. Methods: This prospective study analyzed 1,600 patients who underwent percutaneous microwave ablation, stratified by fertility desire. For the fertility-seeking group, protective interventions including intrauterine and pelvic saline isolation, as well as vaginal fornix support, were implemented. Patients were followed up to assess pregnancy rates, ovarian reserve (AMH), and obstetric outcomes. Results: Menstrual patterns, sex hormone levels, and AMH values showed no significant changes post-ablation. Among 104 patients intending to conceive, 78 achieved successful pregnancy (75.0%), resulting in 52 healthy live births. Higher pregnancy success rates were observed in patients with FIGO type 0-IV fibroids and those ≤ 8 cm in diameter. Standardized protective measures effectively prevented thermal injury to the endometrium, serosa, and vaginal mucosa. Patients are advised to use contraception for 3-6 months post-procedure and attempt conception once the fibroid shrinks to ≤ 4 cm and uterine cavity morphology improves. Conclusion: For fertility-seeking patients, FIGO types 0-6 uterine fibroids measuring ≤ 8 cm in diameter represent favorable indications. Adjunctive techniques during ablation, notably intrauterine catheter-mediated hydrodissection and artificial ascites, effectively preserve the structural integrity of the endometrium, uterine serosa, and ovaries.

Background This study aims to evaluate the efficacy of a three-dimensional visualization operative planning system (3DVOPS) in ultrasound-guided percutaneous microwave ablation (US-PMWA) for the treatment of large uterine fibroids. Methods From October 2020 to December 2023, a total of 30 patients with symptomatic uterine fibroids (≥ 7 cm) who underwent US-PMWA with the assistance of a 3D visualization operative planning system were included in this retrospective study. A control group of 60 patients who underwent US-PMWA using conventional 2D image operative planning methods was also studied. Assessment endpoints included technical efficacy and complications. Results The ablation time and energy consumption in the 3D group were significantly lower than those in the 2D group (45.2 ± 7.5 min vs. 56.6 ± 8.9 min and 77.5 ± 19.3 kJ vs. 100.9 ± 36.7 kJ, respectively; P < 0.05). There was no significant difference in the ablation rate between the two groups. The incidence of vaginal discharge after ablation was lower in the 3D group compared to the 2D group (6.6% vs. 13.3%, P < 0.05). No severe complications were reported during the follow-up period. Conclusions The 3DVOPS can reduce ablation time and microwave energy requirements for the treatment of large uterine fibroids via US-PMWA, while also enhancing the accuracy of ablation.

Objective: To examine the diagnostic efficacy of contrast-enhanced ultrasound (CEUS) with Sonazoid (Sonazoid-CEUS) for endometrial lesions. Methods: In this prospective and multicenter study, data were collected from 84 patients with endometrial lesions from 11 hospitals in China. All the patients received a conventional US and Sonazoid-CEUS examination. The lesion characteristics based on US and Sonazoid-CEUS imaging were collected from the case report forms. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were determined using histopathologic diagnosis as the gold standard. Results: Of the 79 patients included, 29 were diagnosed with benign lesions and 50 with endometrial carcinoma (EC). The accuracy, sensitivity, specificity, PPV, and NPV for Sonazoid-CEUS and US at differentiating EC from benign endometrial lesions were 82.2%, 94%, 62.1%, 81.0%, and 85.7%, and 79.7%, 96%, 51.7%, 92.3%, and 88.2%, respectively, with no significant differences observed for any of the values. For Sonazoid-CEUS, the best delineators of EC versus benign lesions were early enhancement and hyperenhancement (74% vs 53.3%, P = 0.029, 68% vs 45%, P < 0.001), and lesion size enlargement (76% vs 48%, P = 0.001). Despite finding no significant difference in the enhancement patterns (P = .367), a faster wash-in pattern with the contrast agent entering before the surrounding myometrium was more common in the EC vs benign cases (92% vs 48.3%). Conclusions: Sonazoid-CEUS has higher accuracy, specificity, and comparable sensitivity for differentiating EC from benign endometrial lesions compared with conventional US. It provides complementary hemodynamics information reflective of tissue vascularization, which may improve the overall diagnostic efficiency.

Objectives: To prospectively compare the effectiveness and safety of percutaneous microwave ablation (PMWA) and ultrasound-guided radiofrequency ablation (USgRFA) for treating symptomatic uterine adenomyosis. Methods: One hundred and thirty-three women with symptomatic uterine adenomyosis who met the inclusion criteria were enrolled in our study from October 2015 to October 2017. Sixty-eight patients underwent PMWA, and sixty-five patients underwent USgRFA. All patients were followed up for 12 months. Assessment endpoints included treatment time, percentage ablation, percentage uterine regression, symptom severity scores (SSSs), dysmenorrhea scores and adverse events. Results: The mean age of the patients in our study was 39.4 ± 4.2 years (range, 35–50 years), and the median volume of uterine adenomyosis was 124.3 cm³ (range, 28.7–374.5 cm³). The mean ablation time was 16.3 ± 4.9 min (range, 5–23 min) in the MWA group, which was demonstrably superior to that of the RFA group, which was 37.5 ± 6.2 min (range, 5–39 min). The mean percentages of ablation of uterine adenomyosis were 79.7 ± 15.1% and 79.2 ± 14.2% in the MWA group and the RFA group, respectively, and showed no significant difference between the groups. The percentages of regression of uterine volume also showed no marked difference between the two groups. Changes in the dysmenorrhea scores and the SSSs after ablation were similar in the MWA group and in the RFA group, and no significant difference was found between the groups. Finally, the percentage occurrence of adverse events was the same in the two groups. Conclusions: The safety and effectiveness of PMWA and USgRFA in the treatment of uterine adenomyosis were similar; however, the mean ablation time of PMWA was shorter than that of USgRFA.

Purpose: To evaluate the feasibility, safety and technical efficacy of ultrasound-guided percutaneous microwave ablation with artificial ascites for adenomyosis. Materials and methods: Between May 2015 and May 2016, a total of 25 patients with symptomatic adenomyosis who underwent ultrasound-guided percutaneous microwave ablation with artificial ascites were included in this retrospective study. A matching cohort of 50 patients underwent ultrasound-guided percutaneous microwave ablation without artificial ascites as controls. The technical efficacy, complications and short-term treatment effectiveness were assessed and compared with the controls. Results: Artificial ascites was successfully achieved in all of the 25 patients with the administration of a median of 550 mL (range, 250–1200 mL) of solution. There was substantial improvement in achieving a better antenna path in 100% (20/20) of the cases with a poor antenna path. The complete separation was achieved in 23 of 25 patients. The mean ablation time was 26.5 ± 7.3 min and the median non-perfusion volume ratio was 76% which was similar to the control group (p > .05). No serious complications were observed. Patient pain scores for dysmenorrhoea showed a statistically significant decline from the baseline of 6.71 ± 0.96 to 2.92 ± 0.79 and the symptom severity score declined statistically significantly from 21.8 ± 5.5 to 16.4 ± 4.8 at 3 months follow-up. Conclusions: Percutaneous microwave ablation with artificial ascites is feasible, safe and can be effective in improving access for treatment of adenomyosis.

Purpose: To evaluate the clinical efficacy of ultrasound-guided percutaneous microwave ablation (PMWA) therapy for symptomatic uterine fibroids in a multicentre study. Materials and methods: Patients with symptomatic uterine fibroids who underwent PMWA at multiple treatment centres in China between January 2013 and August 2015 were prospectively studied to compare the reduction rate of uterine fibroids, haemoglobin level and uterine fibroid symptom and health-related quality of life questionnaire (UFS-QOL) scores before and at 3, 6 and 12 months after ablation. Results: A total of 311 patients (405 leiomyomas) from eight treatment centres underwent the treatment (age, 29–55 years; mean ± SD, 41 ± 5.11 years). The mean diameter of the myomas ranged from 2.03 to 12.50 cm (mean, 5.10 ± 1.28 cm) and the volume ranged from 4.40 to 1022.14 cm³ (mean, 95.01 ± 70.29 cm³). Forty-eight myomas were identified as FIGO type 1/2 fibroids, 256 as type 3/4 fibroids and 101 as type 5/6 fibroids. The mean ablation rate was 86.6% (54.0–100%). The mean reduction rate was 63.5%, 78.5% and 86.7% at 3, 6 and 12 months posttreatment, respectively. The haemoglobin level increased significantly from 88.84 ± 9.31 g/L before treatment to 107.14 ± 13.32, 116.05 ± 7.66 and 117.79 ± 6.51 g/L at 3, 6 and 12 months posttreatment, respectively (p = .000). The symptom severity score (SSS) and health-related quality of life (HRQL) scores were also significantly improved posttreatment compared with before treatment (p = .000). Conclusion: PMWA is an effective, minimally invasive treatment for symptomatic leiomyomas that can significantly improve the quality of life of patients.

Objectives:The study was conducted to describe ultrasound-guided high intensity focused ultrasound (USgHIFU) ablation in the treatment of intra-abdominal aggressive fibromatosis in seven patients who had failed surgery.Methods:We investigated retrospectively seven patients with pathologically proven intra-abdominal aggressive fibromatosis and surgical failure who were treated with USgHIFU between June 2013 and February 2015. The main causes for surgical failure were a large tumor size or adjacent tissue invasion by the tumor. All of the patients were treated with palliative intent to reduce symptoms of the diseases. The medical records were reviewed during the follow-up period, and the patients were asked to compare the symptoms of their disease as improved, unchanged or worsened based on their levels before treatment. Additionally, contrast-enhanced magnetic resonance imaging (MRI) was conducted to follow the size of the tumors before and after therapy.Results:The procedure was successfully accomplished ...

A total of 142 premenopausal women with symptomatic adenomyosis underwent ultrasound (US)-guided percutaneous microwave ablation (PMWA) at the Chinese PLA General Hospital. This study aimed to evaluate changes in serum pituitary, gonadal hormone and cancer antigen 125 (CA125) levels after US-guided PMWA. Therefore, estradiol (E₂), follicle-stimulating hormone (FSH), prolactin (PRL) and CA125 levels were evaluated before ablation and at 3, 6, 9 and 12 months after ablation. No significant differences were observed in the E₂ and FSH levels pre-ablation and during follow-up (E₂: p = 0.933, p = 0.987, p = 0.106, p = 0.936; FSH: p = 0.552, p = 0.295, p = 0.414, p = 0.760). The mean absolute values of serum CA125 and PRL were significantly decreased at 3, 6, 9 and 12 months after ablation (CA125: p < 0.001, p < 0.001, p < 0.001, p = 0.003; PRL: p < 0.001, p < 0.001, p < 0.001, p < 0.001). A significant correlation between changes in CA125 levels and uterine volume was found (p < 0.001). No evidence of a decline in ovarian function was observed after US-guided PMWA.