Ana Luiza Santos Marques1, Marina Paula Andres2, Rosanne M Kho3, Mauricio Simões Abrão4. 1. Endometriosis Section, Gynecologic Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil (Drs. Marques, Andres, and Abrão). 2. Endometriosis Section, Gynecologic Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil (Drs. Marques, Andres, and Abrão); Gynecologic Division, BP-A Beneficência Portuguesa de São Paulo, São Paulo, São Paulo, Brazil (Drs. Andres and Abrão). 3. Benign Gynecology Surgery Section, Women's Health Institute, Cleveland Clinic, Cleveland, Ohio (Dr. Kho). 4. Endometriosis Section, Gynecologic Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil (Drs. Marques, Andres, and Abrão); Gynecologic Division, BP-A Beneficência Portuguesa de São Paulo, São Paulo, São Paulo, Brazil (Drs. Andres and Abrão). Electronic address: msabrao@mac.com.
Abstract
STUDY OBJECTIVE: To systematically review the literature regarding the efficacy of high-intensity focused ultrasound (HIFU) in reducing adenomyotic lesions, patients' pain and bleeding symptoms, and the impact on patients' quality of life. DATA SOURCE: A search was performed through PubMed/MEDLINE and Cochrane databases. METHODS OF STUDY SELECTION: All available studies published in the English language in the last 10 years that evaluated the effects of HIFU for adenomyosis. TABULATION, INTEGRATION, AND RESULTS: A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A meta-analysis was performed on data from homogeneous studies. Pooled results from the meta-analysis showed that after HIFU treatment for adenomyosis, a large effect was observed in reducing the uterine volume at 12 months (standard mean difference [SMD] = 0.85), a significant reduction in dysmenorrhea at 3 months (SMD = 1.83) and 12 months (SMD = 2.37), and a significant improvement in quality of life at 6 months (SMD = 3.0) and 12 months (SMD = 2.75). Adverse reactions after HIFU were reported in 55.9% of patients. CONCLUSION: This review suggests a potential benefit for HIFU in the treatment of adenomyosis-related symptoms; however, findings of the meta-analysis were based on fewer, nonuniform studies, which did not equally account for each specific symptom/parameter across the board. Results showed there appears to be a potential of HIFU in the treatment of adenomyosis-related symptoms. To date, there are no comparative and randomized clinical trials comparing the HIFU technique with other conservative treatment options. As yet, there are insufficient data regarding fertility and pregnancy outcomes.
STUDY OBJECTIVE: To systematically review the literature regarding the efficacy of high-intensity focused ultrasound (HIFU) in reducing adenomyotic lesions, patients' pain and bleeding symptoms, and the impact on patients' quality of life. DATA SOURCE: A search was performed through PubMed/MEDLINE and Cochrane databases. METHODS OF STUDY SELECTION: All available studies published in the English language in the last 10 years that evaluated the effects of HIFU for adenomyosis. TABULATION, INTEGRATION, AND RESULTS: A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A meta-analysis was performed on data from homogeneous studies. Pooled results from the meta-analysis showed that after HIFU treatment for adenomyosis, a large effect was observed in reducing the uterine volume at 12 months (standard mean difference [SMD] = 0.85), a significant reduction in dysmenorrhea at 3 months (SMD = 1.83) and 12 months (SMD = 2.37), and a significant improvement in quality of life at 6 months (SMD = 3.0) and 12 months (SMD = 2.75). Adverse reactions after HIFU were reported in 55.9% of patients. CONCLUSION: This review suggests a potential benefit for HIFU in the treatment of adenomyosis-related symptoms; however, findings of the meta-analysis were based on fewer, nonuniform studies, which did not equally account for each specific symptom/parameter across the board. Results showed there appears to be a potential of HIFU in the treatment of adenomyosis-related symptoms. To date, there are no comparative and randomized clinical trials comparing the HIFU technique with other conservative treatment options. As yet, there are insufficient data regarding fertility and pregnancy outcomes.