Journal of Therapeutic Ultrasound

Paper: Clinical predictors of successful resonance-guided focused ultrasound (MRgFUS) for uterine leiomyoma
Paper authors: Gorny KR, Borah BJ, Weaver AL et al
Paper ref: (2013)1:15

Fibroids are a common complaint in gynaecology, and for many years, treatment options were limited. Women could recourse to hysterectomy, or for those who wished to preserve fertility at the cost of the obstetric impact of the treatment, myomectomy was an alternative.

More recently, uterine artery embolisation (UAE) was developed as another option for those who wish to avoid surgery, although there is the risk of hysterectomy in the face of massive fibroid degeneration.

This paper discusses a new technique in which focussed ultrasound beams are used to coagulate the fibroid tissue, with post-procedure feedback from MRI. This was approved for the treatment of fibroids by the FDA in 2004, and data as to its success has been accumulating since.

The purpose of this study was to gauge if certain patient groups were more likely to have success with this novel treatment, in order to select treatment candidates more appropriately.

Data was collected on 130 patients treated at the Mayo Clinic Centre in Rochester, USA over a 42-month period and the results stratified by demographic characteristics of the patients, symptoms and radiological features.

Follow-up occurred at three and six months, and yearly thereafter via telephone interviews to ascertain if symptoms had recurred. Whether this is a reliable method of follow-up should be questioned. The paper does not discuss if further MRI images were used to check the volume reduction of the fibroids treated.

Additional treatments with other modalities were noted, not including GNRH analogue or the use of progesterone receptor modulators, two emerging methods. Eighty-seven percent of the patients within this trial were Caucasian, a shortcoming noted by the authors.

Fibroids are much more common in Black and South Asian women than Caucasians, and whether ethnic group is a factor that influences the success of treatment with this modality would be useful information.

Ultimately, the treatment seems to have a similar success rate to the UAE procedure, although the study authors recognise a learning curve with the technique and suboptimal treatment initially due to this. Disappointingly, younger patients treated with the new, focussed ultrasound therapy are more likely to need further treatment as time progresses.

Whilst the non-invasive nature of the technique is a distinct advantage compared to UAE, we need further information as to the cost-effectiveness of this new technique to decide whether or not it will replace it in the long term.

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