Achieving NPVR ≥ 80% as Technical Success of High-Intensity Focused Ultrasound Ablation for Uterine Fibroids: a cohort study

Abstract

Abstract Objective: To report the long-term re-intervention of patients with uterine fibroids after ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation, and analyse the influencing factors of re-intervention in group of NPVR ≥80%. Materials and Methods: The patients were divided into four groups according to different non-perfusion volume ratio (NPVR). Kaplan-Meier survival curve was used to analyse the long-term re-intervention in different NPVR groups, and Cox regression was used to analyse the influencing factors of re-intervention in the NPVR ≥ 80% group. Main Results: Patients with single uterine fibroid who underwent USgHIFU from January 2012 to December 2019 in our hospital were enrolled. A total of 1,257 patients were enrolled, of which 920 were successfully followed up. The median follow-up time was 88 months, and the median NPVR was 85.2%. The cumulative re-intervention rates of 1, 3, 5, 8 and 10 years after USgHIFU were 3.4%, 11.8%, 16.8%, 22.6% and 24.1%, respectively. The 10-year cumulative re-intervention rate was 37.3% in the group of NPVR <70%, 31.0% in the group of NPVR 70%–79%, 18.2% in the group of NPVR 80%–89% and 17.8% in the group of NPVR ≥90% (P <0.05). However, no difference was found between the group of NPVR 80%−89% and the group of NPVR ≥90% (P=0.499). Age of patients and signal intensity on T2WI of tumours were independent risk factors for long-term re-intervention when NPVR was ≥80%. Lower age and higher signal intensity on T2WI corresponded to a higher risk of re-intervention occurrence. Conclusion: USgHIFU, as an alternative treatment of uterine fibroids, has a reliable long-term efficiency. NPVR ≥80% can reduce the long-term re-intervention rates of patients, which can be used as a sign of technical success. However, an important step is to assess before ablation, considering both age of patients and fibroids of signal intensity on T2WI. Trial registration: This retrospective study was approved by the ethics committee at our institution (Registration No. HF2023001; Date: 06/04/2023). The Chinese Clinical Trial Registry provided full approval for the study protocol (Registration No. CHiCTR2300074797; Date: 16/08/2023).