{"paper_id":"9d381a3f-c0b3-466e-ba28-ba0922decdb5","body_text":"Open Access, Volume 4 \nStudy on the application value of high intensity focused \nultrasound in the treatment of gynecological diseases\nReview Article\nwww.jcimcr.org\nJournal of\nClinical Images and Medical Case Reports\nReceived: Jan 08, 2023\nAccepted: Jan 26, 2023\nPublished: Feb 02, 2023  \nArchived: www.jcimcr.org\nCopyright: © Liu L (2023).\nDOI: www.doi.org/10.52768/2766-7820/2268\n*Corresponding Author: Li Liu\nDepartment of Gynecology, The 1st Affiliated Hospi-\ntal of Heilongjiang University of Traditional Chinese \nMedicine, Harbin, Heilongjiang 150036, China.\nEmail: qiding0217@163.com\nISSN 2766-7820\nIntroduction\nThe High Intensity Focused Ultrasound (HIFU) tumor treat -\nment system, known by its acronym, is a new and emerging \ntreatment. As an emerging treatment, it has the advantages of \nnon-invasiveness and quick recovery. It is now widely used in \nthe treatment of tumors and gynecology-related diseases. The \nmain principle of its action is to use high-intensity ultrasound \nfocused on biological tissues to produce thermal effects, which \nare transformed into heat energy to achieve the purpose of “ab-\nlation”, causing instant coagulation necrosis of the tissues in the \nfocal area, but no significant damage and injury to the tissues \noutside the focal area [1], and the coagulated necrotic tissues \ncan be gradually absorbed or scarified through body metabo -\nlism. The coagulated necrotic tissue can be metabolized by the \nbody and gradually absorbed or scarred. This new technique \nfor the local treatment of tumors, also known as thermal “exci-\nsion”, is mainly applicable to the treatment of malignant and \nbenign solid tumors of tissues and organs [2].\nAs clinical development continues and the safety of the tech-\nnology improves, the use of focused ultrasound is becoming \nmore and more widespread, evolving from an adjunct to the \ntreatment of tumor disease to a herbal treatment for clinically \nrelevant oncological diseases. In the twenty-first century, this \ntechnology has also opened up new therapeutic areas, with \npositive effects on non-tumor diseases [3]. In this paper, we \ndiscuss the role and value of focused ultrasound technology in \nthe treatment of gynecology-related diseases, with a view to \nproviding important references for relevant clinicians in clinical \ndiagnosis and treatment.\nAbstract\nAlong with the advancement of science and technology and the on-\ngoing development of adjuvant therapies, the treatment options for \ncommon or difficult diseases related to gynecology have become more \ndiversified. At the same time, due to the increasing health awareness \nand the development of minimally invasive treatments, the majority \nof female patients are more in pursuit of swift and non-invasive treat-\nments. For patients who are relatively poorly controlled by medication \nand fearful of surgical treatment, High-Intensity Focused Ultrasound \n(HIFU), also known as “HEFU”, is a highly advantageous treatment \nfor gynecological-related diseases. It is also publicly recognised in \nthe West as a world-leading Chinese treatment technology. In recent \nyears, there have been many reports on the use of the Heliport in the \ntreatment of gynecology-related diseases, and its clinical efficacy has \nbetter clinical results and fewer adverse effects compared with tradi -\ntional treatment methods.\nKeywords: High-intensity focused ultrasound; Helio knife; uterine \nfibroids; adenomyosis; scar pregnancy; effectiveness.\nDing Qi1; Hongmei Li2; Buwei Han1; Shimeng Wang1; Mengke Yuan1; Rui Zheng Mm1; Li Liu3*\n1Heilongjiang University of Traditional Chinese Medicine, Harbin, Heilongjiang, China.\n2The 2rd Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, Heilongjiang, China.\n3The 1st Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, Heilongjiang, China.\n\nwww.jcimcr.org                Page 2\nCitation: Qi D, Li H, Han B, Wang S, Liu L, et al. Study on the application value of high intensity focused ultrasound in the \ntreatment of gynecological diseases. J Clin Images Med Case Rep. 2023; 4(2): 2268.\nSpecific applications of high-intensity focused ultrasound in \ngynecological diseases\nUterine fibroids\nIn recent years, with the popularization of primary and sec -\nondary prevention, as well as the progress of detection meth -\nods, and the influence of lifestyle and working environment, \nthe incidence of uterine fibroids has been increasing year by \nyear, mostly seen in women of reproductive age [4]. Depending \non the site of growth, fibroids can be classified as cervical, sub \nmucosal, interstitial, or sub plasmalemmal fibroids. Depending \non their number and site of growth, they are further classified \nas either solitary or multiple myomas. Also, as the disease pro -\ngresses, the fibroids tend to degenerate. The enlarged or degen-\nerated fibroids may cause menstrual disorders and increased \nvaginal discharge, as well as compression of local organs or tis-\nsues, resulting in discomfort [5]. The morphology of the uterine \ncavity can be altered by the fibroids, which can affect the devel-\nopment of fertilized eggs and cause serious complications such \nas infertility, which can seriously affect a woman’s physical and \nmental health.\nThe conventional treatment of fibroids includes medication \nand surgery. Medication is mostly used to relieve symptoms and \nreduce the size of fibroids in preparation for further surgery. \nSurgery can be divided into open surgery and lumpectomy, de-\npending on the type of surgery [6]. Traditional open surgery, \nalthough intuitive in its view, allows for rapid management of \nintra operative findings and allows for good removal of complex \nlesions, has a wide surgical reach, large incisions, long recovery \ntime, and poor patient compliance. With lumpectomy, patient \nchoice is higher and in recent years, with the development and \nmaturity of technical means, adverse reactions have gradually \ndiminished, with little impact on physical fitness and rapid pa -\ntient recovery, but there are still corresponding risks, such as \nsubcutaneous emphysema, ureteral injury, intestinal wall injury, \nlarge incisions, difficulty in lumpectomy suturing, postoperative \nbleeding and other adverse reactions, influenced by the opera-\ntor’s proficiency and the patient’s constitution. These are all \nrisks that have to be taken during the procedure.\nThe use of a High-Intensity Focused Ultrasound Knife (HEF), \nin the treatment of uterine fibroids, is the use of an emerging \nin vitro treatment, with the help of the physical characteristics \nof the HEF, while with the assistance of the instrument, to take \nvisual treatment, the use of ultrasound probe the human body, \nthe energy gathered in the focal area to be treated, through \nthe cavitation and mechanical effect, accurate targeting lesions, \nablation of lesions, this treatment method, only effective for \nthe treatment of local This treatment method, which is only \neffective for local treatment, does not damage the surround -\ning healthy tissues, but only if the energy is too high or if the \nsound waves are deflected in the body during the transmission \nprocess, which may cause damage to the body [5]. Cai Dandan \n[7] used the Hepatome in combination with contracting to treat \nuterine fibroids. The preoperative and postoperative imaging \nexaminations, showing the ablation rate, the extent of ablation, \nthe comparison of the blood supply around the lesion, and the \nlong-term follow-up showed that this treatment modality is ef-\nfective and has a higher safety profile, low adverse effects, and \ngood long-term therapeutic effects. Zhou Dan et al. used this \nmethod to treat uterine fibroids, and after the operation, found \nthat the patient’s related symptoms were significantly relieved, \nthe time to resume voluntary exercise after the operation was \nshorter than that of traditional treatment, the quality of life was \nimproved, and there was no effect on the normal physiological \nfunction of the ovaries, which has strong promotion value [8]. \nStudies have shown that the treatment frequency can be ad -\njusted according to the size and extent of the lesion, usually set \nat around 1 MHz, with a stratified spacing of mostly 5 mm and a \npower of mostly 240-400 W [9]. As it is a local treatment, it has \nless impact on the endocrine function of the ovary, and there \nis no significant impact on the function of the Hypothalamic-\nPituitary-Ovarian axis (HPO axis) in postoperative patients. Its \nmechanism of action does not affect the ovarian arteriovenous \nblood supply, so the body is less prone to stressful reactions and \nis safer [10].\nUterine adenomyosis\nThe base of the active endometrium penetrates the myome-\ntrium, resulting in high local hormone levels and consequently \nadenomyosis. However, the exact pathogenesis and cause of \nthe lesion are not yet clear. However, some studies have shown \nthat the development of this disease is related to hormone lev-\nels. When estrogen levels are elevated, the cells are prone to \nirregular changes under the influence of hormones, which af -\nfect the expression of endometrial and myometrial receptors \nand trigger the disease. The development of this condition can \nbe influenced by frequent uterine operations, the mode of de -\nlivery, and breastfeeding [11]. The choice of relevant treatment \nmodalities is determined by the size of the patient’s lesions and \nthe presence or absence of fertility requirements. Pharmaco -\nlogical treatment is aimed at reducing the size of the lesion and \nrelieving clinical symptoms. Surgical treatment, with poorly de-\nfined lesion boundaries, makes complete removal of the lesion \ndifficult and increases the risk of adverse pregnancy outcomes \n[12].\nDuring treatment, patients need to be closely investigated \nand questioned about their previous health status, the bowel \nis prepared in advance, and the identified focal area is treated \nfrom point to line and line to surface to the target area under \nultrasound localization according to the extent and severity of \nthe lesion. The treatment power should not exceed 400 W, the \ntreatment domain should not exceed 5mm, and the treatment \nfrequency is less than 1 MHz, through the cavitation effect, so \nthat the local temperature rises abruptly to 60-100 when the \nlesion undergoes coagulative necrosis, the ultrasound sug -\ngests the appearance of local echogenic enhancement or gray -\nness increase as the standard of effective treatment when all \ntreatment levels show the grayness increase suggests that the \ntreatment can be ended [13], intra operative should be closely \nobserved The patient’s vital signs should be closely observed \nduring the operation, and the operation should be stopped \nimmediately if corresponding discomfort occurs. Jia [14] et al. \nused the Hepatome to treat adenomyosis, and after treatment, \nthe lesion volume was reduced, the degree of dysmenorrhoea \nwas relieved significantly, and physicochemical indices, such as \nhemoglobin concentration, also produced corresponding im -\nprovements, and the operation was safe with few adverse ef -\nfects and no significant complications, proving that this method \nis safe and effective.\n\nwww.jcimcr.org                Page 3\nScarred uterine pregnancy\nThe incidence of cesarean section and uterine fibroids is \ngradually increasing, and the number of operations on the \nuterus is also increasing, while abortion, curettage, and other \noperations on the uterus are also likely to cause damage to the \nuterus and poor recovery, resulting in the formation of a scarred \nuterus. The persistence of a scarred uterus has a major impact \non the safety of another pregnancy, with a reduced ability of \nthe uterus to contract and recover, predisposing it to complica-\ntions such as uterine rupture and postpartum hemorrhage, as \nwell as increasing the risk of scarred pregnancy [15]. The thin \nmuscular layer of the uterine scar, which is affected by a preg -\nnancy, softens the uterus and makes conventional uterine clear-\nance prone to uterine rupture and uterine perforation.\nThe use of high-intensity focused ultrasound for the treat -\nment of recurrent pregnancy in the scarred uterus can be re-vi-\nsualized, with ultrasound waves passing through the moderate-\nly filled abdominal wall and bladder to accurately locate the site \nof the gestational sac, followed by the use of local thermal and \ncavitation effects to kill the gestational sac, causing apoptosis of \ntrophoblast cells and a reduction in peripheral blood flow, while \nintra operative ultrasound equipment can be used to closely \nobserve the patient’s uterine blood perfusion changes in the \nsituation, accurate coagulation, hemostasis and reduction of in-\ntraoperative bleeding. The specific treatment frequency, layer \nspacing, focal range, and treatment power should be set flexibly \naccording to the size of the patient’s gestational sac and the \nthickness of the muscular layer. In a clinical study by Wang Qiao-\nju [16]. using high-intensity focused ultrasound to treat scarred \nuterine pregnancies, it was found that patients had less post -\noperative bleeding, a faster drop in serum human chorionic go-\nnadotropin (blood β-HCG), a shorter time to return to voluntary \nmovement after surgery, higher efficiency and fewer adverse \neffects than with conventional uterine clearance. This method \ncan be used alone or in combination with related therapeutic \ndrugs or physical operations to enhance the therapeutic effect. \nCervical cancer\nThe treatment and prevention of cervical cancer by high-\nintensity focused ultrasound is mainly manifested in two ways: \nFirstly, to prevent and reduce the causes of cervical cancer. The \nsecond is the direct treatment of cancer foci. Cervical cancer \nis a type of neoplastic disease with a relatively clear cause. It \nis mainly manifested by persistent infection with the high-risk \nHuman Papilloma Virus (HPV virus) of the cervix. There is a lack \nof definitive treatment for high-risk HPV viruses and the main \nfocus is on enhancing local immunity. The advantages of using \nhigh-intensity focused ultrasound to treat high-risk HPV infec -\ntion in cervical cancer are gradually becoming apparent. This \ntechnique has a significant therapeutic effect on the target area \nof the lesion, has little impact on normal tissue, is less invasive \nin terms of overall efficacy, and has no impact on reproductive \nfunction [17]. The specific operational reference is as follows: \nfrequency setting range: 10 ± 2 MHz, pulse frequency: 1000 Hz, \ndetermined power range: 3-5 W/cm, 360° diffusion scanning \naround the ectocervix as a round point, stopping treatment \nwhen the ectocervix is slightly invaginated or when atrophy \nof the cervical hyperplastic tissue occurs after treatment. This \nmethod has good therapeutic potential with quick results, short \ntreatment times, and high economic benefits [18].\nIn the early stages of cervical lesions, aggressive treatment \nis an important measure to prevent further deterioration of the \ncervical disease. The results of the study showed that patients \nwith findings suggestive of Cervical Intraepithelial Neoplasia \n(CIN) grade I underwent a single session of focused ultrasound \ntreatment, which resulted in reduced vaginal drainage, shorter \ndrainage time, and faster wound healing after treatment. The \noperation involves continuous scanning and treatment circular-\nly, with the ectocervix as a circular point, from the inside to the \noutside, layer by layer, at a speed of 5-10 mm/s. The scanning \narea is required to cover at least the lesioned area and the nor-\nmal tissue within a range of no less than 2 mm from the outer \nedge of the lesioned tissue. During the follow-up period, immu-\nnohis to chemical examination of the patients revealed that this \ntherapy increased the expression of tumor suppressor genes, \ndecreased cell proliferation activity, further regulated the pro -\nliferation of relevant cells by decreasing the expression of P16 \nand Ki-67 in local cervical tissue, up regulated Fas expression \nand balanced apoptosis among cells, effectively promoting the \nnormalization of cervical lesions [19].\nHigh-intensity focused ultrasound, is important in assisting \nthe diagnosis of cervical cancer and guiding, monitoring, and \nassessing the process and outcome of tumor treatment in real \ntime [20]. The HEF, as an adjunct to cervical cancer treatment, \nis usually used in combination with chemotherapy and radio -\ntherapy and is important in the treatment of cervical cancer le-\nsions in patients with intermediate to advanced disease. During \nthe treatment process, the treatment is usually performed in \na multiple, progressive manner, with the approved treatment \nfrequency varying according to the disease and scope. Changes \nin the patient’s vital signs, according to the patient’s condition \ndetermine the length and period of treatment [21]. \nSclerosing vulvar lichen planus\nVulvar sclerosing Lichen Sclerosus (VLS) is a common inflam-\nmatory, non-tumourous lesion localized to the female vulva. \nThe incidence has been increasing in recent years, but there \nis a lack of accurate and effective treatment. It is mainly de -\ngenerative atrophy of the local skin and mucosa of the vulva, \nwhich, if left untreated, can lead to loss of elasticity and fail -\nure to maintain the normal anatomical function of the local \ntissues. Conventional treatment includes topical medication, \nphysiotherapy, and laser treatment. With the support of high \ntechnology, focused ultrasound can be applied in the treatment \nof vulvar sclerosing moss with remarkable results [22]. Based \non not destroying normal tissues, the thermal effect formed by \nfocused ultrasound is used to eliminate the local lesioned skin \nand subcutaneous tissues, promote local microcirculation, and \nachieve the purpose of relaxing the skin and relieving patients’ \nsymptoms. The latest guidelines state that this method is safe \nand effective when applied to patients who have unsatisfactory \nresults from medication or have contraindications to relevant \ntreatments. Experimental studies have shown that the treat -\nment of rats with simple vulvar sclerosing moss using focused \nultrasound inhibits dermal fibrosis and other cytokines related \nto the inhibition of dermal fibrosis by modulating Transforming \nGrowth Factor Beta (TGF-β) and B-Cell Lymphoma-2 (Bcl-2). Af-\nter active treatment, the degree of local recovery of the lesion \nwas close to that of the normal group [23].\nSummary and outlook\nHigh-intensity focused ultrasound, in clinical application, has \nthe advantages of good directionality, strong aggregation, and \ncontinuous propagation in an elastic medium, which causes a \nrapid increase in local temperature and physical denaturation \n\nwww.jcimcr.org                Page 4\nof the scorched domain tissue due to high temperature, playing \na therapeutic role. In clinical practice, it has been widely used \nin various tumor diseases and proliferative pains and can play \na positive therapeutic role on multiple organs and systems of \nthe whole body. With the continuous development of relevant \ntechnology and further clinical research, focused ultrasound \ntherapy will bring more patients to the gospel. In this paper, \nwe hope to enhance the understanding of this therapy among \nmore clinicians and patients and to provide references for sub-\nsequent related studies [24].\nDeclarations\nAuthor contributions: Data curation: Rui Zheng, Buwei Han, \nMengke Yuan.\nFunding acquistion: Li Liu, Hongmei Li.\nWring draft: Ding Qi, Shimeng Wang.\nWriting - editing: Ding Qi, Li Liu.\nThe data involved in our study were all derived from data -\nbases; therefore, our study did not require separate approval \nfrom the ethics committee.\nConflict of interest: No conflict of interest between the au -\nthors.\nReferences\n1. Gui Feng, Zheng Hao, Li Yanhao. Simulation study of focal do -\nmain temperature distribution in intermittent high-intensi -\nty focused ultrasound treatment [J/OL]. Applied Acoustics: \n1-12 [2021-01-31]. http://kns.cnki.net/kcms/detail/11.2121.\nO4.20210128.1053.004.html.\n2.  Lee Jae Young, Kim Kidong, Hwang Sung Il, et al. 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