Efficacy of high-intensity focused ultrasound combined with LNG-IUS for adenomyosis: a systematic review and meta-analysis

Objective To evaluate the efficacy and safety of high-intensity focused ultrasound (HIFU) combined with the levonorgestrel intrauterine system (LNG-IUS) for adenomyosis.

We searched PubMed, Embase, Cochrane Library, Web of Science, CNKI, SinoMed, Wanfang, and VIP databases from their inception to Nov 20, 2021 for relevant articles that compared HIFU combined with LNG-IUS vs. HIFU alone in patients with adenomyosis. RevMan5.4 software was used for the data analysis. The primary outcome was changes in volume of the uterine. Secondary outcomes included visual analog scale (VAS) scores for dysmenorrhea, serum CA125 level, recurrence rate, changes in volume of the adenomyotic lesion, menstrual volume scores, and adverse reactions. Data synthesis was conducted using a random-effects model with significant heterogeneity (I2 > 50%), and using a fixed-effects model otherwise. This study is registered on the PROSPERO platform (CRD42021295214).

The final analysis included 13 studies, with a total of 1861 patients. Results of analysis revealed that there was no significant difference in uterine volume reduction between the HIFU control group and the HIFU/LNG-IUS group at 3 months after procedure (MD:30.63). Compared with the HIFU control group, the HIFU/LNG-IUS group had more pronounced reduction in uterine volume at 6 (MD:29.04) and 12 months (MD:22.10) after procedure. The HIFU/LNG-IUS group has lower VAS scores for dysmenorrhea than the HIFU control group at 3 (MD:1.68), 6 (MD:1.69), and 12 months (MD:1.30) after procedure. Serum CA125 level in the HIFU/LNG-IUS group decreased more significantly than the HIFU control group at 6 (MD:18.34) and 12 months (MD:18.49) after procedure. The recurrence rate in the HIFU/LNG-IUS group was lower than that in the HIFU control group (RR:0.20).

Compared to HIFU control group, HIFU/LNG-IUS group for the management of adenomyosis had more advantages in alleviating symptoms and decreasing the volumes of the uterine and adenomyotic lesions. However, since the number of the included studies was too small and some of them were not RCT, this conclusion needs to be referenced with caution. Similar content being viewed by others Data availability The original literature provided for the study is featured in the article. For more detailed information, the corresponding author may be contacted directly.

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The opinions expressed in this article are the subjective opinions of patients and do not represent the opinions of their affiliated organizations or the publishers, editors, and reviewers. Funding This study was supported by the two projects. They are analysis of real-world-based prognostic factors of HIFU treatment AM and the role of Chinese medicine intervention (2021MS060, Sichuan Provincial Administration of Traditional Chinese Medicine), and real-world-based study on the management of chronic disease in AM patients after HIFU with integrated Chinese and Western medicine (2020KFA3006, State Key Laboratory of Ultrasound in Medicine and Engineering). The funding organization does not have any role in the design or conduct of this study. Author information Authors and Affiliations Contributions T-TZ developed the search strategy and completed the manuscript writing. R-NL and L-XF completed the electronic search and selected appropriate literature. L-LY and T-TZ extracted the information of the selected studies. T-TZ was responsible for data analysis using RevMan 5.4 software. YW advised on the data analysis and was responsible for correspondence. All authors carefully checked and approved the final manuscript. Corresponding author Ethics declarations Conflict of interest The authors declared that the research was conducted in the absence of any commercial or financial relationships. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. About this article Cite this article Zhao, TT., Pang, LL., Yang, LL. et al. Efficacy of high-intensity focused ultrasound combined with LNG-IUS for adenomyosis: a systematic review and meta-analysis. Arch Gynecol Obstet 308, 351–362 (2023). https://doi.org/10.1007/s00404-022-06720-z Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00404-022-06720-z