Microwave ablation of adenomyosis: five-year follow-up and risk factors for recurrence of symptoms

Zhang Y, Yi Zhang, Li M, Mengying Li, Jueying Li, Gao Q, Qian Gao, Jiu Yin, Yin J, Xiaoyu Zhao, Zhao X, Li J, Jingjing Li, Zhang Q, Qinghua Zhang, Liu J, Jianxin Liu, Shunshi Yang, Yang S
European journal of obstetrics, gynecology, and reproductive biology · 2026 · vol. 326 , pp. 115364 · doi:10.1016/j.ejogrb.2026.115364 · PMID:42580181 · W7202073865
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This retrospective study of 101 adenomyosis patients found that laparoscopic microwave ablation provides durable relief, with symptomatic recurrence independently predicted by larger preoperative uterine volume and elevated CA125 levels.

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Abstract

OBJECTIVES: To evaluate the long-term therapeutic efficacy of laparoscopy combined with transvaginal ultrasound-guided microwave ablation (MWA) for adenomyosis and to identify independent risk factors for postoperative symptomatic recurrence. MATERIAL AND METHODS: This single-centre retrospective cohort study enrolled 101 patients with adenomyosis who underwent laparoscopic transvaginal ultrasound-guided MWA at the Central Hospital of Wuhan, China, with a follow-up of up to 60 months. RESULTS: Kaplan-Meier analysis estimated cumulative symptomatic recurrence rates of 5.9%, 18.3%, 26.3%, 33.1%, 40.3%, and 43.2% at 6, 12, 24, 36, 48, and 60 months,respectively. Significant differences between the symptomatic recurrence (n = 35) and non-recurrence (n = 66) groups were observed in preoperative uterine volume, lesion type, ablation time, and postoperative adjuvant therapy use (all P < 0.05). Multivariable Cox regression (C-index = 0.809) identified three independent predictors of symptomatic recurrence: larger preoperative uterine volume (HR = 1.014; 95% CI 1.008-1.019; P < 0.001),elevated preoperative CA125 (HR = 1.003; 95% CI 1.000-1.006; P = 0.045),and postoperative adjuvant pharmacotherapy as a protective factor (HR = 0.255; 95% CI 0.077-0.842; P = 0.025). ROC analysis identified an optimal preoperative uterine volume cutoff of 268 mL (AUC = 0.814;specificity 97.0%) for stratifying symptomatic recurrence risk. CA125 showed limited standalone discriminative ability (AUC = 0.592). CONCLUSIONS: Laparoscopic combined with transvaginal ultrasound-guided microwave ablation is an effective and safe uterine-preserving treatment for AM. Preoperative uterine volume and postoperative adjuvant therapy are independent risk factors for symptomatic recurrence; CA125 levels are associated with symptomatic recurrence. While microwave ablation offers durable relief for uteri with a volume below 268 mL, those exceeding this threshold may require postoperative adjuvant therapy to optimize outcomes.

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