Percutaneous image-guided cryoablation of umbilical endometriosis: safety, feasibility, clinical, and imaging outcomes

Objectives To evaluate the safety, feasibility and imaging outcomes of percutaneous image-guided cryoablation as a minimally invasive treatment for umbilical endometriosis (UE).

Between March 2017 and December 2024, 17 women (median age: 38 years; [IQR, 32–38]) underwent percutaneous cryoablation of UE at a single institution. Procedures were performed under ultrasound (US) alone or combined US/CT-scan guidance. Pain severity was assessed using the visual analog scale (VAS), imaging (US and MRI) and cosmetic outcomes were compared before and after treatment. Adverse events were reported according to the Society of Interventional Radiology classification (SIR).

Median lesion volume was 2.42 cm3 [IQR, 0.82–4.70] on US and 2.98 cm3 [IQR, 1.14–5.49] on MRI. 12/17 procedures (70%) were performed under general anesthesia and 16/17 on an outpatient basis (94%). Complete pain relief was achieved in 14/17 patients (82%) at a median follow-up of 22 months [IQR, 12.0–31.0]. The median peak VAS score decreased significantly from 8.0 [IQR, 6.5–9.0] to 0.0 [IQR, 0.0–0.0]; p < 0.001. On MRI, median nodule volume decreased from 2.98 cm3 to 0.90 cm3, representing a median individual reduction of 73.0% [IQR, 39.3–88.4%]. Regarding cosmetic outcomes, 82.4% (14/17) of patients were “satisfied” (score 4) or “very satisfied” (score 5). Three adverse events (17.7%) were recorded, two minor (SIR Grade B; superficial frostbite) and one major (SIR Grade C; surgical debridement).

Percutaneous image-guided cryoablation appears to be safe and feasible for umbilical endometriosis, offering significant pain relief, substantial nodule volume reduction and satisfactory cosmetic outcomes with predominantly minor adverse events. Key Points Question Umbilical endometriosis causes disabling pain and cosmetic concerns. Surgical excision is invasive and minimally invasive image-guided alternatives with proven efficacy and safety remain lacking. Findings Percutaneous cryoablation of umbilical endometriosis achieved durable pain relief (82%), significant nodule reduction (73%), and high cosmetic satisfaction in 82% of patients, with few adverse events, confirming its feasibility and safety. Clinical relevance Percutaneous cryoablation represents a minimally invasive, outpatient alternative to surgery for umbilical endometriosis, offering durable symptom relief and improved cosmetic outcomes, with low morbidity, potentially improving patients’ quality of life and broadening therapeutic options for this rare entity. Graphical Abstract Similar content being viewed by others Abbreviations - AWE: - Abdominal wall endometriosis - BMI: - Body mass index - CA: - Cryoablation - DE: - Deep pelvic endometriosis - dPEI: - Deep pelvic endometriosis index - SIR: - Society of Interventional Radiology - UE: - Umbilical endometriosis - VAS: - Visual analog scale

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Cornelis is a consultant for Boston Scientific, Varian-Siemens and Icecure. Statistics and biometry One of the authors has significant statistical expertise. No complex statistical methods were necessary for this paper. Informed consent Written informed consent was waived by the Institutional Review Board. Ethical approval Institutional Review Board approval was obtained. Study subjects or cohorts overlap No study subjects of this cohort were previously reported. Methodology - Retrospective - Observational - Performed at one institution Additional information Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Supplementary information Rights and permissions Springer Nature or its licensor (e.g. a society or other partner) 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 de Rycke, AC., Faure, A., Najdawi, M. et al. Percutaneous image-guided cryoablation of umbilical endometriosis: safety, feasibility, clinical, and imaging outcomes. Eur Radiol (2026). https://doi.org/10.1007/s00330-026-12592-7 Received: Revised: Accepted: Published: Version of record: DOI: https://doi.org/10.1007/s00330-026-12592-7