MRI-Based Classification Systems Combined with Serum CA125 for Predicting Symptom Recurrence After Ultrasound-Guided High-Intensity Focused Ultrasound Ablation Surgery for Adenomyosis: A Retrospective Cohort Study

Tang Y, Tian HD, Chen XM, Wang H, Shen LM, Ni SQ, Su B, Jiang ZJ, Zhu LJ, Luo YX, Shi Q
In: International Journal of Women's Health, Vol Volume 18, Iss Issue 1, Pp 1-12 (2026) · 2026 · W7155111584
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This study found that a preoperative serum CA125 level of ≥ 35 U/mL combined with MRI-defined lesion extent of ≥ 2/3 uterine wall involvement can predict symptom recurrence after focused ultrasound ablation surgery for adenomyosis.

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This retrospective cohort study analyzed 502 patients with adenomyosis to identify predictors of symptom recurrence following ultrasound-guided high-intensity focused ultrasound ablation surgery. Researchers utilized multivariate logistic regression and Kaplan-Meier analysis to evaluate the predictive value of preoperative serum CA125 levels and MRI-based lesion extent, specifically focusing on whether lesions involved two-thirds or more of the uterine wall. The findings indicated that elevated CA125 levels above 35 U/mL combined with extensive uterine involvement significantly correlated with shorter recurrence-free survival, although the combined model demonstrated only modest discriminatory power with an AUC of 0.580. This paper is centrally about adenomyosis — specifically developing a risk prediction model for symptom recurrence after focal ultrasound ablation based on imaging and biomarker data.

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Abstract

Ying Tang,1,2,&ast; Hua-Dong Tian,1,&ast; Xiao-Mei Chen,1,&ast; Hang Wang,3,&ast; Li-Ming Shen,1 Shang-Qi Ni,1 Bin Su,1 Zhi-Jun Jiang,4 Li-Juan Zhu,4 Yue-Xi Luo,1 Qiuling Shi2 1Department of Obstetrics and Gynecology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, People’s Republic of China; 2State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, People’s Republic of China; 3Department of Obstetrics and Gynecology, Si Chuan Mian Yang 404 Hospital, Mian Yang, Sichuan, People’s Republic of China; 4Department of Radiology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yue-Xi Luo, Department of Obstetrics and Gynecology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, People’s Republic of China, Email [email protected] Qiuling Shi, State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, People’s Republic of China, Email [email protected]: The underlying mechanisms of symptom recurrence or established comprehensive predictive models have not yet elucidated. This study aimed to establish a prediction model for symptom recurrence following focused ultrasound ablation surgery (FUAS) in adenomyosis based on magnetic resonance imaging (MRI)-based classification system incorporating serum cancer antigen (CA) 125 levels.Methods: We conducted a retrospective cohort study of 502 adenomyosis patients, divided into recurrence (n=133) and non-recurrence (n=369) groups. Patients were stratified by MRI lesion extent: ≥ 2/3 uterine wall involvement (n=446) vs < 2/3 (n=56). Symptom recurrence (dysmenorrhea and/or menorrhagia) was the primary outcome. Univariate and multivariate logistic regression identified predictors. Receiver operator characteristic curve analysis determined CA125 cutoffs. Kaplan–Meier curves and Cox regression assessed recurrence-free survival.Results: Patients with ≥ 2/3 involvement had higher CA125 (57.9 vs 32.1 U/mL, P< 0.001). Recurrence group had higher CA125 (71.5 vs 51.14 U/mL, P< 0.001). Multivariate analysis identified CA125 (OR=1.002, 95% CI: 1.001– 1.004), diffuse grayscale changes (OR=0.632, 95% CI: 0.407– 0.981), and combined GnRH-a/LNG-IUS therapy (OR=0.504, 95% CI: 0.323– 0.785) as independent predictors. In the ≥ 2/3 subgroup, CA125 > 35 U/mL predicted shorter recurrence-free survival (37.7 vs 43.9 months, P=0.001). The combined model (CA125 ≥ 35 U/mL + lesion ≥ 2/3) yielded an AUC of 0.580 (95% CI: 0.533– 0.626).Conclusion: A preoperative CA125 level ≥ 35 U/mL combined with MRI-based lesion extent ≥ 2/3 uterine wall involvement may effectively identify adenomyosis patients at high risk of post-FUAS recurrence. Further prospective studies are warranted.Plain Language Summary: High CA125 level combined with MRI-based lesion extent ≥ 2/3 uterine wall involvement could better inform symptom recurrence of adenomyosis after FUAS.Keywords: MRI, CA125, adenomyosis, symptom recurrence, focused ultrasound ablation surgery, risk prediction model
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International Journal of Women's Health (Apr 2026) MRI-Based Classification Systems Combined with Serum CA125 for Predicting Symptom Recurrence After Ultrasound-Guided High-Intensity Focused Ultrasound Ablation Surgery for Adenomyosis: A Retrospective Cohort Study Abstract Ying Tang,1,2,* Hua-Dong Tian,1,* Xiao-Mei Chen,1,* Hang Wang,3,* Li-Ming Shen,1 Shang-Qi Ni,1 Bin Su,1 Zhi-Jun Jiang,4 Li-Juan Zhu,4 Yue-Xi Luo,1 Qiuling Shi2 1Department of Obstetrics and Gynecology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, People’s Republic of China; 2State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, People’s Republic of China; 3Department of Obstetrics and Gynecology, Si Chuan Mian Yang 404 Hospital, Mian Yang, Sichuan, People’s Republic of China; 4Department of Radiology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yue-Xi Luo, Department of Obstetrics and Gynecology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, People’s Republic of China, Email [email protected] Qiuling Shi, State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, People’s Republic of China, Email [email protected]: The underlying mechanisms of symptom recurrence or established comprehensive predictive models have not yet elucidated. This study aimed to establish a prediction model for symptom recurrence following focused ultrasound ablation surgery (FUAS) in adenomyosis based on magnetic resonance imaging (MRI)-based classification system incorporating serum cancer antigen (CA) 125 levels.Methods: We conducted a retrospective cohort study of 502 adenomyosis patients, divided into recurrence (n=133) and non-recurrence (n=369) groups. Patients were stratified by MRI lesion extent: ≥ 2/3 uterine wall involvement (n=446) vs < 2/3 (n=56). Symptom recurrence (dysmenorrhea and/or menorrhagia) was the primary outcome. Univariate and multivariate logistic regression identified predictors. Receiver operator characteristic curve analysis determined CA125 cutoffs. Kaplan–Meier curves and Cox regression assessed recurrence-free survival.Results: Patients with ≥ 2/3 involvement had higher CA125 (57.9 vs 32.1 U/mL, P< 0.001). Recurrence group had higher CA125 (71.5 vs 51.14 U/mL, P< 0.001). Multivariate analysis identified CA125 (OR=1.002, 95% CI: 1.001– 1.004), diffuse grayscale changes (OR=0.632, 95% CI: 0.407– 0.981), and combined GnRH-a/LNG-IUS therapy (OR=0.504, 95% CI: 0.323– 0.785) as independent predictors. In the ≥ 2/3 subgroup, CA125 > 35 U/mL predicted shorter recurrence-free survival (37.7 vs 43.9 months, P=0.001). The combined model (CA125 ≥ 35 U/mL + lesion ≥ 2/3) yielded an AUC of 0.580 (95% CI: 0.533– 0.626).Conclusion: A preoperative CA125 level ≥ 35 U/mL combined with MRI-based lesion extent ≥ 2/3 uterine wall involvement may effectively identify adenomyosis patients at high risk of post-FUAS recurrence. Further prospective studies are warranted.Plain Language Summary: High CA125 level combined with MRI-based lesion extent ≥ 2/3 uterine wall involvement could better inform symptom recurrence of adenomyosis after FUAS.Keywords: MRI, CA125, adenomyosis, symptom recurrence, focused ultrasound ablation surgery, risk prediction model

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