Effect of Ovarian Endometriotic Cyst on the Efficacy of High Intensity Focused Ultrasound for Adenomyosis

OBJECTIVE: To assess the effect of ovarian endometriotic cysts on the efficacy of high intensity focused ultrasound (HIFU) in patients with adenomyosis. METHODS: Based on magnetic resonance imaging (MRI) findings, patients were categorized into three groups according to the presence and type of adnexal cyst signal: group A (with endometriotic cyst signal), group B (with simple cyst signal), and group C (without cyst signal). The non-perfused volume ratio (NPVR), postoperative dysmenorrhea scores, and long-term recurrence of HIFU were compared among groups. RESULTS: A total of 396 patients were enrolled, comprising group A (77 cases), group B (134 cases), and group C (185 cases), and the NPVR were 41.83, 44.99, and 50.79%, respectively (P = .021). The postoperative dysmenorrhea scores were 3 (2, 5), 2 (1, 4), and 2 (1, 4) (P = .012), while the pregnancy rates were 20.00%, 27.27%, and 43.59%, respectively (P = .072). Cumulative recurrence rates for patients with endometriotic cysts at 1, 2, 3, 5, and 10 years were 45.60, 56.10, 57.90, 61.90, and 67.30%, respectively (log-rank P < .001). Endometriotic cysts were significantly associated with higher dysmenorrhea scores and represented an independent risk factor for postoperative pregnancy (OR = 0.338, 95% CI: 0.129-0.886, P = .027) and long-term recurrence (HR = 1.865, 95% CI: 1.275-2.728, P = .001). CONCLUSIONS: The signal of endometriotic cyst on MRI exhibits a negative correlation with the efficacy of HIFU in patients with adenomyosis. Preoperative MRI assessment of adnexal cyst signal in patients facilitates the development of a more tailored and comprehensive treatment plan for individuals suffering from adenomyosis.