Correlation between sonographic classification and the efficacy of microwave ablation for adenomyosis

Yufen Lin, Zuolin Li, Min Lin, Xiaolian Li, Sihua Qiu, Jiantang Zhang, Yinyin Xie, Guorong Lyu, Shuiping Li
Quantitative imaging in medicine and surgery · 2024 · vol. 14(12) , pp. 8644–8657 · doi:10.21037/qims-24-933 · PMID:39698632 · PMC11652000 · W4404601130
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This study found that microwave ablation for adenomyosis efficacy varied with disease severity, with higher sonographic scores correlating with worse preoperative symptoms and larger uterine volumes.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This retrospective cross-sectional study evaluated whether ultrasound-based sonographic severity/type classifications of adenomyosis predict the 12-month efficacy of percutaneous microwave ablation (PMWA). Patients treated between 2019 and 2022 at a single hospital underwent transvaginal ultrasound with 3D assessment of the junctional zone, were grouped into mild/moderate/severe by a Lazzeri-style scoring system, and had outcomes tracked using PBAC, VAS dysmenorrhea scores, UFS-QOL, and uterine corpus volume reduction, alongside adverse events graded by SIR. The key finding was the correlation between sonographic classification severity/type and PMWA efficacy categories at follow-up. A major limitation is that the analysis was retrospective, performed at one center by an experienced clinician/team, and includes specified exclusions (e.g., hormonal therapies and MRI/US features of deep endometriosis), which may affect generalizability. This paper is centrally about endometriosis and adenomyosis research — it specifically addresses adenomyosis by correlating ultrasound sonographic classification with the efficacy of microwave ablation.

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Abstract

BACKGROUND: Adenomyosis is a common benign gynecological disease. Patients often experience abnormal uterine bleeding, dysmenorrhea, and infertility. Percutaneous microwave ablation (PMWA) is a minimally invasive method used for treating adenomyosis while preserving the uterus. However, no study has examined whether the efficacy of PMWA differs according to the severity of adenomyosis. This study aimed to investigate the correlation between sonographic classification and the efficacy of ultrasound-guided PMWA for adenomyosis. METHODS: This cross-sectional study included 129 patients with symptomatic adenomyosis who received PMWA in the Longyan First Affiliated Hospital of Fujian Medical University between May 2019 and October 2022. Patients were divided into three groups of sonographic classification: mild (n=31; 1-3 points), moderate (n=50; 4-6 points), and severe (n=48; ≥7 points). To clarify the effect of PMWA treatment in the different degrees of adenomyosis, clinical questionnaire data were obtained for the three groups using the preoperative and 3-, 6-, and 12-month postoperative menstrual pictorial blood loss analysis chart (PBAC), the dysmenorrhea visual analog scale (VAS), symptom severity scale (SSS), and health-related quality of life scale (HRQL). The uterine corpus volume (UCV) and postoperative UCV reduction rate (UCR) were also calculated, and the correlation between the ultrasound scores and these indicators was analyzed. Nonparametric tests were used to examine differences in measures of efficacy between and within groups. The Chi-square or Fisher exact test was used to examine the intergroup differences in the type of adenomyosis composition, satisfaction with efficacy, and complications. RESULTS: The severe group had the highest preoperative menstrual blood loss, uterine volume, and SSS score but the lowest HRQL score. The moderate group had the highest VAS score. Additionally, the PBAC, VAS, SSS, HRQL, and UCV in the three groups improved postoperatively (all P values <0.05). The moderate, mild, and severe groups demonstrated significant improvements in UCR, the highest proportion of satisfactory efficacy, and the highest proportion of unsatisfactory efficacy, respectively. Most adverse reactions were mild. Ultrasound scores were positively correlated with preoperative PBAC [Spearman's rank correlation coefficient (rs) =0.573; 95% confidence interval (CI): 0.384-0.727; P<0.001], SSS (rs =0.299; 95% CI: 0.122-0.467; P=0.002), UCV (rs =0.575; 95% CI: 0.421-0.715; P<0.001), and 12-month postoperative UCR (rs =0.623; 95% CI: 0.485-0.739; P<0.001); meanwhile, ultrasound scores were negatively correlated with preoperative HRQL (rs =-0.301; 95% CI: -0.478 to -0.111; P=0.002). There was no significant correlation between ultrasound scores and preoperative VAS (rs =0.076; 95% CI: -0.119 to 0.262; P=0.450). CONCLUSIONS: Sonographic classification reflected the severity of adenomyosis. The therapeutic effect of PMWA on adenomyosis varied across patients according to the severity of adenomyosis. Sonographic classification may potentially serve as a preoperative image-evaluation tool for predicting the ablation effect of PMWA.

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Outcome instruments

VAS-pain

Condition tags

adenomyosisdysmenorrheainfertility

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (34)

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