High-intensity focused ultrasound (HIFU) combined with gonadotropin-releasing hormone analogs (GnRHa) and levonorgestrel-releasing intrauterine system (LNG-IUS) for adenomyosis: a case series with long-term follow up

Figures & data

Table 1. Baseline characteristics of AD patients.

Variable	Patients, n = 142
Age, year, median (range)	39 (27–46)
Previous pregnancies, n (%)
0	5 (3.52)
1	43 (30.28)
2	87 (61.27)
3	7 (4.93)
Previous miscarriages, n (%)
0	34 (23.94)
1	90 (63.38))
2	18 (12.68)
Previous deliveries, n (%)
0	35 (24.65)
1	98 (69.01)
2	9 (6.34)
Position of uterine, n (%)
Anteposition	97 (68.31)
Retroposition	12 (8.45)
Mesoposition	33 (23.24)
Uterine volumes, cm^3 (mean ± SD)	220.32 ± 78.21
Location of AD, n (%)
Anterior wall	51 (35.92)
Posterior wall	77 (54.23)
Fundus	11 (7.75)
Lateral wall	3 (2.11)
Lesion volumes, cm^3 (mean ± SD)	120.32 ± 18.27
Anemia, n (%)
Mild (90 g/L ≤ Hemoglobin < 110 g/L)	33 (23.2)
Moderate (60 g/L ≤ Hemoglobin < 90 g/L)	18 (12.7)
Hemoglobin, g/L (mean ± SD)	94. 80 ± 3.62

Figure 1. Two-dimensional transvaginal ultrasonography imaging of uterus by GE Voluson E8 color flow ultrasound machine. (A) Before HIFU treatment, the muscular layer of the anterior wall of the uterus was significantly thickened (30.3 mm, yellow bipolar arrow); with multiple hyperechoic striations and tiny myometrial cysts (white arrows) in the interior. Endometrium was asymmetric. (B) Three months after HIFU treatment, the muscular layer of the anterior wall of the uterus was significantly thinned (21.6 mm, yellow bipolar arrow); with few hyperechoic striations and tiny myometrial cysts (white arrow) in the interior. Endometrium was symmetric.

Table 2. Uterine and AD lesions volumes of patients before HIFU and after treatment.

Time after HIFU, months	Uterine volume, cm^3 (mean ± SE)	Average reduction rate (%)	Lesion volume, cm^3 (mean ± SE)	Average reduction rate (%)	HGB, g/L (mean ± SE)	Average increase rate (%)
Before HIFU	220.32 ± 78.21		120.32 ± 18.27		94. 80 ± 3.62
1, n = 142	179.23 ± 65.82*	18.77 ± 6.49	78.21 ± 15.93*	35.07 ± 11.39	105.13 ± 4.29*	12.34 ± 3.21
3. n = 142	148.21 ± 52.63*	33.21 ± 10.15	49.33 ± 10.95*	59.13 ± 16.41	121.32 ± 5.42**	27.39 ± 4.16
6, n = 142	127.05 ± 46.72**	42.24 ± 13.43	18.05 ± 7.67**	85.33 ± 21.27	130.10 ± 6.44**	36.31 ± 4.82
12, n = 123^a	122.07 ± 44.12**	45.02 ± 13.83	24.06 ± 7.18**	80.74 ± 20.39	143.23 ± 9.03**	51.62 ± 5.92
24, n = 120^a	125.12 ± 49.56**	43.28 ± 12.29	27.38 ± 7.36**	77.26 ± 19.21	133.92 ± 8.22**	41.08 ± 5.08
36, n = 114^a	132.82 ± 48.36**	39.97 ± 11.78	32.77 ± 8.63**	72.67 ± 18.98	128.73 ± 7.71**	34.63 ± 4.77
48, n = 113^a	135.23 ± 49.21*	38.66 ± 11.47	37.85 ± 8.96**	68.45 ± 17.66	116.19 ± 6.38**	22.75 ± 4.36
60, n = 113^a	142.74 ± 51.47*	35.65 ± 11.02	40.34 ± 9.35*	66.47 ± 17.02	110.67 ± 6.92**	16.83 ± 3.78

*p < .05 versus baseline; **p < .01 versus baseline; HGB: hemoglobin.

^aCases who removed ING-IUS were excluded from this analysis.

Table 3. Dysmenorrhea score and menstrual flow analysis.

Time after HIFU, months	Dysmenorrhea score (mean ± SE)	Average reduction rate, %	p Value	Menstrual flow, mL (mean ± SE)	Average reduction rate, %	p value
Before HIFU	8.11 ± 1.63			86.64 ± 19.43
1, n = 142	6.09 ± 1.47	23.44 ± 6.32	<.05	57.88 ± 17.15	36.35 ± 11.20	<.05
3. n = 142	4.93 ± 1.33	32.73 ± 7.69	<.05	50.98 ± 16.04	40.43 ± 12.27	<.05
6, n = 142	2.07 ± 1.02	68.50 ± 11.18	<.01	43.69 ± 15.06	49.78 ± 14.53	<.01
12, n = 123^a	2.32 ± 1.05	62.46 ± 9.86	<.01	40.17 ± 15.22	52.37 ± 14.21	<.01
24, n = 120^a	2.66 ± 1.07	57.22 ± 9.03	<.01	42.67 ± 15.44	50.93 ± 16.15	<.01
36, n = 114^a	2.44 ± 1.19	60.37 ± 8.42	<.01	43.23 ± 14.89	49.29 ± 15.33	<.01
48, n = 113^a	2.89 ± 1.22	52.03 ± 8.80	<.05	44.53 ± 16.11	47.38 ± 15.92	<.05
60, n = 113^a	3.03 ± 1.22	49.57 ± 9.26	<.05	45.88 ± 15.78	44.42 ± 16.32	<.05

^aCases who removed ING-IUS were excluded from this analysis.

Table 4. Response rate and recurrence rate after treatment.

Time after HIFU, months	Dysmenorrhea, n (%)			Menstrual flow, n (%)
	CR/MR/PR/NR	Response	Recurrence	CR/MR/PR/NR	Response	Recurrence
1, n = 142	27 (19.01)/87 (61.27)/ 24 (16.90)/4 (2.82)	138 (97.18)	–	26 (18.31)/84 (59.15)/ 25 (17.61)/7 (4.93)	135 (95.07)
3. n = 142	30 (21.13)/92 (64.79)/ 20 (14.08)/2 (1.41)	140 (98.59)	–	28 (19.72)/90 (63.38)/ 19 (13.38)/5 (3.55)	137 (96.50)	–
6, n = 142	34 (23.94)/82 (57.75)/ 25 (17.61)/1 (0.70)	141 (99.30)	–	29 (20.42)/91 (65.04)/ 19 (13.38)/3 (2.11)	139 (97.89)	–
12, n = 123^a	32 (26.02)/71 (57.72)/ 19 (15.45)/1 (0.81)	122 (99.19)	0	26 (21.14)/80 (63.38)/ 15 (12.20)/2 (1.63)	121 (98.47)	1 (0.72)
24, n = 120^a	31 (25.83)/70 (58.33)/ 16 (13.33)/3 (2.50)	117 (97.50)	2 (1.42)	25 (20.83)/79 (65.83)/ 13 (10.83)/3 (2.50)	117 (97.50)	2 (1.44)
36, n = 114^a	27 (23.68)/68 (59.65)/ 14 (12.28)/5 (4.39)	109 (95.51)	4 (2.84)	22 (19.30)/75 (65.79)/ 11 (9.65)/6 (6.26)	108 (93.74)	5 (3.60)
48, n = 113^a	25 (22.12)/66 (58.41)/ 16 (14.16)/6 (5.31)	107 (94.69)	5 (3.55)	21 (18.58)/74 (60.16)/ 11 (9.73)/7 (6.19)	105 (93.81)	7 (5.04)
60, n = 113^a	24 (21.23)/67 (59.29)/ 13 (11.50)/9 (7.96)	102 (92.04)	8 (5.68)	20 (17.70)/73 (64.60)/ 9 (7.96)/11 (9.73)	101 (90.27)	11 (7.91)

CR: complete response; MR: major response; PR: partial response; NR: no response

^aCases who removed ING-IUS were excluded from this analysis.