HIFU as an alternative modality for patients with uterine fibroids who require fertility-sparing treatment

Figures & data

Figure 1. Flow diagram of literature selection was shown, with the final number of studies as 54.

Table 1. Characteristics and quality assessment of the included studies.

Author	Year	Study design	Age (mean or median)			Clinical period year	Patients				NOS score
			HIFU	UAE	Myomectomy		HIFU	UAE	Myomectomy	Total
Morita Y	2008	Prospective	42.6			2005.01–2006.02	48			48	6
Funaki K	2009	Prospective	40.4			2004.06–2008.06	80			80	5
Qin J	2012	Retrospective	34.5			2006.10–2009.10	435			435	3
Froeling V	2013	Retrospective	36.2	42.7		2002–2009	36	41		77	7
Yoon SW	2013	Retrospective	41.3			2006.08–2007.05	52			52	4
Lee JS	2015	Retrospective	40.49			2010.02–2015.10	272			618	3
Mindjuk I	2015	Retrospective	42.6			2005.01–2006.02	48			48	6
Thiburce AC	2015	Retrospective	43.5			2008.10–2012.11	32			32	4
Chen R	2016	Prospective	44.5			NR	107			107	4
Zou M	2017	Retrospective	NR			2011.04–2016.03	406			406	3
Li JS	2017	Retrospective	31.4			2010.01–2015.01	189			189	5
Keserci B	2017	Prospective	39.2			NR	76			76	7
Liu X	2018	Prospective	NR			2008.01–2004.12	174			174	5
Loziński T	2019	Retrospective	33.2			2015.04–2018.05	276			276	4
Wu G	2020	Prospective	NR		NR	2009.05–2018.05	320		336	676	7
Verpalen IM	2020	Retrospective	NR			2010.04–2017.12	112			112	7
Campo S	1999	Prospective			33.9	1993.06–1996.12			60	60	7
Seracchioli R	2000	Prospective			34.0(LM), 33.9(TAM)	1993.01–1998.01			66(LM), 65(TAM)	131	8
Dessolle L	2001	Retrospective			36.1	1990.01–1998.10			88	88	5
Campo S	2003	Prospective			34.3(LM), 33.1(TAM)	1990.01–1996.12			22(LM), 19(TAM)	41	7
Soriano D	2003	Retrospective			36.1(LM), 34.7(TAM)	1990.01–1998.10			88(LM), 18(TAM)	106	7
Kumakiri J	2005	Retrospective			35.5	1998.01–2002.12			108	108	7
Paul PG	2006	Retrospective			30	1993.06–2003.08			217	217	4
Sizzi O	2007	Prospective			NR	1998.01–2004.12			1683	1683	8
Palomba S	2007	Prospective			28	2002.01–2003.03			68(LM), 68(TAM)	136	7
Liu WM	2007	Prospective			33.9(LM), 34.2(TAM)	1999.01–2004.01			30(LM), 52(TAM)	82	7
Kavallaris A	2010	Retrospective			34.5	2001.01–2006.12			65	65	4
Tinelli A	2012	Prospective			36.5	2005.03–2010.09			325	325	5
Pitter MC	2013	Retrospective			34.8	2005.10–2010.11			872	872	4
Bernardi TS	2014	Prospective			33	2001.01–2006.12			59	59	3
Zhang Y	2014	Retrospective			NR	2008.01–2012.06			280(LM),191(TAM)	471	6
Pitter MC	2015	Retrospective			37.9	2005.08–2013.11			426	426	6
Koo YJ	2015	Retrospective			31.7	1994.08–2012.12			523	523	5
Chan CC	2016	Prospective			NR	2010.01–2012.08			62	62	7
Tian YC	2017	Prospective			NR	2008.06–2012.11			35(LM),48(TAM)	83	7
Kang SY	2017	Retrospective			35.3	2009.04–2013.10			92	92	4
Xie L	2018	Retrospective			NR	2014.01–2015.11			40	40	7
Kundu S	2018	Retrospective			NR	2009–2013			78(LM),177(TAM)	255	6
Pepin K	2020	Retrospective			NR	2008.04–2016.12			240	240	6
Floss K	2015	Retrospective			34.6	2004.06–2008.06			160	160	5
Walker WJ	2002	Prospective		NR		1996.12–2001.02		365		365	5
Carpenter TT	2005	Retrospective		NR		1996.12–2003.01		470		470	3
Pron G	2005	Prospective		43		1998.11–2000.11		555		555	5
Dutton S	2007	Retrospective		43.8		1994.10–2002.12		649		649	5
Volkers NA	2007	Prospective		NR		2002.03–2004.02		81		81	7
Holub Z	2008	Prospective		NR		2000.03–2006.06		112		112	7
Pinto Pabón I	2008	Prospective		39.7		2002.01–2006.06		100		100	5
Mara M	2008	Prospective		NR		2001.11–2005.12		58		58	7
Firouznia K	2009	Prospective		31.2		2001.11–2004.11		102		102	5
Bonduki CE	2011	Retrospective		34.3		2005.07–2008.12		187		187	3
Mara M	2012	Prospective		33.1		NR		100		100	7
Redecha M	2013	Prospective		NR		2009.06–2011.10		98		98	6
McLucas B	2014	Retrospective		33		2000–2012		104		104	5
Torre A	2014	Prospective		NR		2006.12–2011.6		62		62	7

Age is shown as the mean or median. HIFU: high-intensity focused ultrasound; LM: laparoscopic myomectomy; TAM: transabdominal myomectomy; UAE: uterine artery embolization; NR: not reported.

Table 2. Pregnancy rate and miscarriage rate following HIFU and other surgical methods in the treatment of uterine fibroids.

Variables	Number of studies	Number of patients	Ratio	I-squared (%)	p Value
			(95%CI)
Pregnancy rate
HIFU	16	2867	0.18 (0.10, 0.26)	98.7	0.000
Myomectomy	25	6655	0.43 (0.36, 0.49)	97.2	0.000
UAE	14	3043	0.08 (0.06, 0.10)	86.9	0.000
Miscarriage rate
HIFU	8	495	0.08 (0.04, 0.12)	50.5	0.049
Myomectomy	13	984	0.15 (0.09, 0.21)	81.4	0.000
UAE	2	25	0.16 (0.01, 0.30)	0	0.665

HIFU: high-intensity focused ultrasound; UAE: uterine artery embolization.

Table 3. Pregnancy rate and miscarriage rate following USgHIFU and MRgHIFU in the treatment of uterine fibroids.

Variables	Number of studies	Number of patients	Ratio	I-squared (%)	p Value
			(95%CI)
Pregnancy rate
HIFU	16	2867	0.18 (0.10, 0.26)	98.7	0.000
USgHIFU	6	1796	0.35 (0.16, 0.53)	99.6	0.000
MRgHIFU	10	1071	0.06 (0.04, 0.08)	61.3	0.000
Miscarriage rate
HIFU	8	495	0.08 (0.04, 0.12)	50.5	0.049
USgHIFU	4	452	0.07 (0.03, 0.11)	56.5	0.075
MRgHIFU	4	43	0.17 (0.02, 0.33)	44.4	0.145

USgHIFU: ultrasound-guided high-intensity focused ultrasound; MRgHIFU: magnetic resonance-guided high-intensity focused ultrasound.

Table 4. Characteristics of the patients with uterine fibroids treated with HIFU (n = 26).

Items	Mean ± SD/ratio
Age	35.38 ± 5.53
BMI	22.00 ± 3.28
SSS	24.23 ± 6.74
UFS-QOL	65.46 ± 17.91
Menometrorrhagia
Yes	12 (46.2%)
No	14 (53.8%)
Dysmenorrhea
Yes	15 (57.7%)
No	11 (42.3%)
Polyuria and/or constipation
Yes	8 (30.8%)
No	18 (69.2%)
Anemia
Yes	10 (38.5%)
No	16 (61.5%)
T2WI
Iso-low signal	13 (50%)
High-confounding signal	13 (50%)

BMI: body mass index; SSS: symptom severity score; UFS-QOL: Uterine Fibroid Symptom Quality of Life; T2WI: T2-weighted MRI.

Table 5. Self-control of PI, RI and S/D before and after HIFU.

Items	Mean ± SD		p Value
	Pre-treatment	Post-treatment
PI
Left side	1.651 ± 0.714	1.798 ± 0.531	0.281
Right side	1.637 ± 0.435	1.845 ± 0.469	0.033
RI
Left side	0.738 ± 0.129	0.778 ± 0.073	0.15
Right side	0.729 ± 0.141	0.784 ± 0.081	0.039
S/D
Left side	4.769 ± 2.851	5.067 ± 1.998	0.616
Right side	4.394 ± 1.559	4.914 ± 1.918	0.259

PI: pulsatility index; RI: resistance index; S/D: systolic-to-diastolic peak velocity (S/D).

Data availability statement

The authors confirm that the data supporting the findings of this study are available within the article.