Long-term outcome and risk factors of reintervention after high intensity focused ultrasound ablation for uterine fibroids: a systematic review and meta-analysis

Figures & data

Figure 1. Study selection flow chart.

Table 1. Characteristics of the studies included in this meta-analysis.

NO.	First author, year	Country	Data years	Study design	Sample size	Age, y	Fibroid size/diameter cm,	NPV%	T2WI image (event/n)	Follow-up (m)	Reintervention (event/n)	Monitors
							Volume, mm^3
1	Funaki, 2009	Japan	2004–2008	Prospective cohort	91	40.4 ± 4.6	177.40 ± 164.96	52.7 ± 21.63	Hypo-/iso- 12/80	24	14/91	MR-guide
									Hyper- 2/11
2	Froeling, 2013	Germany	2002–2009	Retrospective	50	36.1 ± 9.85	67.4 (40.5–138.1)	41.2% (25–75%)	None	60.7	1year 15/50	MR-guide
											5year-rei 24/36
3	Ikink, 2014	Netherlands	2010–2013	Retrospective	51	46 ± 4.44	8.5 (6.5–10.7)	<0.5 15/35	None	15(9–26)	24/51	MR-guide
								≥0.5 3/16
4	Gorny, 2014	USA	2005-–2011	Retrospective	138	45.6 ± 5.8	343.3 ± 300.4	45.5 ± 22.7	Hypo-/iso- 23/116	34(12–85)	29/138	MR-guide
									Hyper- 6/21
5	Quinn,2014	England	2003–2010	Retrospective	180	42.2	396.3	44.2	Hypo-/iso- 68/130	None	3year-rei 77/180	MR-guide
									Hyper- 35/44		5year-rei 96/162
6	Mindjuk, 2015	Germany	2010–2012	Retrospective	250	42.1 ± 6.9	5.3 ± 2.1	88.7 ± 14.4%	None	19.4	28/250	MR-guide
7	Thiburce, 2015	France	2008–2012	Retrospective	36	43.5 (41–46)	255			21.4	1Year-rei 1/36	MR-guide
											2year-rei 5/36
8	Zhao,2017	China	2012–2015	Prospective	165	37.1 ± 6.0	6.04 (3.46–10.97)	76.2 ± 20.7	Hypo-/iso- 8/112	12	22/165	US-guide
									Hyper- 12/53
9	Chen,2017	China	2011–2013	Prospective	1357	41.31 ± 5.08		87.2		12	1year-rei 14/1353	US-guide
10	Mohr-Sasson,2018	Israel	2012–2017	Retrospective	68	44 ± 6.67	7 ± 1.85	None	None	36.5(24.2–41.7)	9/68	MR-guide
11	Xu,2018	China, Suining	2010–2014	Retrospective	450	42 ± 5		83 (65–100)		24	1year-rei 6/450	US-guide
											2year-rei 13/450
12	Laughlin-Tommaso, 2019	America	2010–2014	Prospective	43	44.5 ± 5.0	249.2 ± 159.9	None	None	36	3year-Riv 13/43	MR-guide
13	Verpalen, 2020	Netherlands	2010–2017	Retrospective	87	44.6 ± 4.7	9.3 ± 3.1	45.03 ± 27.89	None	63.5 ± 29.0	29/87	MR-guide
14	Li, 2020	China	2012–2014	Retrospective	381	42.4 ± 5.0	5.46 ± 1.52	81.9 (90.36–91.91)	Hypo-/iso- 53/303	70.0 ± 9.0	79/381	US-guide
									Hyper- 26/78
15	Hu,2020	China	2011–2014	Retrospective	412	40 ± 5.6	6.2 ± 1.6	87.1 ± 16.3	2year Hypo-/iso-6/331 Hyper- 7/81	77	1year-rei 3/412	US-guide
											2year-rei 13/412
									5year Hypo-/iso- 25/331 Hyper- 19/81		3year-rei 29/412
									5year-rei 44/412
16	Liu, 2021	China	2011–2016	Retrospective	536	40.59 ± 9.46	5.7 ± 1.94	>74.3	Hypo-/iso- 47/395	69(48–89)	77/536	US-guide
									Hyper- 63/142
17	Liu, 2022	China	2007–2016	Retrospective cohort	730	38.8 ± 6.3	6.4 ± 2	86 ± 32.59	None	84(44–142)	1year-rei 5/730	US-guide
											3year-Riv 30/730
											5year-Riv 50/730
18	Zeng, 2022	China. Nanchong	2016–2017	Retrospective	191	41	<6.58		Hypo-/iso- 28/156	60	5year-rei 43/191	US-guide
									Hyper- 28/77

NPV, non-perfusion volume; Hyper-, Hyper-intensity fibroids on T2WI; Hypo-/iso-, Hypo-/iso-intensity fibroids on T2WI; 1 year-rei, 1-year reintervention; 2 year-rei, 2-year reintervention; 3 year-rei, 3-year reintervention; 5 year-rei, 5-year reintervention; MR-guide, Magnetic resonance guide; US-guide, ultrasound guide.

Figure 2. Forest map of overall intervention risk at 12-,24-,36-,60-months. A. Forest map of overall intervention risk at 12-month; B. Forest map of overall intervention risk at 24-month; C. Forest map of overall intervention risk at 36-month; D. Forest map of overall intervention risk at 60-month.

Table 2. Overall reintervention risk.

Time	Rei (95%CI) %	I ^2%	Total sample size
12- month	1 (1–1)	92	3247 [9,12,18,20,22,24,26,30]
24- month	7 (4–11)	86	1239 [12,22,25,28,30]
36- month	19 (11–27)	96	1762 [11,20–21,23,27,29,31]
60- month	29 (14–44)	97	2535 [12,17,20,21,24,27–29]

Rei, reintervention rate.

Table 3. Subgroup reintervention rate.

	12-month Rei%					24-month Rei%					36-month Rei%					60-month Rei%
Subgroup	(95%CI)	I^2%	No.	Sample size	P-value	(95%CI)	I^2%	No.	Sample size	P-value	(95%CI)	I^2%	No.	Sample size	P-value	(95%CI)	I^2%	No.	Sample size	P-value
the year of surgery																				<0.001
<2010	None					None					None					61 (54–67)	0	2	198
≥2010	None					None					None					16 (14–17)	88	5	1607
sample size					0.08					0.007					0.82					0.11
<100	12 (7–16)	95	3	137		15 (0.8–21)	0	2	127		21 (4–37)	77	2	111		49 (17–82)	92	2	123
>100	0.9 (0.6–1)	83	5	3110		5 (2–9)	87	3	1112		19 (9–28)	97	5	1651		22 (13–31)	98	6	2412
Guide method					0.08					<0.001					0.004					0.0002
MR-guide	12 (7–16)	95	3	137		12 (9–16)	0	3	377		29 (15–42)	90	4	429		53 (33–72)	90	3	285
US-guide	0.9 (0.6–1)	83	5	3110		3 (2–4)	0	2	862		8 (3–12)	88	3	1333		15 (9–20)	93	5	2250
NPVR					<0.001										<0.001					0.0002
<50%	38 (22–55)	69	2	101		None					36 (21–50)	87	2	318		53 (33–72)	90	3	285
>50%	1 (0.3–2)	83	5	3110		None					5 (3–8)	75	2	1142		15 (9–20)	93	5	2250

Rei, reintervention rate; MR-guide, Magnetic resonance guide; US-guide, Ultrasound guide; NPVR, non-perfusion volume ratio; No. Number of studies.

Figure 3. Forest map of different T2WI signal intensity. Hyper-, Hyper-intensity fibroids on T2WI; Hypo-/iso-, Hypo-/iso-intensity fibroids on T2WI.

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Data availability statement

This is a meta-analysis study, and the data that support the findings of this study are available in reference number [9,11,12,17,18,20–31]. The Characteristics of included studies are shown in Supplement 2.