High intensity focused ultrasound treatment for non-neoplastic epithelial disorders of the vulva: Factors affecting effectiveness and recurrence

Figures & data

Figure 1. Pathological features of SH before and after HIFU treatment. (A) SH before treatment, squamous epithelial cell proliferation, extended epithelial ridges, excessive cornification in epidermis, thickened prickle cell layers, and various degrees of lymphocytes infiltration. (B) SH after treatment, the cornification of epithelial cells and the structure of the prickle cell layer are normalised. HE (hematoxylin-eosin staining) 100 × diseased tissues.

Figure 2. Pathological features of LS before and after HIFU treatment. (A) LS before treatment, squamous epithelium is thin, epithelial ridge becomes blunt or disappeared; cornification appears in epidermis, the superficial layer of dermis develops oedema, and fibrous tissue shows hyperplasia and glassy degeneration. (B) LS after treatment, the epithelium is thickened, epithelial ridges become obvious, and number of inflammatory infiltrated cells has decreased. HE (hematoxylin-eosin staining) 100 × diseased tissues.

Table 1. Single factor analysis of the effectiveness of HIFU treatment for NNEVD.

Variable	Ineffective (N = 16)	Effective (N = 533)	Curative (N = 401)	Z	P
Age				−3.024	0.003
≤42 years (N = 493)	7 (1.4%)	255 (51.7%)	231 (46.9%)
>42 (N = 457)	9 (2.0%)	278 (60.8%)	170 (37.2%)
Course				−0.976	0.329
≤3 years (N = 484)	10 (2.1%)	260 (53.7%)	214 (44.2%)
>3 years (N = 449)	6 (1.3%)	261 (58.1%)	182 (40.5%)
Menopause				−2.544	0.011
Post-menopause (N = 297)	8 (2.7%)	180 (60.6%)	109 (36.7%)
Pre-menopause (N = 648)	8 (1.2%)	349 (53.9%)	291 (44.9%)
HPV infection				−1.397	0.162
Positive (N = 796)	15 (1.9%)	436 (54.8%)	345 (43.3%)
Negative (N = 154)	1 (0.7%)	97 (63.0%)	56 (36.4%)
Lesion size/vulva size				6.972	0.031
<30% (N = 228)	5 (2.2%)	116 (50.9%)	107 (46.9%)
30–50% (N = 556)	7 (1.3%)	311 (55.9%)	238 (42.8%)
>50% (N = 166)	4 (2.4%)	106 (63.9%)	56 (33.7%)
Pathological type				−2.524	0.012
SH (N = 800)	15 (1.9%)	432 (54.0%)	353 (44.1%)
LH (N = 150)	1 (0.7%)	101 (67.3%)	48 (32.0%)
Symptoms				1.746	0.418
No/mild (N = 22)	1 (4.6%)	14 (63.6%)	7 (31.8%)
Moderate (N = 18)	0 (0.0%)	12 (66.7%)	6 (33.3%)
Severe (N = 910)	15 (1.7%)	507 (55.7%)	388 (42.6%)

Note: 17 patients had no specific symptoms and the disease course was not clear; five patients were non-menarchal.

Table 2. Single-factor analysis of the recurrence of HIFU treatment for NNEVD.

Variable	No recurrence (N = 861)	Recurrence (N = 89)	χ^2	P
Age			1.679	0.195
≤42 (N = 493)	441 (89.5%)	52 (10.6%)
>42 (N = 547)	420 (91.9%)	37 (8.1%)
Course			4.741	0.029
≤3 years (N = 484)	449 (92.8%)	35 (7.2%)
>3 years (N = 449)	398 (88.6%)	51 (11.4%)
Menopause			0.007	0.934
Post-menopause (N = 297)	270 (90.9%)	27 (9.1%)
Pre-menopause (N = 648)	588 (90.7%)	60 (9.3%)
HPV infection			0.030	0.863
Positive (N = 796)	722 (90.7%)	74 (9.3%)
Negative (N = 154)	139 (90.3%)	15 (9.7%)
Lesion size/vulva size			0.021	0.990
<30% (N = 228)	207 (90.8%)	21 (9.2%)
30%–50% (N = 556)	504 (90.7%)	52 (9.4%)
>50% (N = 166)	150 (90.4%)	16 (9.6%)
Pathological type			5.889	0.015
SH (N = 800)	733 (91.6%)	67 (8.4%)
LH (N = 150)	128 (85.3%)	22 (14.7%)
Symptoms				0.609*
No/mild (N = 22)	19 (86.4%)	3 (13.6%)
Moderate (N = 18)	16 (88. %9)	2 (11.1%)
Severe (N = 910)	826 (90.8%)	84 (9.2%)

Note: 17 patients had no specific symptoms and the disease course was not clear; five patients were non-menarchal.

*Fisher’s exact test.

Table 3. Multi-variant analysis of the effectiveness of HIFU treatment for NNEVD.

Variable	B	SE	Wald χ^2	p Value	OR (95%CI)
Age	−0.389	0.133	8.501	0.004	0.678 (0.522, 0.880)
Menopause	0.102	0.191	0.285	0.594	1.107 (0.762, 1.609)
Lesion/vulva size	−0.248	0.104	5.655	0.017	0.780 (0.636, 0.957)
Pathological type	−0.395	0.189	4.372	0.034	0.674 (0.465, 0.976)

B: coefficient of the variable in the model, S.E: standard error of the coefficent; OR:, odds ratio; 95%CI, 5% confidence interval.

Table 4. Multiple variant analysis of recurrence after HIFU treatment for NNEDV.

Variable	B	SE	Wald χ^2	p Value	OR (95%CI)
Course of  disease	0.490	0.231	4.525	0.033	1.633 (1.039, 2.566)
Pathological  type	0.550	0.274	4.034	0.045	1.734 (1.013, 2.965)

B: coefficient of the variable in the model, S.E: standard error of the coefficent OR:, odds ratio; 95%CI, 95% confidence interval.