Variables associated with vaginal discharge after ultrasound-guided percutaneous microwave ablation for adenomyosis

Figures & data

Figure 1. MRI images of the sagittal view in patients with adenomyosis. (A, C) T2-weighted images pre-ablation; globally enlarged uterus with local and diffuse widening of junctional zones can be seen in each image. (B, D) T1-weighted contrast-enhanced images showing non-perfused lesions corresponding to the ablated necrotic zone of A and C post-PMWA; the yellow arrow identifies the endometrium.

Table 1. Patient baseline characteristics; means ± SD or M (P25∼P75).

	Group
Items	G1 (0 days)	G2 (1–19 days)	G3 (≥ 20 days)	P
Sample size	26	40	51
Age	39.6 ± 4.9	38.0 ± 4.9	40.2 ± 4.8	0.109
BMI	22.4 ± 3.7	22.3 ± 2.6	23.4 ± 2.6	0.238
<18.5	3	3	0
18.5–23.9	16	27	33
24–27.9	5	9	15
≥28	2	1	3
Obstetric history
Gestation	2.0 ± 1.8	1.8 ± 1.3	2.0 ± 1.4	0.616
Parity	0.9 ± 0.6	0.9 ± 0.6	1.0 ± 0.5	0.729
Abortion	1.2 ± 1.5	0.8 ± 1.3	1.0 ± 1.3	0.517
Previous intrauterine treatment (With Mirena or not)				0.651
Yes	6	6	11
No	20	34	40
Phase of menstrual cycle upon treatment				0.673
Pre-ovulation	9	13	21
Post-ovulation	17	27	30
Adenomyosis type				0.005
Diffuse	5	13	29
Focal	19	27	22
Endometrium thickness (cm)	0.83 ± 0.37	0.76 ± 0.40	0.79 ± 0.31	0.755
Dysmenorrhoea score	6.3 ± 1.8	6.9 ± 2.2	7.3 ± 2.1	0.137
Hb (g/L)	109.1 ± 18.6	108.7 ± 22.9	105.2 ± 23.3	0.680
Gonadal hormonal
TTE	6.6 ± 27.8	6.8 ± 25.4	5.7 ± 23.2	0.977
E2	358.9 ± 214.6	532.0 ± 496.7	387.4 ± 284.4	0.090
LH (median)	5.8 (2.7, 8.0)	6.7 (5.4, 11.9)	5.6 (1.6, 10.0)	0.204
PRL	37.0 ± 63.7	46.0 ± 71.1	36.8 ± 60.9	0.772
FSH (median)	5.7 (3.7, 7.8)	5.5 (3.7, 8.7)	5.1 (3.8, 6.9)	0.285
P	20.2 ± 38.6	31.3 ± 95.0	19.2 ± 50.8	0.667
UFS-QOL
SSS	19.9 ± 5.2	19.9 ± 5.0	20.8 ± 4.6	0.616
HRQL	87.2 ± 25.8	94.3 ± 25.4	91.8 ± 25.2	0.544

BMI: body mass index; Hb: haemoglobin; TTE: testosterone; E₂: estradiol; LH: luteinizing hormone; PRL: prolactin; FSH: follicle-stimulating hormone; P: prog; UFS-QOL: Uterine Fibroid Symptoms Quality Of Life questionnaire; SSS: Symptom Severity Score; HRQL: Health-Related Quality of Life.

Table 2. Comparison of characteristics of lesion & microwave ablation relative parameters among groups; means ± SD or mean (P25∼P75).

	Group
Items	G1 (0 days)	G2 (1–19 days)	G3 (≥ 20 days)	P
Uterine volume pre-ablation (cm^3)a	191.3 (138.6, 302.7)	206.7 (161.9, 335.6)	297.6 (222.8, 461.0)	0.000
Minimum distance from the NPL margin to EMJ (mm, median)b	0.80 (0.28, 2.00)	0.00 (0.00, 0.58)	0.00 (0.00, 0.00)	0.000
Shrinkage rate (%)	26.52 ± 29.72	26.28 ± 23.71	21.06 ± 21.50	0.503
Total ablation energy (KJ)c	62.1 (42.0, 84.1)	77.0 (45.8, 116.5)	100.5 (70.8, 149.5)	0.000
Total ablation volume (cm^3)d	69.6 ± 58.2	76.3 ± 44.2	111.2 ± 73.1	0.005

NPL: non-perfused lesion; EMJ: endomyometrial junction;

Pairwise comparison:

^aZ_G1/G2 = −0.866, p_G1/G2 = 0.386; ^aZ_G2/G23 = −3.382, p_G2/G3 = 0.001; ^aZ_G1/G3 = −3.156, p_G1/G3 = 0.002;

^bZ_G1/G2 = −2.858, p_G1/G2 = 0.004; ^bZ_G2/G23 = −3.721, p_G2/G3 = 0.000; ^bZ_G1/G3 = −6.636, p_G1/G3=0.000;

^cZ_G1/G2 = −1.555, p_G1/G2 = 0.120; ^cZ_G2/G23 = −2.551, p_G2/G3 = 0.011; ^cZ_G1/G3 = −3.716, p_G1/G3 = 0.000;

^dZ_G1/G2 = −0.528, p_G1/G2 = 0.600; ^dZ_G2/G23 = −2.666, p_G2/G3 = 0.009; ^dZ_G1/G3 = −2.523, p_G1/G3 = 0.014;

Table 3. Logistic regression analysis of variables associated with presence of vaginal discharge post-ablation.

	P	OR	95% CI
Adenomyosis type	0.057	2.872	0.968–8.520
Uterine volume pre-ablation (cm^3)	0.971	1.000	0.995–1.006
Total ablation energy (kJ)	0.092	1.014	0.998–1.030
Total ablation volume (cm^3)	0.916	0.999	0.984–1.014
Minimum distance from NPL margin to EMJ (mm)	0.018	0.632	0.432–0.923
Constant	0.171	2.240

OR: odd ratio; CI: confidence index; NPL: non-perfused lesion; EMJ: endomyometrial junction.

Table 4. Logistic regression analysis of variables associated with prolonged (≥ 20 days) vaginal discharge post-ablation.

	P	OR	95% CI
Adenomyosis type	0.000	3.641	1.759–7.536
Uterine volume pre-ablation (cm^3)	0.396	1.001	0.998–1.005
Total ablation energy (kJ)	0.226	1.004	0.998–0.009
Total ablation volume (cm^3)	0.167	1.007	0.997–1.017
Minimum distance from NPL margin to EMJ (mm)	0.000	0.003	0.000–0.054
Constant	0.065	0.422

CI: confidence index; OR: odd ratio; NPL: non-perfused lesion; EMJ: endomyometrial junction.

Figure 2. (A, B) The zone of liquidation necrosis as observed via ultrasonography; yellow arrows identify the endometrium. The liquidation necrotic zones were connected to the endometrium. (C) Schematic diagram post-ablation. EMJ, endomyometrial junction; NPV, non-perfused lesion volume; NPL, non-perfused lesion.