Correlation between sonographic classification and the efficacy of microwave ablation for adenomyosis

Adenomyosis is a common benign gynecological disease. Patients often experience abnormal uterine bleeding, dysmenorrhea, and infertility. Percutaneous microwave ablation (PMWA) is a minimally invasive method used for treating adenomyosis while preserving the uterus. However, no study has examined whether the efficacy of PMWA differs according to the severity of adenomyosis. This study aimed to investigate the correlation between sonographic classification and the efficacy of ultrasound-guided PMWA for adenomyosis.

This cross-sectional study included 129 patients with symptomatic adenomyosis who received PMWA in the Longyan First Affiliated Hospital of Fujian Medical University between May 2019 and October 2022. Patients were divided into three groups of sonographic classification: mild (n=31; 1-3 points), moderate (n=50; 4-6 points), and severe (n=48; ≥7 points). To clarify the effect of PMWA treatment in the different degrees of adenomyosis, clinical questionnaire data were obtained for the three groups using the preoperative and 3-, 6-, and 12-month postoperative menstrual pictorial blood loss analysis chart (PBAC), the dysmenorrhea visual analog scale (VAS), symptom severity scale (SSS), and health-related quality of life scale (HRQL). The uterine corpus volume (UCV) and postoperative UCV reduction rate (UCR) were also calculated, and the correlation between the ultrasound scores and these indicators was analyzed. Nonparametric tests were used to examine differences in measures of efficacy between and within groups. The Chi-square or Fisher exact test was used to examine the intergroup differences in the type of adenomyosis composition, satisfaction with efficacy, and complications.

The severe group had the highest preoperative menstrual blood loss, uterine volume, and SSS score but the lowest HRQL score. The moderate group had the highest VAS score. Additionally, the PBAC, VAS, SSS, HRQL, and UCV in the three groups improved postoperatively (all P values <0.05). The moderate, mild, and severe groups demonstrated significant improvements in UCR, the highest proportion of satisfactory efficacy, and the highest proportion of unsatisfactory efficacy, respectively. Most adverse reactions were mild. Ultrasound scores were positively correlated with preoperative PBAC [Spearman's rank correlation coefficient (r_s) =0.573; 95% confidence interval (CI): 0.384-0.727; P<0.001], SSS (r_s =0.299; 95% CI: 0.122-0.467; P=0.002), UCV (r_s =0.575; 95% CI: 0.421-0.715; P<0.001), and 12-month postoperative UCR (r_s =0.623; 95% CI: 0.485-0.739; P<0.001); meanwhile, ultrasound scores were negatively correlated with preoperative HRQL (r_s =-0.301; 95% CI: -0.478 to -0.111; P=0.002). There was no significant correlation between ultrasound scores and preoperative VAS (r_s =0.076; 95% CI: -0.119 to 0.262; P=0.450).

Sonographic classification reflected the severity of adenomyosis. The therapeutic effect of PMWA on adenomyosis varied across patients according to the severity of adenomyosis. Sonographic classification may potentially serve as a preoperative image-evaluation tool for predicting the ablation effect of PMWA.