Ultrasound-guided percutaneous cryoablation under local anesthesia: a promising treatment method for symptomatic...

Adenomyosis is characterized by ectopic endometrial tissue, which causes dysmenorrhea, menstruation, and infertility, significantly impairing quality of life. Current treatments-including medications, surgery, and interventional methods-all have limitations. Cryoablation, a technique that induces tissue necrosis through ultra-low temperature exposure followed by rapid thawing, has demonstrated efficacy in treating solid tumors (e.g., liver and kidney cancer). However, its application in adenomyosis remains in the exploratory phase. This study aims to evaluate the feasibility and efficacy of ultrasound (US)-guided percutaneous cryoablation for adenomyosis.

A retrospective study was conducted on symptomatic adenomyosis patients seeking uterine and fertility preservation who underwent US-guided percutaneous cryoablation at the Shengjing Hospital of China Medical University from January 2024 to September 2024. Follow-up assessments were conducted at 1, 3, and 6 months postoperatively. Dysmenorrhea severity was evaluated using the Visual Analogue Scale (VAS). The quality of life was quantified using the Uterine Fibroid Symptom and Quality of Life Questionnaire (UFS-QOL) score. Treatment efficacy was assessed based on changes in uterine volume and lesion volume measured by US. Intraoperative and postoperative complications were recorded to evaluate safety.

A total of 8 patients with adenomyosis underwent cryoablation under local anesthesia. The median VAS score was 8.5 [interquartile range (IQR), 7.75-9] postoperatively, 5.5 (IQR, 4.75-6; P<0.05) at 1 month, 4 (IQR, 4-4; P<0.05) at 3 months, and 3 (IQR, 2.75-3.25; P<0.05) at 6 months. Six months postoperatively, the median UFS-QOL score decreased from 132 (IQR, 121.5-138) preoperatively to 93 (IQR, 87.5-98, P<0.05). US revealed a 68% uterine volume reduction from 334.89 cm³ (IQR, 259.22-410.52 cm³) to 106.49 cm³ (IQR, 72.91-185.16 cm³, P<0.05). Adenomyosis lesion volume decreased from 134.93 cm³ (IQR, 122.94-196.07 cm³) to 20.58 cm³ (IQR, 19.60-69.61 cm³, P<0.05). No intraoperative complications were reported. Within 2 hours postoperatively, 5 out of 8 patients (62.5%) reported abdominal pain, but all pain resolved on the same day.

US-guided percutaneous cryoablation under local anesthesia is safe and effective in the short-term follow-up for treating adenomyosis, offering a promising uterine-sparing alternative for symptomatic patients.