OGCO-E33 Protocol for high intensity focused ultrasound (HIFU) for the treatment of symptomatic uterine fibroid and adenomyosis

Question 1

Patient selection for HIFU for treatment of symptomatic uterine fibroid and adenomyosis

Answer 1

• Age: women >35 yo, women <35yo can be considered under special circumstances
• Fertility wish: women with fertility wish can be offered HIFU after a fully informed discussion about the limitations of such a procedure and the relative lack of convincing data regarding future fertility and pregnancy outcomes
• Abd wall thickness of >5cm as measured in MRI study
• Clinical uterine size of less than 24 weeks gestation
• Women with history of abdominal or pelvic surgery resulting in extensive scarring of the lower abd wall, especially those with midline and/or repeated laparotomy scars will be excluded: patietns with only previous C-section via suprapubic transverse abd incision can be considered for HIFU
• Patients with severe/moderate endometriosis (ASRM score) will be excluded

Question 2

Indications for HIFU in uterine fibroid?

Answer 2

• Women with symptomatic fibroids who might otherwise be advised to have surgical treatment
• Women with symptomatic fibroids but wish to avoid surgery or unwilling to receive a blood transfusion
• One dominant fibroid of less than 12 cm in diameter without significant areas of necrosis as judged by contrast-enhanced MRI, a non- pedunculated fibroid, and a fibroid not suspicious of malignancy

Question 3

Indications for HIFU in adenomyosis?

Answer 3

• Women with significant symptoms related to adenomyosis, intractable to standard medical therapy, or patient considering radiological intervention (uterine artery embolization) or surgery.
• Localized adenomyotic lesion or adenomyoma identified of less than 10 cm in diameter as judged by contrast- enhanced MRI, involving only anterior or posterior uterine wall, and not both.