Focused Ultrasound Therapy
Focused ultrasound is an early-stage, noninvasive, therapeutic technology with the potential to improve the quality of life and decrease the cost of care for patients with adenomyosis. This novel technology focuses beams of ultrasound energy precisely and accurately on targets deep in the body without damaging surrounding normal tissue. Where the beams converge, the ultrasound produces precise ablation (thermal destruction of tissue) enabling adenomyosis to be treated without surgery.
The primary options for treatment of adenomyosis include medication and surgery.
For certain patients, focused ultrasound could provide a noninvasive alternative to surgery with less risk of complications and lower cost.
- Focused ultrasound is noninvasive, so it does not carry added concerns like surgical wound healing or infection.
- Focused ultrasound can reach the desired target without damaging surrounding tissue.
- Shorter recovery time, with return to work or other activities the next day.
- The treatment has the potential to preserve fertility, because the uterus is not removed. Case studies have reported that women have conceived and had healthy babies after focused ultrasound.
A clinical trial is underway in Finland that is assessing focused ultrasound to treat adenomyosis as well as the impact for fertility after the procedure.
Another clinical trial is underway in Hong Kong, and is enrolling patients by invitation. The research is assessing the overall success in using focused ultrasound to treat adenomyosis by using a menstrual pain score.
Regulatory Approval and Reimbusement
Several companies have approval to treat adenomyosis in Europe, Russia, China, Korea, the Middle East, and Taiwan.
To the best of our knowledge, focused ultrasound treatment of adenomyosis is not universally reimbursed by medical insurers in the US.
Keserci B, Duc NM. Magnetic resonance imaging features influencing high-intensity focused ultrasound ablation of adenomyosis with a nonperfused volume ratio of ≥90% as a measure of clinical treatment success: retrospective multivariate analysis. Int J Hyperthermia. 2018 Oct 11:1-11. doi: 10.1080/02656736.2018.1516301.
Guo Q, Xu F, Ding Z, Li P, Wang X, Gao B. High intensity focused ultrasound treatment of adenomyosis: a comparative study. Int J Hyperthermia. 2018 Oct 11:1-5. doi: 10.1080/02656736.2018.1509238.
Liu Y, Zhang WW, He M, Gong C, Xie B, Wen X, Li D, Zhang L. Adverse effect analysis of high-intensity focused ultrasound in the treatment of benign uterine diseases. Int J Hyperthermia. 2018 May 24:1-6. doi: 10.1080/02656736.2018.1473894.
Jingqi W, Lu Z, Jun Z, Yuhong M, Wei Y, Lifeng R, Chengbing J, Dobromir DD, Hui Z, Kun Z. Clinical Usefulness of the Microbubble Contrast Agent SonoVue in Enhancing the Effects of High-Intensity Focused Ultrasound for the Treatment of Adenomyosis. J Ultrasound Med. 2018 Apr 24. doi: 10.1002/jum.14638.
Dueholm M. Minimally invasive treatment of adenomyosis. Best Pract Res Clin Obstet Gynaecol. 2018 Feb 15. pii: S1521-6934(18)30034-8. doi: 10.1016/j.bpobgyn.2018.01.016.
Xiao-Ying Z, Ying-Shu G, Jiu-Mei C, Jin-Juan W, Hong Y, Chun-Yi Z, Hua D. Effect of pre-treatment with gonadotropin-releasing hormone analogue GnRH-α on high-intensity focussed ultrasound ablation for diffuse adenomyosis: a preliminary study. Int J Hyperthermia. 2018 Mar 2:1-9. doi: 10.1080/02656736.2018.1440014.
Hou Y, Qin Z, Fan K, Xu Y, Huang X. Combination therapeutic effects of high intensity focused ultrasound and Metformin for the treatment of adenomyosis. Exp Ther Med. 2018 Feb;15(2):2104-2108. doi: 10.3892/etm.2017.5601. Epub 2017 Dec 6.
Ou KY, Jeng CJ, Long CY, Chuang L. Re: Pregnancy outcomes in patients with uterine fibroids treated with ultrasound-guided high-intensity focused ultrasound: Is the noninvasive nature of HIFU ablation for uterine fibroids and adenomyosis setting patients up for future operative delivery? BJOG. 2018 May;125(6):762-763. doi: 10.1111/1471-0528.15114. Epub 2018 Feb 6. No abstract available.
Video courtesy of Insightec.