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.
How it Works
Where the beams converge, focused 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 – such as surgical wound healing or infection – at a lower cost and with a shorter recovery time. It can reach the desired target without damaging surrounding tissue and is repeatable, if necessary. 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.
Regulatory Approval and Reimbursement
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.
Xu Y, Zhou Z, Wang H, Shao L, Liu G. High-Intensity Focused Ultrasound Combined With Gonadotropin-Releasing Hormone Agonist or Levonorgestrel-Releasing Intrauterine System in Treating Dysmenorrhea of Severe Adenomyosis. J Comput Assist Tomogr. 2021 Mar-Apr 01;45(2):224-231. doi: 10.1097/RCT.0000000000001138.
Li X, Zhu X, He S, Jiang Z, Li H, Tian X, Long W, Xue M, Deng X, Ye M. High-intensity focused ultrasound in the management of adenomyosis: long-term results from a single center. Int J Hyperthermia. 2021;38(1):241-247. doi: 10.1080/02656736.2021.1886347.
Du CC, Wang YQ, Qu DC, Jiang LP, Yu X, Zhou HG. Magnetic resonance imaging T2WI hyperintense foci number and the prognosis of adenomyosis after high-intensity focused ultrasound treatment. Int J Gynaecol Obstet. 2021 Jan 9. doi: 10.1002/ijgo.13587.
Li W, Mao J, Liu Y, Zhu Y, Li X, Zhang Z, Bai X, Zheng W, Wang L. Clinical effectiveness and potential long-term benefits of high-intensity focused ultrasound therapy for patients with adenomyosis. J Int Med Res. 2020 Dec;48(12):300060520976492. doi: 10.1177/0300060520976492.
Zhou XJ, Zhao ZM, Liu P, Zhao CY, Lin YJ, Liu Y, Wang M, Tian C, Li HY, Hou CX, Li XM, Zhao ZY, Zhou YJ. Efficacy of high intensity focused ultrasound treatment for cystic adenomyosis: a report of four cases. Ann Palliat Med. 2020 Nov;9(6):3742-3749. doi: 10.21037/apm-20-1599.
Chen J, Porter AE, Kho KA. Current and Future Surgical and Interventional Management Options for Adenomyosis. Semin Reprod Med. 2020 Nov 5. doi: 10.1055/s-0040-1718921.
Li Z, Zhang J, Song Y, Yin X, Chen A, Tang N, Prince MR, Yang G, Wang H. Eur Utilization of radiomics to predict long-term outcome of magnetic resonance-guided focused ultrasound ablation therapy in adenomyosis. Radiol. 2020 Jul 28. doi: 10.1007/s00330-020-07076-1.
Haiyan S, Lin W, Shuhua H, Wang W. High-intensity focused ultrasound (HIFU) combined with gonadotropin-releasing hormone analogs (GnRHa) and levonorgestrel-releasing intrauterine system (LNG-IUS) for adenomyosis: a case series with long-term follow up. Int J Hyperthermia. 2019;36(1):1179-1185. doi: 10.1080/02656736.2019.1679892.
Nguyen MD. Magnetic Resonance-Guided Focused Ultrasound Surgery for Leiomyoma and Adenomyosis: An Alternative Nonvascular Approach. Gynecol Minim Invasive Ther. 2019 Oct 24;8(4):196-198. doi: 10.4103/GMIT.GMIT_19_19. eCollection 2019 Oct-Dec.
Dev B, Gadddam S, Kumar M, Varadarajan S. MR-guided focused ultrasound surgery: A novel non-invasive technique in the treatment of adenomyosis -18 month's follow-up of 12 cases. Indian J Radiol Imaging. 2019 Jul-Sep;29(3):284-288. doi: 10.4103/ijri.IJRI_53_19. Epub 2019 Oct 30.
Lee JS, Hong GY, Lee KH, Song JH, Kim TE. Safety and Efficacy of Ultrasound-Guided High-Intensity Focused Ultrasound Treatment for Uterine Fibroids and Adenomyosis. Ultrasound Med Biol. 2019 Sep 25. pii: S0301-5629(19)31477-2. doi: 10.1016/j.ultrasmedbio.2019.08.022.
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.