Fibroid embolization and high intensity focused U/S

Key Points

New interventional techniques under study or being introduced for women with uterine fibroids promise to further expand your patients' minimally invasive treatment options. Our goal here is to focus on evaluating and testing two of the latest therapies-magnetic resonance imaging-guided focused ultrasound surgery and uterine artery embolization-and on the salient points for treatments. We'll also briefly touch on the many options for endometrial ablation that have become easier for most gynecologic surgeons to use here and now.

The UFS-QOL questionnaire is gaining importance

Quality of life (QOL) measures are increasingly important as outcomes in clinical studies. For new fibroid treatments, these QOL measures are replacing the old standbys-measurement of fibroid shrinkage or change in hematocrit-as the primary endpoints of studies. In addition to the well-known SF-36 or SF-12, which assesses general quality-of-life attributes, the many new disease-specific QOL measures will become critical for ob/gyns to understand as new fibroid therapies are introduced.

The SSS is the scale most often used in clinical trials. It assesses both menorrhagia symptoms and bulk-related symptoms with a single 100-point scale (with 100 representing the most severe symptoms-versus 0 for no symptoms). Fibroid-free women have an average SSS of 20, while on average women with symptomatic leiomyoma score 40 or higher. ¹

For the HRQL total score and individual subscores, the scoring scale runs in just the opposite direction from the SSS, with an HRQL score of 100 being the best news, while women experiencing fibroid symptoms show lower scores due to their disease.

MRI-guided focused ultrasound surgery

The innovative magnetic resonance imaging-guided focused ultrasound surgery (MRgFUS or FUS) exemplifies ultrasound's growing role in therapeutic interventions, beyond its traditional diagnostic use. In 2004 the FDA approved the FUS ablation system, ExAblate 2000 (Insightec, Haifa, Israel) for the treatment of symptomatic uterine fibroids.

With this technique, multiple U/S waves pass safely through the anterior abdominal wall and converge in the fibroid, where they cause thermal damage at the focal point. Each burst of therapeutic U/S is termed a sonication.