Long-term outcome of MR-guided focused ultrasound treatment and laparoscopic myomectomy for symptomatic uterine fibroid tumors

• Published in: American journal of obstetrics and gynecology 2018-10, Vol.219 (4), p.375.e1-375.e7
• Main Authors: Mohr-Sasson, Aya, Machtinger, Ronit, Mashiach, Roy, Nir, Omer, Inbar, Yael, Maliyanker, Nirit, Goldenberg, Motti, Rabinovici, Jaron
• Format: Article
• Language: English
• Subjects: fibroid tumors; laparoscopic myomectomy; magnetic resonance–guided focused ultrasound (MRgFUS)
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2018.09.002

Fibroid tumors are the most common benign tumors in women of reproductive age. Treatment is usually indicated for those who are symptomatic, with different techniques being used. The purpose of this study was to compare the long-term outcome of laparoscopic myomectomy with magnetic resonance–guided focused ultrasound for symptomatic uterine fibroid tumors. A cohort study was conducted on all patients with symptomatic uterine fibroid tumors who were admitted to a single tertiary care center and treated operatively with laparoscopic myomectomy or treated conservatively with magnetic resonance–guided focused ultrasound from January 2012 until January 2017. Assessment for further interventions and sustained fibroid-associated symptoms was performed, with the use of the Uterine Fibroid Symptom and Quality of Life symptom severity score. One hundred fifty-four women met the inclusion criteria. Complete follow-up evaluation was achieved for 64 women who underwent laparoscopic myomectomy and for 68 women who were treated by magnetic resonance–guided focused ultrasound. Follow-up time was similar for the 2 groups (median, 31 months [interquartile range, 17–51 months] vs 36 months [interquartile range, 24–41]; P=.95). The rate of additional interventions was 5 (7.8%) and 9 (13.2%), respectively (P=0.312). Similarly, the Uterine Fibroid Symptom and Quality of Life symptom severity score questionnaire score at follow-up interviews revealed comparable median scores of 17 (interquartile range, 12–21) vs 17 (interquartile range, 13–22) for laparoscopic myomectomy and magnetic resonance–guided focused ultrasound, respectively (P=.439). Analysis of each of the symptoms separately (bleeding, changes in menstruation, abdominal pain, bladder activity, nocturia, fatigue) did not change these findings, nor did a multivariate analysis. Satisfaction with long-term outcome and rate of reinterventions after magnetic resonance–guided focused ultrasound treatment or laparoscopic myomectomy for uterine fibroid tumors was comparable. Further larger randomized trials are needed to confirm these findings.