Ultrasound-guided percutaneous cryoablation under local anesthesia: a promising treatment method for symptomatic adenomyosis

Abstract

Background: Adenomyosis is characterized by ectopic endometrial tissue, which causes dysmenorrhea, menstruation, and infertility, significantly impairing quality of life. Current treatments-including medications, surgery, and interventional methods-all have limitations. Cryoablation, a technique that induces tissue necrosis through ultra-low temperature exposure followed by rapid thawing, has demonstrated efficacy in treating solid tumors (e.g., liver and kidney cancer). However, its application in adenomyosis remains in the exploratory phase. This study aims to evaluate the feasibility and efficacy of ultrasound (US)-guided percutaneous cryoablation for adenomyosis.

Methods: A retrospective study was conducted on symptomatic adenomyosis patients seeking uterine and fertility preservation who underwent US-guided percutaneous cryoablation at the Shengjing Hospital of China Medical University from January 2024 to September 2024. Follow-up assessments were conducted at 1, 3, and 6 months postoperatively. Dysmenorrhea severity was evaluated using the Visual Analogue Scale (VAS). The quality of life was quantified using the Uterine Fibroid Symptom and Quality of Life Questionnaire (UFS-QOL) score. Treatment efficacy was assessed based on changes in uterine volume and lesion volume measured by US. Intraoperative and postoperative complications were recorded to evaluate safety.

Results: A total of 8 patients with adenomyosis underwent cryoablation under local anesthesia. The median VAS score was 8.5 [interquartile range (IQR), 7.75-9] postoperatively, 5.5 (IQR, 4.75-6; P<0.05) at 1 month, 4 (IQR, 4-4; P<0.05) at 3 months, and 3 (IQR, 2.75-3.25; P<0.05) at 6 months. Six months postoperatively, the median UFS-QOL score decreased from 132 (IQR, 121.5-138) preoperatively to 93 (IQR, 87.5-98, P<0.05). US revealed a 68% uterine volume reduction from 334.89 cm³ (IQR, 259.22-410.52 cm³) to 106.49 cm³ (IQR, 72.91-185.16 cm³, P<0.05). Adenomyosis lesion volume decreased from 134.93 cm³ (IQR, 122.94-196.07 cm³) to 20.58 cm³ (IQR, 19.60-69.61 cm³, P<0.05). No intraoperative complications were reported. Within 2 hours postoperatively, 5 out of 8 patients (62.5%) reported abdominal pain, but all pain resolved on the same day.

Conclusions: US-guided percutaneous cryoablation under local anesthesia is safe and effective in the short-term follow-up for treating adenomyosis, offering a promising uterine-sparing alternative for symptomatic patients.

Keywords: Adenomyosis; cryoablation; interventional radiology; safety; ultrasound (US).

Figure 1

Schematic diagram of the percutaneous cryoablation of adenomyosis. (A) Preprocedural ultrasound evaluation of lesion and adjacent tissue for approach planning. (B,C) Insertion of 1–2 cryoablation probes into the adenomyosis lesion based on size and morphology. (D) Activation of the argon gas freezing mode, real-time monitoring of ice ball formation, and cessation of freezing when the ice ball covers the entire lesion.

Figure 2

Cryoablation probe configurations. (A) Two probes are arranged in a nearly parallel fashion via two subcutaneous approaches. (B) Two probes are arranged in a crossing fashion through a single subcutaneous approach.

Figure 3

Changes in ultrasound images before, during, and after cryoablation in a 36-year-old patient with adenomyosis. (A) Preoperative transabdominal scan reveals an enlarged uterine body measuring approximately 8.10 cm × 6.97 cm with rough and uneven echogenicity on the anterior wall (VAS score: 9). (B) After local anesthesia, insertion of two cryoablation probes (one indicated by the arrow) into the lesion. (C) During cryoablation, the ice ball appears as a hyperechoic line with posterior acoustic shadowing. (D) At 6-month follow-up, ultrasound reveals a reduction in uterine body size to approximately 5.63 cm × 5.12 cm (VAS score: 2). VAS, Visual Analogue Scale.

Figure 4

Comparison of (A) VAS scores, (B) UFS-QOL score, (C) uterine volume and (D) lesion volume before and after cryoablation. *, P<0.05; **, P<0.01. UFS-QOL, Uterine Fibroid Symptom and Quality of Life Questionnaire; VAS, Visual Analogue Scale.