Image-guided cryoablation for uterine diseases: a systematic review

Abstract

Background: Cryoablation is a minimally invasive treatment, with limited research on uterine diseases. This paper provides a review of image-guided cryoablation for the treatment of gynecologic diseases, such as uterine myoma, abdominal wall endometriosis (AWE) and adenomyoma, from a safety and efficacy perspective.

Methods: A comprehensive literature search was conducted using the databases Medline (via PubMed), EMBASE, and Web of Science. 2 researchers were responsible for identifying relevant studies. 18 studies that reported outcomes of image-guided cryoablation in gynecologic conditions were included. The baseline characteristics of patients and the clinical outcomes of cryoablation were all assessed. The different types of uterine pathology were discussed separately and the data were statistically analyzed independently to avoid the influence of methodological heterogeneity on the results to the greatest extent possible.

Results: Mean volume reduction of uterine myoma was 69.8% at 24 months after cryoablation; the initial ablation efficiency rate of AWE was 82% per patient and 93.6% per AWE lesion; and the mean volume reduction of adenomyoma at 12 months was 65.8%. A significant decrease in visual analogue score (VAS) from baseline was reported in all included studies for patients with the 3 aforementioned uterine diseases following cryoablation. Eleven studies reported postoperative complications, with major complications occurring in an average of 3.82% of patients. During follow-up, less than 10% of patients had residual symptoms or lesions.

Conclusions: Image-guided cryoablation is a minimally invasive therapy for uterine diseases with statistically and clinically significant effectiveness and a low incidence of major complications.

Keywords: Adenomyoma; endometriosis; image-guided; interventional; uterine myoma.

Figure 1

Flow diagram of the study selection process.