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#Grand Rounds

Transcervical Ablation for Fibroids – a New Approach?

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BACKGROUND AND PURPOSE:

  • Chudnoff et al. (Obstetrics & Gynecology, 2019) assessed the 12-month safety and effectiveness of transcervical ablation as treatment of symptomatic fibroids

METHODS:

  • Prospective, multicenter, single-arm interventional trial
  • Participants
    • Uterine fibroids (non-pedunculated)
    • Premenopausal women, ages 25-50 years with regular cycles
    • ≤10 leiomyomas with ≥1 leiomyoma altering on the endometrial cavity
    • Range of menstrual blood loss (150 to 500 using pictorial tool) and regular cycles
  • Procedure performed under ultrasound guidance, using transcervical radiofrequency ablation
  • Transcervical ablation was performed on 1–10 leiomyomas per patient
    • Fibroids ranging from 1 to 5 cm in diameter
  • Coprimary endpoints assessed at 12 months were
    • Reduction in menstrual blood loss using a validated pictorial blood loss assessment chart
    • Rate of surgical reintervention due to treatment failure
  • Secondary outcomes included
    • Symptom severity | Quality of life | Patient satisfaction | Reductions in uterine and leiomyoma volumes | Safety

RESULTS:

  • 147 patients were enrolled and treated
  • Primary endpoints
    • 64.8% of patients (95% CI, 56.3–72.6%) experienced 50% or greater reduction in menstrual bleeding
    • 99.3% of patients (95% CI, 95.1–99.9%) did not require surgical reintervention
  • The mean pictorial blood loss assessment chart score significantly decreased (P<.001)
    • 3 months: decrease 38.9%
    • 6 months: decrease 48.4%
    • 12 months: decrease 51.1%
    • Overall reduced menstrual bleeding at 12 months: 95.1%
  • Symptom severity and health-related quality of life both significantly improved (all P<.001) at 12 months
    • Symptom improvement: 96.3%
    • Satisfaction with the treatment: 97%
  • Mean maximal fibroid volume reduction per patient: 62.4% (P<.001)
  • Most women returned to normal activity within a day
    • Average return to normal daily activities: 2.2±2.2 days
  • There were no reported device-related adverse events

CONCLUSION:

  • Transcervical ablation led to a significant reduction in leiomyoma symptoms at 12 months

Learn More – Primary Sources:

Ultrasound-Guided Transcervical Ablation of Uterine Leiomyomas

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Related ObG Topics:

Uterine Artery Embolization or Hysterectomy for Fibroids?
High-Intensity Ultrasound for Fibroids – What are the Pregnancy Outcomes?
Uterine Artery Embolization or Focused Ultrasound for Uterine Fibroids?

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