P66. Pilot Study on Subserosal and Intramural Uterine Leiomyomas and Magnetic Resonance-guided Focused Ultrasound Surgery ( MRgFUS): Are there New Predictive Indexes?

Background: Uterine fibroids, found in 20–35% of women over the age of 35, are symptomatic in one-third. From 20 to 50% of cases symptoms are severe enough to justify a treatment. Surgery is the most employed management, with severe morbidity ac- counting for 3%. Additional semi-invasive approaches were in- troduced. Magnetic Resonance-guided Focus Ultrasound Surgery ( MRgFUS) was presented as a new totally non-invasive leiomyomas thermal ablation. Objectives: Evaluate eligibility, feasibility and outcomes of Magnetic Resonance-guided Focused Ultrasound Surgery ( MRgFUS) and find predictive indexes for treatment success. Methods: Single-centre prospective pilot study to evaluate MRgFUS for subserosal/intramural uterine leiomyomas. Post- treatment leiomyomas’ volume reduction and symptoms im- provement were assessed, with a 3 months apart follow-up. Results: 102 pre-menopausal women with symptomatic uter- ine leiomyomas were screened in the Gynaecology and Radi- ology Departments of ‘‘Sapienza’’ University of Rome (August 2010-August 2011). Eligible patients were 36 (35%); 24 women23%) performed MRgFUS, 12 refused. Three patients (12%) underwent surgical myomectomy for severe pelvic pain and meno-menometrorrhagia within one month from MRgFUS. For 20 patients, symptomatology decreased of 30% after 3 months, according to Symptom Severity Score (SSS) values (p < 0.01). Mean volume change ratio was significant (p < 0.01) at 6 months, with 27% of reduction, reaching 47% at 12 months. Feasibility rate was 35%. A Vascularity Index < 1 showed significant posi- tive difference with symptoms improvement (p-value 0,04), with a decrease of 32% (23% for VI > 1, SSS). Fibroids £ 70 mm of diameter showed a significant (p-value < 0,05) volume reduction ( - 21%) if compared to greater ones ( - 14%). Conclusions: Most women with leiomyomas are unsuitable for MRgFUS (anatomical limits and urgent fertility desire). In eligible patients, rapid symptom reduction rates were obtained; otherwise, volume reduction ratio is slower and incomplete. Vascularity Index (VI) and fibroids’ size ( £ 70 mm) could be used as predictive indexes. An accurate patient selection is needed for higher success and lower re-intervention rates.