Adenomyosis

NICE, FRANCE -- Uterine artery embolization should not be withheld from women with adenomyosis, according to investigators who conducted a prospective, multicenter study in 42 symptomatic patients.

At a median clinical follow-up of 17 months, 37 women had avoided hysterectomy, Paul N.M. Lohle, M.D., reported at the annual meeting of the Cardiovascular and Interventional Radiological Society of Europe.

Pain, bleeding, and mass-related symptoms were improved or resolved in nearly all patients, said Dr. Lohle of St. Elisabeth Hospital in Tilburg, the Netherlands.

Magnetic resonance imaging attested to the effectiveness of embolization in these patients at a median of 12 months. The data presented included median decreases of 45% for uterine volume, 72% for fibroid volume, and 23% for adenomyosis junctional zone thickness. Investigators claimed a technical success rate of 100% for all 42 bilateral embolizations.

"Therefore, it seems unjustified to withhold [from] women an embolization treatment based on the presence of adenomyosis associated with fibroids," Dr. Lohle said. He urged that larger studies be conducted with longer follow-up.

Speaking on behalf of collaborators at St. Elisabeth Hospital and at Charite University Hospital in Berlin, Dr. Lohle said they conducted the study because they were not convinced by reports of poor clinical outcomes from embolization in the presence of adenomyosis. He described much of the evidence as anecdotal, whereas he said the results of clinical studies ranged from disappointing to encouraging.

Among possible explanations for poor experiences, Dr. Lohle said, is the fact that magnetic resonance imaging is not always used to diagnose adenomyosis, nor are contrast MRIs always used to check the infarction rate. In addition, he said many clinics use polyvinyl alcohol particles instead of microspheres.

For their study, Dr. Lohle and his collaborators used 500- to 700-[micro]m, calibrated trisacryl gelatine microspheres. They set the angiographic embolization end point as complete stasis in the ascending distal part of the uterine artery. "This [positioning] is important to achieve maximal infarction of the adenomyosis," he told this newspaper.

The investigators were able to detect adenomyosis infarctions in 10 women. Dr. Lohle reported the median infarction rate as 100% and the average as 76.5% with a range of 10%-100%.

The trial enrolled consecutive patients from January 1998 to November 2004. All the women, median age 46 years, were premenopausal. Symptoms included menorrhagia in 41 women, pain in 36, and mass effects in 17.

Seventeen had adenomyosis without fibroids. For this group, the investigators reported three hysterectomies and one surgical resection subsequent to the embolization procedure. Bleeding was improved or resolved in 12 of 13 women with that symptom. Pain and mass effects were improved in all with those symptoms.

Adenomyosis was the dominant disorder in a second group of 16 women, who also suffered from fibroids. Despite improvements in bleeding and pain, two subsequently underwent hysterectomy. Among the remaining women, pain and mass symptoms were resolved and bleeding improved or resolved for all with those complaints.

No hysterectomies were reported in a third group of nine women with adenomyosis for whom fibroids were the dominant disorder. Pain was resolved in seven of eight patients with pain. Otherwise, mass-related symptoms were completely resolved, and bleeding improved or resolved in all affected women.

BY JANE SALODOF MACNEIL

Southwest Bureau

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