{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T11:52:30Z","timestamp":1772797950387,"version":"3.50.1"},"reference-count":46,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2022,2,5]],"date-time":"2022-02-05T00:00:00Z","timestamp":1644019200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Minimally invasive interventions for myomata treatment have gained acceptance due to the possibility of preserving fertility with reduced trauma induced by laparotomy as way of entrance. There are insufficient data regarding outcomes of high intensity focused ultrasound (HIFU) in non-Asiatic women. Therefore, we revised the available evidence to present an expert opinion that could support physicians, patients and policy-makers for considering this approach in other populations. We revisited systematic reviews, randomized controlled trials and cohort studies from January 2018 to August 2021 using PubMed and Google scholar, regarding short and long term outcomes after ablation with focused ultrasound waves. In total, 33 studies, including 114,810 adult patients showed that outcomes of this approach depend on several parameters directly related with resistance to thermal ablation, especially fibroid size and vascularization. Two studies report satisfactory outcomes in Afro-American women. In accordance to the technique used, fibroid volume reduction showed to be higher in fibroids &lt;300 cm3 after ultrasound guided HIFU than after MRI guided. Compared to myomectomy and uterine artery embolization, HIFU seems to have shorter hospital stay, higher pregnancy rates and similar adverse events rates, with skin burn being the most reported. Symptoms and quality of life improvement is similar to myomectomy but lower than embolization, however reintervention rate is higher after HIFU. Lacks evidence about long-term sarcoma risk after ablation. Available evidence shows that HIFU can be considered as a uterine sparing treatment for women of different ethnicities suffering of uterine myomatosis, especially for those wishing to preserve their fertility.<\/jats:p>","DOI":"10.3390\/jcm11030839","type":"journal-article","created":{"date-parts":[[2022,2,6]],"date-time":"2022-02-06T20:38:40Z","timestamp":1644179920000},"page":"839","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Should Ultrasound-Guided High Frequency Focused Ultrasound Be Considered as an Alternative Non-Surgical Treatment of Uterine Fibroids in Non-Asiatic Countries? An Opinion Paper"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1237-4192","authenticated-orcid":false,"given":"Luz Angela","family":"Torres-de la Roche","sequence":"first","affiliation":[{"name":"University Hospital for Gynecology, Pius Hospital, University Medicine Oldenburg, 26121 Oldenburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Rafiq","sequence":"additional","affiliation":[{"name":"University Hospital for Gynecology, Pius Hospital, University Medicine Oldenburg, 26121 Oldenburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7795-7749","authenticated-orcid":false,"given":"Rajesh","family":"Devassy","sequence":"additional","affiliation":[{"name":"Centre of Excellence in Gynecological Minimal Access Surgery and Oncology, Dubai London Clinic and Speciality Hospital, Dubai 3371500, United Arab Emirates"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hugo Christian","family":"Verhoeven","sequence":"additional","affiliation":[{"name":"Center for Endocrinology, Preventive Medicine, Reproductive Medicine and Gynecology, 40211 D\u00fcsseldorf, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sven","family":"Becker","sequence":"additional","affiliation":[{"name":"University Hospital for Gynecology and Obstetrics, University Hospital Frankfurt, 60590 Frankfurt, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5759-9745","authenticated-orcid":false,"given":"Rudy Leon","family":"De Wilde","sequence":"additional","affiliation":[{"name":"University Hospital for Gynecology, Pius Hospital, University Medicine Oldenburg, 26121 Oldenburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,2,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"149","DOI":"10.5603\/GP.2020.0032","article-title":"Minimally invasive surgery for uterine fibroids","volume":"91","author":"Wang","year":"2020","journal-title":"Ginekol. Pol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Izadifar, Z., Chapman, D., and Babyn, P. (2020). An introduction to high intensity focused ultrasound: A systematic review on principles, devices and clinical applications. J. Clin. Med., 9.","DOI":"10.3390\/jcm9020460"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1016\/j.tjog.2020.09.013","article-title":"500 cases of high intensity focused ultrasound HIFU ablated uterine fibroids and adenomyosis","volume":"59","author":"Jeng","year":"2020","journal-title":"Taiwan J. Obstet. Gynecol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1111\/1471-0528.14738","article-title":"Efficacy and safety of ultrasound guided high intensity focused ultrasound ablation of symptomatic uterine fibroids in black women: A preliminary study","volume":"124","author":"Zhang","year":"2017","journal-title":"BJOG"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"15","DOI":"10.2147\/RMI.S166580","article-title":"Adverse events of focused ultrasound surgery for uterine fibroids and adenomyosis","volume":"11","author":"Duc","year":"2018","journal-title":"Rep. Med. Imaging"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1111\/1471-0528.14745","article-title":"High intensity focused ultrasound and laproscopic myomectomy in the treatment of uterine fibroids: A comparative study","volume":"124","author":"Liu","year":"2017","journal-title":"BJOG"},{"key":"ref_7","first-page":"484","article-title":"Comparative effectiveness and safety of high intensity focused ultrasound for uterine fibroids: A meta analysis","volume":"11","author":"Wang","year":"2021","journal-title":"Front. Oncol."},{"key":"ref_8","first-page":"218","article-title":"Uterine artery embolization compared with high intensity focused ultrasound ablation for the treatment of symptomatic uterine myomas: A systemic review and meta analysis","volume":"28","author":"Liu","year":"2020","journal-title":"JMIG"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1007\/s00404-017-4494-6","article-title":"Pathobiology of myomatosis uteri: The underlying knowledge to support our clinical practice","volume":"296","author":"Becker","year":"2017","journal-title":"Arch Gynecol Obstet."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"10907","DOI":"10.1038\/s41598-019-47484-y","article-title":"Comprehensive feature selection for classifying the treatment outcome of high intensity ultrasound therapy in uterine fibroids","volume":"9","author":"Suomi","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1080\/02656736.2018.1511837","article-title":"Factors affecting effects of ultrasound guided high intensity focused ultrasound for single uterine fibroids: A retrospective analysis","volume":"35","author":"Fan","year":"2018","journal-title":"Int. J. Hyperth."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1511","DOI":"10.1002\/jum.14838","article-title":"Predictive value of Quantitative uterine fibroids perfusion parametres from contrast enhanced ultrasound for the therapeutic effect of high intensity focused ultrasound ablation","volume":"38","author":"Wang","year":"2018","journal-title":"J. Ultrasound Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1298","DOI":"10.1080\/02656736.2018.1433880","article-title":"Factors influencing thermal injury to skin and abdominal wall structures in HIFU ablation of uterine fibroids","volume":"34","author":"Yin","year":"2018","journal-title":"Int. J. Hyperth."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1080\/01443615.2019.1581740","article-title":"Efficacy and safety of ultrasound-guided highintensity focused ultrasound for uterine fibroids: A preliminary experience","volume":"39","author":"Cheung","year":"2019","journal-title":"J. Obstet. Gynaecol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1102","DOI":"10.1016\/j.acra.2020.05.010","article-title":"Long term clinical outcomes of US-guided high intensity focused ultrasound ablation for symptomatic submucosal fibroids: A retrospective comparison with uterus sparing surgery","volume":"28","author":"Wang","year":"2020","journal-title":"Acad Radiol."},{"key":"ref_16","first-page":"174.e1","article-title":"FIRSTT study: Randomized controlled trial of uterine artery embolization vs. focused ultrasound surgery","volume":"220","author":"Barnard","year":"2018","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1304","DOI":"10.1080\/02656736.2017.1421323","article-title":"A reterospective study of ultrasound guided high intensity focused ultrasound ablation for multiple uterine fibroids in South Africa","volume":"34","author":"He","year":"2017","journal-title":"Int. J. Hyperth."},{"key":"ref_18","first-page":"1554","article-title":"Poratble ultrasound guided high intensity focused ultrasound with functions for safe and rapid ablation: Prospective clinical trial for uterine fibroids- short term and long term results","volume":"34","author":"Lee","year":"2019","journal-title":"Eur. Radiol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Lozinski, T., Filipowska, J., Pyka, M., Baczkowska, M., and Ciebiera, M. (2021). Magnetic resonance-guided high-intensity ultrasound (MR-HIFU) in the treatment of symptomatic uterine fibroids\u2014Five-year experience. Ginekol. Pol.","DOI":"10.5603\/GP.a2021.0098"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1080\/02656736.2020.1811903","article-title":"High intensity focused ultrasound for the treatment of uterine fibroids: Does HIFU significantly increase the risk of pelvic adhesion","volume":"37","author":"Liu","year":"2020","journal-title":"Int. J. Hyperth."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1080\/02656736.2018.1473894","article-title":"Adverse effect analysis of high intensity focused ultrasound in the treatment of benign uterine diseases","volume":"35","author":"Liu","year":"2018","journal-title":"Int. J. Hyperth."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"724","DOI":"10.3348\/kjr.2018.19.4.724","article-title":"Efficacy, Efficiency, and Safety of Magnetic Resonance-Guided High-Intensity Focused Ultrasound for Ablation of Uterine Fibroids: Comparison with Ultrasound-Guided Method","volume":"19","author":"Wang","year":"2018","journal-title":"Korean J. Radiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1080\/02656736.2020.1807617","article-title":"Long term follow up outcome and reintervention analysis of ultrasound guided focused ultrasound treatment for uterine fibroids","volume":"37","author":"Li","year":"2020","journal-title":"Int. J. Hyperth."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1422","DOI":"10.1111\/1471-0528.16262","article-title":"Comparison of high intensity focused ultrasound ablation and secondary myomectomy for recurrent symptomatic uterine fibroids following myomectomy: A retrospective study","volume":"127","author":"Liu","year":"2020","journal-title":"Bjog"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1080\/02656736.2020.1774081","article-title":"A comparison of the preganancy outcomes between ultrasound guided high intensity focused ultrasound ablation and laproscopic myomectomy for uterine fibroids: A comaparative study","volume":"37","author":"Wu","year":"2020","journal-title":"Int. J. Hyperth."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1080\/02656736.2018.1510548","article-title":"Vaginal delivery outcomes of pregnancies following ultrasound guided high intensity focused ultrasound ablation treatment for uterine fibroids","volume":"35","author":"Liu","year":"2018","journal-title":"Int. J. Hyperth."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1080\/02656736.2021.1921288","article-title":"MRI features and clinical outcomes of unexpected uterine sarcomas in patients who underwent high intensity focused ultrasound ablation for presumed uterine fibroids","volume":"38","author":"Wang","year":"2021","journal-title":"Int. J. Hyperth."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1016\/j.tjog.2020.07.012","article-title":"Comparison of magnetic resonance guided high intensity focused ultrasound with uterine artery embolization for the treatment of uterine myomas: A systemic literature review and meta-analysis","volume":"59","author":"Jeng","year":"2020","journal-title":"Taiwan J. Obstet. Gynecol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.1080\/02656736.2021.1954245","article-title":"The efficacy and safety of MRgHIFU and US-HIFU in treating uterine fibroids with volume <300 cm3: A metanalysis","volume":"38","author":"Yu","year":"2021","journal-title":"Int. J. Hyperth."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.ultrasmedbio.2020.09.016","article-title":"Contrast-Enhanced Ultrasound For Monitoring Non-Surgical Treatments Of Uterine Fibroids: A Systematic Review","volume":"47","author":"Torkzaban","year":"2020","journal-title":"Ultrasound Med. Biol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1016\/j.fertnstert.2017.11.033","article-title":"Reintervention risk and quality of life outcomes after uterine sparing interventions for fibroids: A systemic review and meta-analysis","volume":"109","author":"Sandberg","year":"2018","journal-title":"Fertil. Steril."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"108700","DOI":"10.1016\/j.ejrad.2019.108700","article-title":"Magnetic resonance-high intensity focused ultrasound (MR-HIFU) therapy of symptomatic uterine fibroids with unrestrictive treatment protocols: A systematic review and meta-analysis","volume":"120","author":"Verpalena","year":"2019","journal-title":"Eur. J. Radiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1080\/02656736.2021.1933216","article-title":"The comparison of myomectomy, UAE and MRgFUS in the treatment of uterine fibroids: A metaanalysis","volume":"38","author":"Xu","year":"2021","journal-title":"Int. J. Hyperth."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1080\/02656736.2018.1564843","article-title":"Nonresective treatments for uterine fibroids: A systematic review of uterine and fibroid volume reductions","volume":"36","author":"Taheri","year":"2019","journal-title":"Int. J. Hyperth."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"109801","DOI":"10.1016\/j.ejrad.2021.109801","article-title":"Systematic review of reproductive outcomes after high intensity focused ultrasound treatment of uterine fibroids","volume":"141","author":"Anneveldt","year":"2021","journal-title":"Eur. J. Radiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"283","DOI":"10.5152\/dir.2018.18111","article-title":"Review of influential clinical factors in reducing the risk of unsuccessful MRI guided HIFU treatment outcome of uterine fibroids","volume":"24","author":"Duc","year":"2018","journal-title":"Diagn Interv Radiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1111\/1471-0528.14689","article-title":"Evaluation of high-intensity focused ultrasound ablation for uterine fibroids: An IDEAL prospective exploration study","volume":"125","author":"Chen","year":"2018","journal-title":"Bjog"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1080\/02656736.2020.1754473","article-title":"The impact of ultrasound-guided high-intensity focused ultrasound for uterine fibroids on ovarian reserve","volume":"37","author":"Qu","year":"2020","journal-title":"Int. J. Hyperth."},{"key":"ref_39","first-page":"0300060520942107","article-title":"High-intensity focused ultrasound for treatment of recurrent uterine leiomyosarcoma: A case report and literature review","volume":"48","author":"Li","year":"2020","journal-title":"J. Int. Med. Res."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1080\/02656736.2021.1899311","article-title":"Oxford\u2019s clinical experience in the development of high intensity focused ultrasound therapy","volume":"32","author":"Prachee","year":"2021","journal-title":"Int. J. Hyperth."},{"key":"ref_41","first-page":"CD005073","article-title":"Uterine artery embolization for symptomatic uterine fibroids","volume":"26","author":"Gupta","year":"2014","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_42","unstructured":"Togioka, B.M., and Tonismae, T. Uterine Rupture. StatPearls, StatPearls Publishing."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/j.ejogrb.2018.10.007","article-title":"Vaginal birth after prior myomectomy","volume":"231","author":"Penati","year":"2018","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1055\/s-0033-1360311","article-title":"High-Intensity Focused Ultrasound Ablation of Uterine Fibroids\u2014Potential Impact on Fertility and Pregnancy Outcome","volume":"74","author":"Bohlmann","year":"2014","journal-title":"Geburtshilfe Frauenheilkd."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.maturitas.2014.06.002","article-title":"EMAS position statement: Management of uterine fibroids","volume":"79","author":"Ornat","year":"2014","journal-title":"Maturitas"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.jogc.2019.08.025","article-title":"Interventional Uterine-Sparing Therapies for Leiomyomas: A Commentary on Myolysis","volume":"42","author":"Vilos","year":"2020","journal-title":"J. Obstet. Gynaecol. Can."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/3\/839\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:14:30Z","timestamp":1760134470000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/3\/839"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,5]]},"references-count":46,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,2]]}},"alternative-id":["jcm11030839"],"URL":"https:\/\/doi.org\/10.3390\/jcm11030839","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,5]]}}}