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Comparison of the therapeutic efficacy and ovarian reserve between catheter-directed sclerotherapy and surgical excision for ovarian endometrioma

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Abstract

Objectives

To compare the efficacies of catheter-directed sclerotherapy (CDS) with 99% ethanol and surgery for ovarian endometrioma and their impact on the ovarian reserve.

Methods

From January 2011 to June 2019, 71 patients who underwent surgical excision (n = 51) or CDS (n = 20) for symptomatic ovarian endometriomas were reviewed. To analyze the effect on the ovarian reserve, serum anti-Müllerian hormone (AMH) levels were compared before and after the procedure. Symptoms, serum cancer antigen 125 (CA-125), lesion size, recurrence, hospitalization, and complications were reviewed retrospectively.

Results

During a mean follow-up of 22.3 months (range, 6 to 94 months), no significant difference in symptom relief was found between CDS and surgery (95.0% [19/20] and 92.2% [47/51], respectively, p > 0.999). The hospital stay was shorter with CDS than with surgery (2.6 ± 0.6 days and 4.1 ± 0.5 days, respectively, p < 0.001). There was no significant difference in serum AMH levels before and after CDS (2.3 (interquartile range (IQR) 1.1–5.3) ng/mL and 2.6 (IQR 0.9–4.9) ng/mL, respectively, p = 0.243), but there was a significant decrease in serum AMH in the surgery group (3.0 (IQR 1.3–5.5) ng/mL and 1.6 (IQR 0.7–3.2) ng/mL, respectively, p < 0.001). CA-125 decreased in both CDS and surgery groups (p = 0.001 and < 0.001, respectively). Two minor complications occurred in the surgery group, while no complication was observed in the CDS group.

Conclusions

The therapeutic efficacy of CDS appears to be comparable to that of surgical resection for ovarian endometrioma. Ovarian function was well-preserved, and a shorter hospital stay was required in patients who underwent CDS.

Key Points

• There was no significant difference in symptom relief between CDS and surgery (95.0% [19/20], 92.2% [47/51], respectively, p >0.999).

• No significant difference in serum AMH levels was seen before and after CDS (2.3 (1.1, 5.3)* ng/mL, 2.6 (0.9, 4.9)* ng/mL, respectively, p = 0.243), whereas serum AMH levels significantly decreased after surgical resection (3.0 (1.3, 5.5)* ng/mL, 1.6 (0.7, 3.2)* ng/mL, respectively, p <0.001). *Median (25 quartiles, 75 quartiles)

• The hospitalization period was shorter with CDS than with surgery (2.6 ± 0.6 days, 4.1 ± 0.5 days, respectively, p <0.001).

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Abbreviations

AMH:

Anti-Müllerian hormone

CDS:

Catheter-directed sclerotherapy

NDS:

Needle-directed sclerotherapy

CA-125:

Serum cancer antigen 125

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Funding

This study was supported by a faculty research grant of Yonsei University College of Medicine (6-2020-0007).

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Author notes

  1. Ja Ho Koo and Inha Lee equally contributed to this work as co-first authors.

  2. Kichang Han and Seok Kyo Seo equally contributed to this work as co-corresponding authors.

Authors and Affiliations

  1. Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea

    Ja Ho Koo, Kichang Han, Man-Deuk Kim, Joon Ho Kwon, Gyoung Min Kim, Junhyung Lee & Jong Yun Won

  2. Department of Obstetrics and Gynecology, Severance Hospital, Yonsei College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea

    Inha Lee, Seok Kyo Seo & Jae Kyung Lee

Authors
  1. Ja Ho Koo
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  2. Inha Lee
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Corresponding authors

Correspondence to Kichang Han or Seok Kyo Seo.

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Guarantor

The scientific guarantor of this publication is Kichang Han.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Fourteen of the 20 patients who had undergone CDS have been previously reported [13]. The prior study was a single-arm study lacking a control group, whereas in this manuscript, we compared CDS with surgical resection.

Methodology

• Retrospective

• Observational

• Performed at one institution

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Koo, J.H., Lee, I., Han, K. et al. Comparison of the therapeutic efficacy and ovarian reserve between catheter-directed sclerotherapy and surgical excision for ovarian endometrioma. Eur Radiol 31, 543–548 (2021). https://doi.org/10.1007/s00330-020-07111-1

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  • DOI: https://doi.org/10.1007/s00330-020-07111-1

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