ArticleInternational journal of women's health2026
MRI-Based Classification Systems Combined with Serum CA125 for Predicting Symptom Recurrence After Ultrasound-Guided High-Intensity Focused Ultrasound Ablation Surgery for Adenomyosis: A Retrospective Cohort Study.
Article in International journal of women's health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The underlying mechanisms of symptom recurrence or established comprehensive predictive models have not yet elucidated. This study aimed to establish a prediction model for symptom recurrence following focused ultrasound ablation surgery (FUAS) in adenomyosis based on magnetic resonance imaging (MRI)-based classification system incorporating serum cancer antigen (CA) 125 levels. Methods: We conducted a retrospective cohort study of 502 adenomyosis patients, divided into recurrence (n=133) and non-recurrence (n=369) groups. Patients were stratified by MRI lesion extent: ≥2/3 uterine wall involvement (n=446) vs <2/3 (n=56). Symptom recurrence (dysmenorrhea and/or menorrhagia) was the primary outcome. Univariate and multivariate logistic regression identified predictors. Receiver operator characteristic curve analysis determined CA125 cutoffs. Kaplan-Meier curves and Cox regression assessed recurrence-free survival. Results: Patients with ≥2/3 involvement had higher CA125 (57.9 vs 32.1 U/mL, P<0.001). Recurrence group had higher CA125 (71.5 vs 51.14 U/mL, P<0.001). Multivariate analysis identified CA125 (OR=1.002, 95% CI: 1.001-1.004), diffuse grayscale changes (OR=0.632, 95% CI: 0.407-0.981), and combined GnRH-a/LNG-IUS therapy (OR=0.504, 95% CI: 0.323-0.785) as independent predictors. In the ≥2/3 subgroup, CA125 >35 U/mL predicted shorter recurrence-free survival (37.7 vs 43.9 months, P=0.001). The combined model (CA125 ≥35 U/mL + lesion ≥2/3) yielded an AUC of 0.580 (95% CI: 0.533-0.626). Conclusion: A preoperative CA125 level ≥35 U/mL combined with MRI-based lesion extent ≥2/3 uterine wall involvement may effectively identify adenomyosis patients at high risk of post-FUAS recurrence. Further prospective studies are warranted.
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