Catheter-directed sclerotherapy (CDS) better preserves a person's ovarian reserve compared to surgical removal of an ovarian cyst -- and without significant effect on therapeutic efficacy, researchers have reported.
The results "advance the level of evidence supporting CDS as an ovary-sparing cystectomy alternative for appropriately selected patients," wrote a team led by Minha Hwang, MD, of Yonsei University College of Medicine in Seoul, Korea. The group's findings were published March 25 in the American Journal of Roentgenology.
Ovarian cystectomy is standard treatment for endometrioma but is associated with decreased ovarian reserve, the investigators explained. CDA is an ovary-sparing, image-guided alternative used by interventional radiologists to treat ovarian cysts, but the existing evidence of its performance for this indication consists only of retrospective comparative and prospective single-arm studies.
To address the knowledge gap, the team conducted a randomized controlled trial that compared the therapeutic efficacy and effect on ovarian function between CDS and ovarian cystectomy in women with ovarian endometrioma. The study included 40 women who were evaluated for unilateral unilocular endometrioma measuring >3 cm between March 2022 and July 2024. The women were randomized into two equal treatment groups: fluoroscopic and ultrasound-guided CDS or laparoscopic cystectomy. In the CDS group, average age was 33 years, and in the cystectomy group, 35 years.
The primary endpoint of the research was percentage decline from baseline to 12 months in serum anti-Müllerian hormone (AMH), which is an ovarian functional reserve marker. The group also tracked additional procedural and 12-month outcomes using the Endometriosis Health Profile-30 (EHP-30) questionnaire, which addresses endometriosis-related symptoms and quality of life; lower scores translate to better status.
The investigators found that CDS showed better preservation of ovarian reserve compared to cystectomy without significant therapeutic difference. They reported the following:
Comparison of CDS to cystectomy for therapeutic efficacy and effect on ovarian function | |||
Measure | Cystectomy | CDS | P-value |
| Mean 12-month percentage decline in AMH | 39.8% | 14.9% | 0.02 |
| Hospital length of stay | 4.2 days | 2.3 days | <0.001 |
From baseline to 12 months | |||
| Ultrasound-based cyst size | 5.3 cm to 0.0 cm | 5.8 cm to 0.6 cm | <0.001 |
| Mean AMH | 3.3 ng/mL to 2 ng/mL | 3.1 ng/mL to 2.7 ng/mL | <0.001 for cystectomy and 0.08 for CDS |
| Mean Cancer Antigen 125 (CA-125) | 54.6 to 14.8 U/mL | 69.2 to 17.3 U/mL | <0.001 |
| Mean EHP-30 score | 34.5 to 8.1 | 31.3 to 6.3 | <0.001 |
The team also found that there were no complications after CDS and one after cystectomy.
The results show that CDS could serve as an ovary-sparing cystectomy alternative for appropriately selected patients, according to the authors.
More research is needed, wrote Hyeon Yu, MD, of the University of North Carolina at Chapel Hill, in an accompanying editorial.
"Within the narrow population of patients with uncomplicated unilateral disease, these data support CDS as an ovary-sparing alternative that warrants further validation in larger cohorts and with longer follow-up," Yu noted.
Access the full study here.
