Percutaneous image-guided cryoablation of umbilical endometriosis: safety, feasibility, clinical, and imaging outcomes.

Abstract

To evaluate the safety, feasibility and imaging outcomes of percutaneous image-guided cryoablation as a minimally invasive treatment for umbilical endometriosis (UE). Between March 2017 and December 2024, 17 women (median age: 38 years; [IQR, 32-38]) underwent percutaneous cryoablation of UE at a single institution. Procedures were performed under ultrasound (US) alone or combined US/CT-scan guidance. Pain severity was assessed using the visual analog scale (VAS), imaging (US and MRI) and cosmetic outcomes were compared before and after treatment. Adverse events were reported according to the Society of Interventional Radiology classification (SIR). Median lesion volume was 2.42 cm³ [IQR, 0.82-4.70] on US and 2.98 cm³ [IQR, 1.14-5.49] on MRI. 12/17 procedures (70%) were performed under general anesthesia and 16/17 on an outpatient basis (94%). Complete pain relief was achieved in 14/17 patients (82%) at a median follow-up of 22 months [IQR, 12.0-31.0]. The median peak VAS score decreased significantly from 8.0 [IQR, 6.5-9.0] to 0.0 [IQR, 0.0-0.0]; p < 0.001. On MRI, median nodule volume decreased from 2.98 cm³ to 0.90 cm³, representing a median individual reduction of 73.0% [IQR, 39.3-88.4%]. Regarding cosmetic outcomes, 82.4% (14/17) of patients were "satisfied" (score 4) or "very satisfied" (score 5). Three adverse events (17.7%) were recorded, two minor (SIR Grade B; superficial frostbite) and one major (SIR Grade C; surgical debridement). Percutaneous image-guided cryoablation appears to be safe and feasible for umbilical endometriosis, offering significant pain relief, substantial nodule volume reduction and satisfactory cosmetic outcomes with predominantly minor adverse events. Question Umbilical endometriosis causes disabling pain and cosmetic concerns. Surgical excision is invasive and minimally invasive image-guided alternatives with proven efficacy and safety remain lacking. Findings Percutaneous cryoablation of umbilical endometriosis achieved durable pain relief (82%), significant nodule reduction (73%), and high cosmetic satisfaction in 82% of patients, with few adverse events, confirming its feasibility and safety. Clinical relevance Percutaneous cryoablation represents a minimally invasive, outpatient alternative to surgery for umbilical endometriosis, offering durable symptom relief and improved cosmetic outcomes, with low morbidity, potentially improving patients' quality of life and broadening therapeutic options for this rare entity.