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April 19, 2026Open Access

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

YTYing TangNorth Sichuan Medical University HTHua-Dong TianNorth Sichuan Medical University XCXi ChenNorth Sichuan Medical University

Key Points

To develop a predictive model for symptom recurrence following focused ultrasound ablation surgery in adenomyosis using MRI and CA125 levels.
Conducted a retrospective cohort study of 502 adenomyosis patients
Stratified patients by MRI lesion extent: ≥ 2/3 uterine wall vs < 2/3
Utilized logistic regression to identify predictors
Performed receiver operator characteristic curve analysis for CA125 cutoffs
Calculated recurrence-free survival using Kaplan–Meier and Cox regression
Higher CA125 levels were observed in patients with ≥ 2/3 uterine wall involvement (57.9 vs 32.1 U/mL, P< 0.001)
Recurrence group showed higher CA125 (71.5 vs 51.14 U/mL, P< 0.001)
Identified CA125, grayscale changes, and combined therapy as independent predictors of recurrence
CA125 > 35 U/mL predicted shorter recurrence-free survival (37.7 vs 43.9 months, P=0.001)
Combined model achieved an AUC of 0.580 for predicting recurrence risk

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 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. Plain Language Summary: High CA125 level combined with MRI-based lesion extent ≥ 2/3 uterine wall involvement could better inform symptom recurrence of adenomyosis after FUAS. Keywords: MRI, CA125, adenomyosis, symptom recurrence, focused ultrasound ablation surgery, risk prediction model

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