Abstract No. 185 Factors affecting the technical outcome of catheter-directed sclerotherapy for ovarian endometriomas: suggesting guidance for patient selection criteria

To identify the factors related to technical outcome of catheter-directed sclerotherapy (CDS) and to suggest patient selection criteria for performing CDS in patients with ovarian endometrioma. From November 2015 to June 2023, a total of 323 patients with 401 ovarian endometriomas treated by CDS were included in this single-center retrospective study. The characteristic of endometriomas including cyst diameter, location, morphology, T2 signal intensity (SI) were evaluated on pre-procedure MRI. Technical success was defined as achieving the following three criteria: (1) inserting 7-French (Fr) or 8-Fr catheter into the cyst, (2) fully aspirating internal contents, and (3) completing sclerotherapy without any alcohol leakage. Multivariate logistic regression analyses were used to identify the factors associated with technical outcome of CDS. Furthermore, the risk prediction model and nomogram for probability of technical failure were constructed based on potential covariates from the multivariate analyses. The discriminatory performance of the technical failure prediction model was assessed using area under the curve (AUC). Technical failures occurred in the 24 of 401 endometriomas (6.0%). Comparing the between two groups (technical success vs. technical failure), cyst diameter was significantly smaller (3.9 cm vs. 5.6 cm, p< 0.0001), the proportion of cysts with T2 low SI was significantly higher (25.0% vs. 4.2%, p< 0.0001) and TV access was more frequently employed (62.5% vs. 28.1%, p=0.0004) in technical failure group than technical success group. On multivariate analysis, cyst diameter < 3 cm (OR, 41.218; p< 0.0001), low T2 SI of cyst (OR, 21.803; p=0.0054), and TV access (OR, 3.893; p=0.0051) was associated with technical failure. Based on the results of regression analysis, a prediction model and nomogram were developed using the independently associated factors including cyst diameter < 3 cm, T2 SI of cyst, and TV access. The model scores ranged from 0 to 220, and when the sum of the scores was more than 137, 169, 183, and 200, the suspected probabilities of technical failure of CDS were 54.0%, 79.5%, 86.7%, and 96.3%, respectively. The AUC of the prediction model was 0.845 (95% CI: 0.805–0.895). Small cyst size (< 3 cm), low T2 SI of cyst, and TV access was identified as the significant risk factors affecting technical failure of CDS. The developed nomogram model can help clinicians to determine treatment modality between CDS and surgery and to create personalized therapeutic strategies.