Proof quality and the possibility of bias
Two reviewers separately measured the level of proof in all publications
using the Oxford Centre for Evidence-based Medicine (OCEBM)
recommendations. A Delphi methodology was used to build an 18-criterion
method to determine the consistency of the case series. A score of 14 or
higher showed high efficiency. Dissension was used to identify and
address discrepancies. When the two authors could not agree, a third
author was contacted.
The articles that were considered had applied similar inclusion
criteria: patients of more than 18 years of age or at pre-or
peri-menopausal state. These studies have excluded patients in whom MRI
with gadolinium is contraindicated or pregnant women. Chen et
al. 15, Tung S L et al. 16, Jeong J,
H et al. 17 and Tan N et al.20excluded uterine fibroids larger than 10 to 12 cm. Funaki Type 3 fibroid
was also excluded in Chen et al. 15, Tung S L et
al. 16, Jeong J H et al. 17 and Park
M J et al.22. Besides, Jeong J H et
al. 17 also included the effectiveness of MR-HIFU in
patients with concomitant adenomyosis. The characteristics of these
studies are tabulated in Table 2.
Meta-analysis was performed using NCSS software. The data were analyzed
at a 95% confidence level with a level of precision at 0.05. The NPV%,
tSSS change%, and QoL were computed. Meta-Regression was done to
evaluate the association between the different parameters.