1
|
Ansaripour S, Yazdchi K, Sadeghi MR, Nasseri N, Karimi A, Ataei M, Madadi N, Jalalinejad F, Rahimi F. Comparison of ultra-long gonadotropin releasing hormone agonist versus standard downregulation in women with adenomyosis undergoing frozen-thawed embryo transfer: a randomized clinical trial. Contracept Reprod Med 2024; 9:44. [PMID: 39256889 PMCID: PMC11385168 DOI: 10.1186/s40834-024-00304-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Accepted: 08/20/2024] [Indexed: 09/12/2024] Open
Abstract
BACKGROUND Adenomyosis can lead to infertility and failure of in vitro fertilization. Limited evidence suggests that the use of long-term treatment with gonadotropin-releasing hormone (GnRH) agonists followed by frozen-thawed embryo transfer (FET) may be the preferred approach for women with adenomyosis. OBJECTIVE The aim of this randomized controlled trial is to compare the efficacy of an ultra-long GnRH agonist with standard downregulation in women with adenomyosis undergoing FET. MATERIALS AND METHODS This randomized controlled trial enrolled 72 women with adenomyosis diagnosed by sonographic criteria who underwent FET cycles at the Avicenna Infertility Center. These women were randomly assigned to two equal groups: one received GnRH agonist treatment for three months before the FET cycle and the other served as the standard downregulation group. Results were reported as chemical and clinical pregnancy rates. RESULTS The two groups were similar in age, body mass index, anti-Müllerian hormone levels, number of previous pregnancies and miscarriages, presence of uterine myomas, and endometriosis. However, the total dose of estradiol used until embryo transfer was significantly higher in the ultra-long GnRH agonist group than in the standard group (96.14 mg vs. 80.52 mg, p-value = 0.004). Nevertheless, chemical and clinical pregnancy rates did not differ significantly between the two groups. CONCLUSIONS Ultra-long GnRH agonist downregulation did not improve the chemical and clinical pregnancy rate in the FET cycle in women with adenomyosis compared with standard GnRH agonist downregulation in the other words, ultra-long GnRH agonist downregulation is not superior to standard protocol. In women with adenomyosis (without history of endometriosis), downregulation of standard GnRH agonists prior to frozen-thawed embryo transfer may be the preferred embryo transfer protocol to gain higher clinical/chemical pregnancy rate. TRIAL REGISTRATION Clinical trial registry: IRCT20160717028967N9, available at: https://irct.behdasht.gov.ir/trial/36103 .
Collapse
Affiliation(s)
- Soheila Ansaripour
- Reproductive Biotechnology Research Centre, Avicenna Research Institute (ARI), Academic Centre for Education, Culture and Research (ACECR), Tehran, Iran
| | - Katayoun Yazdchi
- Reproductive Biotechnology Research Centre, Avicenna Research Institute (ARI), Academic Centre for Education, Culture and Research (ACECR), Tehran, Iran.
| | - Mohammad Reza Sadeghi
- Reproductive Biotechnology Research Centre, Avicenna Research Institute (ARI), Academic Centre for Education, Culture and Research (ACECR), Tehran, Iran
| | - Nasim Nasseri
- Reproductive Biotechnology Research Centre, Avicenna Research Institute (ARI), Academic Centre for Education, Culture and Research (ACECR), Tehran, Iran
| | - Atousa Karimi
- Reproductive Biotechnology Research Centre, Avicenna Research Institute (ARI), Academic Centre for Education, Culture and Research (ACECR), Tehran, Iran
| | - Mina Ataei
- Department of Obstetrics and Gynecology, Research Center, School of Medical Sciences, Social Determinants of Health, Alborz University of Medical Sciences, Karaj, Iran
| | - Narges Madadi
- Reproductive Biotechnology Research Centre, Avicenna Research Institute (ARI), Academic Centre for Education, Culture and Research (ACECR), Tehran, Iran
| | - Fateme Jalalinejad
- Reproductive Biotechnology Research Centre, Avicenna Research Institute (ARI), Academic Centre for Education, Culture and Research (ACECR), Tehran, Iran
| | - Fahimeh Rahimi
- Reproductive Biotechnology Research Centre, Avicenna Research Institute (ARI), Academic Centre for Education, Culture and Research (ACECR), Tehran, Iran
| |
Collapse
|
2
|
Selntigia A, Molinaro P, Tartaglia S, Pellicer A, Galliano D, Cozzolino M. Adenomyosis: An Update Concerning Diagnosis, Treatment, and Fertility. J Clin Med 2024; 13:5224. [PMID: 39274438 PMCID: PMC11396652 DOI: 10.3390/jcm13175224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 08/12/2024] [Accepted: 08/30/2024] [Indexed: 09/16/2024] Open
Abstract
This review article aims to summarize current tools used in the diagnosis of adenomyosis with relative pharmacological and surgical treatment and to clarify the relative association between adenomyosis and infertility, considering the importance of an accurate diagnosis of this heterogeneous disease. Among different reported concepts, direction invagination of gland cells from the basalis endometrium deep into the myometrium is the most widely accepted opinion on the development of adenomyosis. Adenomyosis has been increasingly identified in young women with pain, AUB, infertility, or no symptoms by using imaging techniques such as transvaginal ultrasound and magnetic resonance. Furthermore, adenomyosis often coexists with other gynecological conditions, such as endometriosis and uterine fibroids, increasing the heterogeneity of available data. However, there is no agreement on the definition and classification of adenomyotic lesions from both the histopathology and the imaging points of view, and diagnosis remains difficult and unclear. A standard, universally accepted classification system needs to be implemented to improve our understanding and inform precise diagnosis of the type of adenomyosis. This could be the key to designing RCT studies and evaluating the impact of adenomyosis on quality of life in terms of menstrual symptoms, fertility, and pregnancy outcome, given the high risk of miscarriage and obstetric complications.
Collapse
Affiliation(s)
| | - Pietro Molinaro
- IVIRMA Global Research Alliance, IVIRMA Roma, 00169 Rome, Italy
| | - Silvio Tartaglia
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Viale Montpellier 1, 00133 Rome, Italy
- Department of Women, Children, and Public Health Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, 00168 Rome, Italy
| | | | | | - Mauro Cozzolino
- IVIRMA Global Research Alliance, IVIRMA Roma, 00169 Rome, Italy
| |
Collapse
|
3
|
Krentel H, Constantin A, Naem A, Otto K, Andrikos D, De Wilde RL. Transvaginale Ultraschalldiagnostik der Adenomyose. GYNAKOLOGISCHE ENDOKRINOLOGIE 2024; 22:209-215. [DOI: 10.1007/s10304-024-00579-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2024] [Indexed: 09/09/2024]
|
4
|
Bourdon M, Maignien C, Marcellin L, Maitrot Mantelet L, Parpex G, Santulli P, Chapron C. Distribution of endometriosis phenotypes according to patients' age in adult women with surgical evaluation. Hum Reprod 2024:deae180. [PMID: 39186806 DOI: 10.1093/humrep/deae180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 07/01/2024] [Indexed: 08/28/2024] Open
Abstract
STUDY QUESTION What is the distribution of endometriosis phenotypes according to age in adult women undergoing surgery? SUMMARY ANSWER The phenotype of endometriosis did not significantly vary after 24 years old. WHAT IS KNOWN ALREADY The phenotypic evolution of endometriosis over time remains unclear. While adolescents can exhibit any type of endometriosis lesions, ovarian endometriosis (OMA) and/or deep-infiltrating endometriosis (DIE) tend to increase with age in young adults. In adulthood, understanding the evolution of lesions is crucial for disease management, but the literature on this subject is limited. This study aims to examine the distribution of endometriosis phenotypes in relation to age among adult patients requiring surgical treatment. STUDY DESIGN, SIZE, DURATION This observational cohort study included patients aged between ≥18 and ≤42 years, who underwent surgery for benign gynecological conditions at our institution between January 2004 and December 2022. A standardized questionnaire was completed for each patient during a face-to-face interview conducted by the surgeon in the month preceding surgery. Women with histologically proven endometriosis were included. PARTICIPANTS/MATERIALS, SETTING, METHODS The distribution of endometriosis phenotypes (isolated superficial (SUP) endometriosis, OMA ± SUP, DIE ± SUP/OMA) was compared between young adults (≤24 years) and adults (>24 years) and among adults (25-28 years, 29-33 years, 34-38 years, 39 to ≤42 years) using univariate and multivariate analysis. The distribution of different subtypes of DIE (uterosacral ligament(s), vagina, bladder, intestine, and ureter), OMA size, and intensity of pain symptoms were also examined. MAIN RESULTS AND THE ROLE OF CHANCE A total of 1311 adult women with histologically proven endometriosis were included. In women aged 24 years or younger (n = 116), the distribution of endometriosis phenotypes differed significantly from women older than 24 years (n = 1195): The frequency of the DIE ± SUP/OMA phenotype was lower (41.4% versus 56.1%, respectively), while the rate of isolated superficial lesions was higher (from 32.0% versus 25.9%) (P = 0.001). In the group of women aged >24 years, a significantly higher proportion of vaginal DIE lesions (P = 0.012) and a lower proportion of uterosacral ligament DIE lesions (P = 0.004) were found compared to women aged ≤24 years. No significant differences were observed in terms of endometrioma size. Between the ages of 25 and 42 years, there were no significant changes in the distribution of endometriosis phenotypes after univariate and multivariate analysis. The distribution of subtype of DIE lesions did not significantly change with age between 25 and 42 years. Concerning pain symptom scores, there was a significant decrease with age for dysmenorrhea and dyspareunia. LIMITATIONS, REASONS FOR CAUTION Inclusion of only surgical patients may have introduced a selection bias. Women referred to our center may have suffered from particularly severe clinical forms of endometriosis. WIDER IMPLICATIONS OF THE FINDINGS This study highlights that endometriosis presentation did not change with age in adult women. Further research on endometriosis phenotype evolution is necessary to assist practitioners in clinical decisions and treatment strategies. STUDY FUNDING/COMPETING INTERESTS None declared. TRIAL REGISTRATION NUMBER N/A.
Collapse
Affiliation(s)
- M Bourdon
- Faculté de Médecine, Université de Paris Cité, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department "Development, Reproduction and Cancer", Cochin Institute, INSERM U1016, Paris, France
| | - C Maignien
- Department of Gynecology Obstetrics II and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
| | - L Marcellin
- Faculté de Médecine, Université de Paris Cité, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department "Development, Reproduction and Cancer", Cochin Institute, INSERM U1016, Paris, France
| | - L Maitrot Mantelet
- Department of Gynecology Obstetrics II and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
| | - G Parpex
- Faculté de Médecine, Université de Paris Cité, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department "Development, Reproduction and Cancer", Cochin Institute, INSERM U1016, Paris, France
| | - P Santulli
- Faculté de Médecine, Université de Paris Cité, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department "Development, Reproduction and Cancer", Cochin Institute, INSERM U1016, Paris, France
| | - C Chapron
- Faculté de Médecine, Université de Paris Cité, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department "Development, Reproduction and Cancer", Cochin Institute, INSERM U1016, Paris, France
| |
Collapse
|
5
|
Liang E, Parvez R, Ng S, Brown B. Is ultrasound sufficient in detecting adenomyosis as pre-procedure work-up for uterine artery embolisation? An audit in the community setting. J Med Imaging Radiat Oncol 2024. [PMID: 39073057 DOI: 10.1111/1754-9485.13739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 07/18/2024] [Indexed: 07/30/2024]
Affiliation(s)
- Eisen Liang
- Sydney Fibroid Clinic, Sydney, New South Wales, Australia
| | - Razeen Parvez
- Sydney Fibroid Clinic, Sydney, New South Wales, Australia
| | - Sylvia Ng
- Gosford Hospital, Gosford, New South Wales, Australia
| | - Bevan Brown
- Sydney Adventist Hospital Clinical School, Gosford, Australia
| |
Collapse
|
6
|
Bae H, Shin YR, Rha SE. [Classification of Uterine Adenomyosis: A Pictorial Essay]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2024; 85:549-565. [PMID: 38873382 PMCID: PMC11166578 DOI: 10.3348/jksr.2023.0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/07/2023] [Accepted: 10/05/2023] [Indexed: 06/15/2024]
Abstract
MRI is a crucial tool for diagnosing adenomyosis and identifying its related pathologies. To accurately diagnose adenomyosis, it is necessary to recognize both the typical MRI findings and atypical features of the condition. Recently, a standardized classification system has been developed to facilitate precise presurgical diagnosis of adenomyosis and to determine the appropriate treatment method. Differentiating between various subtypes based on MRI-based classification and identifying different MRI phenotypes can aid in categorizing patients with adenomyosis into specific treatment groups and monitoring their response to therapy.
Collapse
|
7
|
Jeerakornpassawat D, Tantipalakorn C, Sirilert S, Tongsong T. Sonographic Features of Uterine Arteriovenous Malformation: A Case Series. Diagnostics (Basel) 2024; 14:873. [PMID: 38732288 PMCID: PMC11083442 DOI: 10.3390/diagnostics14090873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/18/2024] [Accepted: 04/20/2024] [Indexed: 05/13/2024] Open
Abstract
Uterine arteriovenous malformation (AVM) is very rare but potentially life-threatening. Early and accurate diagnosis is the cornerstone of its management. The objective of this study is to encourage sonographers to become familiar with a variety of grayscale sonographic features, facilitating rapid recognition of the patterns and prompting them to apply color flow Doppler for a diagnosis of uterine AVM and possible further investigations or interventions. We present six cases of uterine AVM presenting with abnormal uterine bleeding at varying degrees of severity, from abnormal menstruation to life-threatening bleeding following curettage. All initially provided some clues of uterine AVM upon grayscale ultrasound, leading to the application of color Doppler flow to support a diagnosis, with confirmation using abdominal computer tomography angiography (CTA) in most cases, resulting in definitive treatment using uterine artery embolization or other interventions. Most importantly, this study provides various sonographic features of uterine AVM, such as appearances of small tubular structures, spongy patterns, a conceptive-product-like appearance, and spaghetti-like patterns. Hopefully, familiarity with these sonographic features can facilitate practitioners to make an early diagnosis, leading to proper further investigation and intervention, and to prevent serious complications from potentially being caused by this subtle but very serious disorder.
Collapse
Affiliation(s)
| | | | | | - Theera Tongsong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| |
Collapse
|
8
|
Viganò S, Smedile A, Cazzella C, Marra P, Bonaffini PA, Sironi S. Abnormal Uterine Bleeding: A Pictorial Review on Differential Diagnosis and Not-So-Common Cases of Interventional Radiology Management. Diagnostics (Basel) 2024; 14:798. [PMID: 38667444 PMCID: PMC11049404 DOI: 10.3390/diagnostics14080798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 04/05/2024] [Accepted: 04/07/2024] [Indexed: 04/28/2024] Open
Abstract
Abnormal uterine bleeding (AUB) poses a multifaceted challenge in women's health, necessitating an integrated approach that addresses its diverse etiologies and clinical presentations. The International Federation of Gynecology and Obstetrics PALM-COEIN classification system provides a systematic approach to the diagnosis of AUB in non-pregnant women, based on clinical and imaging-based categorization of causes into structural (Polyps, Adenomyosis, Leiomyomas and Malignancy; PALM), and non-structural causes (Coagulopathies, Ovulatory disorders, primary Endometrial disorders, Iatrogenic and Not otherwise classified; COEIN). On the other hand, placental disorders, uterine rupture, ectopic pregnancy and retained products of conceptions are the main causes of uterine bleeding during pregnancy and in the peripartum period. Ultrasound is usually the first-line imaging technique for the differential diagnosis of causes of AUB. Computed Tomography may be useful if ultrasound findings are unclear, especially in emergency settings. Magnetic resonance imaging, when indicated, is an excellent second-line diagnostic tool for a better non-invasive characterization of the underlying cause of AUB. This pictorial review aims to illustrate the main causes of AUB from the point of view of diagnostic imaging and to show not-so-common cases that can be treated by means of interventional radiology.
Collapse
Affiliation(s)
- Sara Viganò
- Department of Radiology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy; (A.S.); (C.C.); (P.M.); (P.A.B.); (S.S.)
| | - Antonella Smedile
- Department of Radiology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy; (A.S.); (C.C.); (P.M.); (P.A.B.); (S.S.)
| | - Caterina Cazzella
- Department of Radiology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy; (A.S.); (C.C.); (P.M.); (P.A.B.); (S.S.)
| | - Paolo Marra
- Department of Radiology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy; (A.S.); (C.C.); (P.M.); (P.A.B.); (S.S.)
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milano, Italy
| | - Pietro Andrea Bonaffini
- Department of Radiology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy; (A.S.); (C.C.); (P.M.); (P.A.B.); (S.S.)
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milano, Italy
| | - Sandro Sironi
- Department of Radiology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy; (A.S.); (C.C.); (P.M.); (P.A.B.); (S.S.)
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milano, Italy
| |
Collapse
|
9
|
Bae JS, Lee JY, Chung HH, Lee M, Jeon MJ, Kim H, Kim HS, Kim K, Lee CS, Son K, Han JK. Optimized treatment parameter by computer simulation for high-intensity focused ultrasound treatment of uterine adenomyosis: Short-term and long-term results. PLoS One 2024; 19:e0301193. [PMID: 38547090 PMCID: PMC10977802 DOI: 10.1371/journal.pone.0301193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 02/29/2024] [Indexed: 04/02/2024] Open
Abstract
This study aimed to investigate the efficacy and safety of using optimized parameters obtained by computer simulation for ultrasound-guided high-intensity focused ultrasound (HIFU) treatment of uterine adenomyosis in comparison with conventional parameters. We retrospectively assessed a single-institution, prospective study that was registered at Clinical Research Information Service (CRiS) of Republic of Korea (KCT0003586). Sixty-six female participants (median age: 44 years) with focal uterine adenomyosis were prospectively enrolled. All participants were treated with a HIFU system by using treatment parameters either for treating uterine fibroids (Group A, first 20 participants) or obtained via computer simulation (Group B, later 46 participants). To assess the treatment efficacy of HIFU, qualitative indices, including the clinically effective dysmenorrhea improvement index (DII), were evaluated up to 3 years after treatment, whereas quantitative indices, such as the nonperfused volume ratio and adenomyosis volume shrinkage ratio (AVSR), on MRI were evaluated up to 3 months after treatment. Quantitative/qualitative indices were compared between Groups A and B by using generalized linear mixed effect model. A safety assessment was also performed. Results showed that clinically effective DII was more frequently observed in Group B than in Group A (odds ratio, 3.69; P = 0.025), and AVSR were higher in Group B than in Group A (least-squares means, 21.61; P = 0.001). However, two participants in Group B developed skin burns at the buttock and sciatic nerve pain and required treatment. In conclusion, parameters obtained by computer simulation were more effective than the conventional parameters for treating uterine adenomyosis by using HIFU in terms of clinically effective DII and AVSR. However, care should be taken because of the risk of adverse events.
Collapse
Affiliation(s)
- Jae Seok Bae
- Department of Radiology, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Jongno-gu, Seoul, Republic of Korea
| | - Jae Young Lee
- Department of Radiology, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Jongno-gu, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Jongno-gu, Seoul, Republic of Korea
| | - Hyun Hoon Chung
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
| | - Maria Lee
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
| | - Myung Jae Jeon
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
| | - Hoon Kim
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
| | - Hee Seung Kim
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
| | - Kidong Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Chang-Soon Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
| | - Keonho Son
- System Division, IMGT Co., Ltd., Healthcare Innovation Park, Bundang-gu, Seongnam-si, Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Jongno-gu, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Jongno-gu, Seoul, Republic of Korea
| |
Collapse
|
10
|
Bourdon M, Santulli P, Maignien C, Bordonne C, Millischer AE, Chargui A, Marcellin L, Mantelet LM, Fouque Gadol L, Chapron C. The "freeze-all" strategy seems to improve the chances of birth in adenomyosis-affected women. Fertil Steril 2024; 121:460-469. [PMID: 38056519 DOI: 10.1016/j.fertnstert.2023.11.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 11/30/2023] [Accepted: 11/30/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE To compare assisted reproductive technologies (ARTs) outcomes between fresh vs. freeze-all strategies in infertile women affected by adenomyosis. DESIGN A single-center observational study. SETTINGS University hospital-based research center. PATIENTS Adenomyosis-affected women undergoing blastocyst embryo transfer after in vitro fertilization and intracytoplasmic sperm injection between January 1, 2018, and November 31, 2021. The diagnosis of adenomyosis was based on imaging criteria (i.e., transvaginal ultrasound and/or magnetic resonance imaging). INTERVENTION(S) Women who underwent a freeze-all strategy were compared with those who underwent a fresh embryo transfer (ET) strategy. MAIN OUTCOME MEASURE(S) Cumulative live birth rate (LBR). RESULTS A total of 306 women were included in the analysis: 111 in the fresh ET group and 195 in the freeze-all group. The adenomyosis phenotype (internal diffuse adenomyosis, external focal adenomyosis, and adenomyoma) was not significantly different between the two groups. The cumulative LBR (86 [44.1%] vs. 34 [30.6%], respectively), and the cumulative ongoing pregnancy rate (88 [45.1%] vs. 36 [32.4%], respectively) were significantly higher in the freeze-all group compared with the fresh ET group. After multivariate logistic regression analysis, the freeze-all strategy in women with adenomyosis was associated with significantly higher odds of live birth compared with fresh ET (odds ratio = 1.80; 95% confidence interval = 1.02-3.16). CONCLUSION The freeze-all strategy in women afflicted with adenomyosis undergoing ART was associated with significantly higher cumulative LBRs. Our preliminary results suggest that the freeze-all strategy is an attractive option that increases ART success rates. Additional studies, with a randomized design, should be conducted to further test whether the freeze-all strategy enhances the pregnancy rate in adenomyosis-affected women.
Collapse
Affiliation(s)
- Mathilde Bourdon
- Université de Paris Cité, Faculté de santé, Faculté de Médecine Paris Centre, Paris, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Paris, France; Department of Gynaecology Obstetrics and Reproductive Medicine, Centre Hospitalier Universitaire (CHU) Cochin, Paris, France; Department 3I "Infection, Immunité et inflammation", Institut Cochin, INSERM U1016, Paris, France
| | - Pietro Santulli
- Université de Paris Cité, Faculté de santé, Faculté de Médecine Paris Centre, Paris, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Paris, France; Department of Gynaecology Obstetrics and Reproductive Medicine, Centre Hospitalier Universitaire (CHU) Cochin, Paris, France; Department 3I "Infection, Immunité et inflammation", Institut Cochin, INSERM U1016, Paris, France.
| | - Chloé Maignien
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Paris, France; Department of Gynaecology Obstetrics and Reproductive Medicine, Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
| | - Corinne Bordonne
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Paris, France; Department of Gynaecology Obstetrics and Reproductive Medicine, Centre Hospitalier Universitaire (CHU) Cochin, Paris, France; Department of Radiology, Centre Hospitalier Universitaire (CHU) Hotel Dieu, Paris, France; Imagerie Médicale Paris Centre (IMPC) Bachaumont-IFEEN - Ramsay Santé, Centre de Radiologie, Paris, France
| | - Anne Elodie Millischer
- Imagerie Médicale Paris Centre (IMPC) Bachaumont-IFEEN - Ramsay Santé, Centre de Radiologie, Paris, France
| | - Ahmed Chargui
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Paris, France; Department of Histology-Embryology and Reproductive Biology Centre, Hospitalier Universitaire (CHU) Cochin, Paris, France
| | - Louis Marcellin
- Université de Paris Cité, Faculté de santé, Faculté de Médecine Paris Centre, Paris, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Paris, France; Department of Gynaecology Obstetrics and Reproductive Medicine, Centre Hospitalier Universitaire (CHU) Cochin, Paris, France; Department 3I "Infection, Immunité et inflammation", Institut Cochin, INSERM U1016, Paris, France
| | - Lorraine Maitrot Mantelet
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Paris, France; Department of Gynaecology Obstetrics and Reproductive Medicine, Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
| | - Laura Fouque Gadol
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Paris, France; Department of Gynaecology Obstetrics and Reproductive Medicine, Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
| | - Charles Chapron
- Université de Paris Cité, Faculté de santé, Faculté de Médecine Paris Centre, Paris, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Paris, France; Department of Gynaecology Obstetrics and Reproductive Medicine, Centre Hospitalier Universitaire (CHU) Cochin, Paris, France; Department 3I "Infection, Immunité et inflammation", Institut Cochin, INSERM U1016, Paris, France
| |
Collapse
|
11
|
Medema AM, Zanolli NC, Cline B, Pabon-Ramos W, Martin JG. Comparing magnetic resonance imaging and ultrasound in the clinical evaluation of fibroids prior to uterine artery embolization. Curr Probl Diagn Radiol 2024; 53:308-312. [PMID: 38267343 DOI: 10.1067/j.cpradiol.2024.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 01/18/2024] [Accepted: 01/18/2024] [Indexed: 01/26/2024]
Abstract
PURPOSE Uterine artery embolization has become established as a frontline treatment for uterine leiomyomata. In planning embolization, preprocedural imaging can further characterize pathology and anatomy, but it may also reveal coexisting diagnoses that have the potential to change clinical management. The purpose of this study is to compare the diagnostic outcomes of ultrasound and MRI performed for patients prior to undergoing embolization. METHODS The study cohort consisted of 199 patients who underwent uterine artery embolization at a single academic institution between 2013 and 2018. Prior to embolization, all patients had an MRI confirming a leiomyomata diagnosis. Additionally, 118 patients underwent transvaginal ultrasound within five years prior to MRI. MRI findings were analyzed and, when applicable, compared to prior ultrasound impressions to assess for the incidence of new findings. The diagnoses of interest were adenomyosis, hydrosalpinx, predominantly infarcted leiomyomata, and large intracavitary leiomyomata. Data were collected from retrospective chart review and included demographics, symptomology, and imaging reports. RESULTS 199 patients ultimately underwent embolization for treatment of MRI-confirmed leiomyomata. Of 118 patients who also had an ultrasound within five years prior to their MRI, 26 (22.0%) received a second gynecologic diagnosis based on MRI findings that was not previously seen on ultrasound. Of 81 patients who only had an MRI before embolization, 19 (23.5%) received a second gynecologic diagnosis not previously documented. The most common coexisting pathology was adenomyosis, presenting in 34 (17.1%) patients with leiomyomata, followed by large intracavitary leiomyomata (8, 4.0%), infarcted leiomyomata (7, 3.5%), and hydrosalpinx (6, 3.0%),. CONCLUSIONS When considering uterine artery embolization for the treatment of symptomatic leiomyomata, preprocedural MRI is superior to ultrasound in detecting coexisting pathologies, including adenomyosis and hydrosalpinx. It can also better characterize leiomyomata, including identifying lesions as intracavitary or infarcted. These findings have the potential to alter clinical management or contraindicate embolization entirely.
Collapse
Affiliation(s)
- Alexis M Medema
- Duke University School of Medicine, Box 3808, Durham, NC 27710, USA
| | - Nicole C Zanolli
- Duke University School of Medicine, Box 3808, Durham, NC 27710, USA
| | - Brendan Cline
- Department of Radiology, Division of Interventional Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710, USA
| | - Waleska Pabon-Ramos
- Department of Radiology, Division of Interventional Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710, USA
| | - Jonathan G Martin
- Department of Radiology, Division of Interventional Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710, USA.
| |
Collapse
|
12
|
Gao M, Bhosale P, Devine C, Palmquist S, Javadi S. US, MRI, CT Performance and Interpretation of Uterine Masses. Semin Ultrasound CT MR 2023; 44:541-559. [PMID: 37821051 DOI: 10.1053/j.sult.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
Uterine masses are commonly encountered as incidental findings during cross-sectional imaging or when individuals present with symptoms such as pain and bleeding. The World Health Organization categorizes tumors of the uterine corpus into 5 distinct groups: endometrial epithelial tumors and their precursors, tumor-like growths, mesenchymal uterine tumors, tumors with a combination of epithelial and mesenchymal elements, and various other types of tumors. The primary imaging method for assessing uterine abnormalities is transvaginal ultrasound. However, magnetic resonance imaging (MRI) can be employed to enhance the visualization of soft tissues, enabling a more detailed characterization of uterine masses. This article aims to outline the imaging features of both benign and malignant uterine masses using ultrasound, MRI, and computed tomography.
Collapse
Affiliation(s)
- Mamie Gao
- University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Priya Bhosale
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Sanaz Javadi
- University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
13
|
Hurtado S, Shetty MK. Post-Menopausal Bleeding: Role of Imaging. Semin Ultrasound CT MR 2023; 44:519-527. [PMID: 37832697 DOI: 10.1053/j.sult.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
Post-menopausal bleeding (PMB) accounts for 5% of gynecologic office visits and is the presenting symptom in 90% of women with endometrial cancer, which requires prompt evaluation. The most common etiology of PMB is vaginal or endometrial atrophy and endometrial polyps, while endometrial hyperplasia and carcinoma account for less than 10% of PMB. Transvaginal ultrasonography measurement of an endometrial thickness (EMT) less than or equal to 4 mm has a 99% negative predictive value for endometrial carcinoma. Endometrial sampling is required if EMT >4 mm or persistent bleeding occurs. Further evaluation can be accomplished with saline infusion sonography, magnetic resonance imaging, and hysteroscopy.
Collapse
|
14
|
Paspulati RM. Chronic Pelvic Pain: Role of Imaging in the Diagnosis and Management. Semin Ultrasound CT MR 2023; 44:501-510. [PMID: 37879545 DOI: 10.1053/j.sult.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
Chronic pelvic pain (CPP) in women is not uncommon, and it may be difficult to identify the exact cause difficult to manage. It is major health problem for women that affects the quality of their daily lives. The etiology of chronic pelvic pain may be of gynecological or non-gynecological origin and associated with several predisposing and precipitating factors. Psychological and social factors also contribute to the syndrome of CPP and must be evaluated before managing these patients. Due to multifactorial etiology, CPP needs a multidisciplinary approach for diagnosis and management. A detailed history and physical examination supported by appropriate laboratory tests and imaging are the keys to diagnosis. In this paper, the role of imaging in diagnosis and management of CPP is reviewed. Imaging findings should be correlated with detailed clinical examination findings as there are imaging findings that may be unrelated and not the cause of CPP in a particular patient, imaging findings should be correlated with the clinical circumstances.
Collapse
Affiliation(s)
- Raj Mohan Paspulati
- Department of Diagnostic and Interventional Radiology, Moffitt Cancer Center, Tampa, Florida; Department of Medical Oncology, University of South Florida, Tampa, Florida.
| |
Collapse
|
15
|
Krentel H, Keckstein J, Füger T, Hornung D, Theben J, Salehin D, Buchweitz O, Mueller A, Schäfer SD, Sillem M, Schweppe KW, Tchartchian G, Gilman E, De Wilde RL. Accuracy of ultrasound signs on two-dimensional transvaginal ultrasound in prediction of adenomyosis: prospective multicenter study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:739-746. [PMID: 36920431 DOI: 10.1002/uog.26197] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 01/09/2023] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE Two-dimensional (2D) transvaginal ultrasound (TVS) is an accessible and cost-effective diagnostic tool for the detection of adenomyosis. Different ultrasound features related to adenomyosis have been described, but the predictive value of each ultrasound sign and their combinations requires further investigation. We aimed to analyze the accuracy of 2D-TVS and describe possible combinations of ultrasound signs with a high predictive value in the diagnosis of adenomyosis. METHODS This was a prospective multicenter study of patients scheduled for laparoscopic hysterectomy who had been examined using standardized 2D-TVS at nine expert centers specializing in the diagnosis and treatment of endometriosis. 2D-TVS examination included nine typical adenomyosis ultrasound features, comprising heterogeneous myometrium, myometrial linear striations, myometrial cysts, subendometrial microcysts, asymmetrical myometrial thickening, uterine enlargement, the 'question mark sign', thickening of the junctional zone and hyperechoic myometrial spots, in order to predict or exclude the presence of adenomyosis. Ultrasound examination results were compared with histology after hysterectomy. The diagnostic reliability of the nine ultrasound signs and their combinations, and the influence of concurrent fibroids on the accuracy of the results, were analyzed. RESULTS A total of 202 patients were enrolled into the study. Histopathological examination revealed adenomyosis in 130 patients (64.4%). The accuracy of prediction of adenomyosis by 2D-TVS examination using all signs was 63.4% (positive predictive value, 71.5%; negative predictive value, 48.6%; sensitivity, 71.5%; specificity, 48.6%). Heterogeneous myometrium, myometrial cysts, subendometrial microcysts and hyperechoic myometrial spots showed the highest accuracy (55.7-62.1%) as individual ultrasound signs for the prediction of adenomyosis. The combination of the most accurate ultrasound signs (subendometrial microcysts, myometrial cysts and heterogeneous myometrium) improved the specificity of prediction (86.1%) when compared with that of these three single markers (35.2-81.7%). Uterine enlargement and asymmetry showed both low sensitivity (60.8% and 52.3%, respectively) and specificity (41.7% and 49.3%, respectively) as individual sonographic signs. CONCLUSIONS Heterogeneous myometrium, myometrial cysts, subendometrial microcysts and hyperechoic myometrial spots showed the highest accuracy for the detection of adenomyosis in this study, while uterine enlargement and asymmetry led to high false-positive and false-negative results. A combination of ultrasound features including the most accurate signs increases specificity. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- H Krentel
- Department of Gynecology, Obstetrics and Gynecological Oncology, Academic Teaching Hospital, Bethesda Krankenhaus Duisburg, Duisburg, Germany
| | - J Keckstein
- Endometriosis Clinic, Dres. Keckstein, Villach, Austria
| | - T Füger
- MIC Zentrum, München, Germany
| | - D Hornung
- Department of Obstetrics and Gynecology, Vidia Diakonissenkrankenhaus, Karlsruhe, Germany
| | - J Theben
- Department of Obstetrics and Gynecology, St Elisabeth Hospital Köln-Hohenlind, Köln, Germany
| | - D Salehin
- Department of Obstetrics and Gynecology, Evangelisches Krankenhaus Bethesda, Mönchengladbach, Germany
| | | | - A Mueller
- Department of Obstetrics and Gynecology, Städtisches Klinikum, Karlsruhe, Germany
| | - S D Schäfer
- Department of Obstetrics and Gynecology, University Hospital Münster, Münster, Germany
| | - M Sillem
- Praxisklinik am Rosengarten, Mannheim and Saarland University Medical Centre, Homburg, Germany
| | - K W Schweppe
- Stiftung Endometrioseforschung, Westerstede, Germany
| | | | - E Gilman
- Gilman Biometrics, Köln, Germany
| | - R L De Wilde
- Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius-Hospital Oldenburg, Medical Campus University of Oldenburg, Germany
| |
Collapse
|
16
|
Xiong L, Cheng W, Wang Z, Shi Q. Pregnancy outcomes of adenomyotic patients with primary infertility after high-intensity focused ultrasound treatment. Int J Hyperthermia 2023; 40:2264547. [PMID: 37903541 DOI: 10.1080/02656736.2023.2264547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/22/2023] [Indexed: 11/01/2023] Open
Abstract
OBJECTIVE To evaluate the therapeutic effect of high-intensity focused ultrasound (HIFU) treatment for adenomyotic patients with primary infertility and to explore the factors that affect the pregnancy outcomes. MATERIALS AND METHODS Twenty-seven adenomyotic patients with primary infertility who underwent HIFU at HUNAN Provincial Maternal and Child Health Care Hospital, China, between July 2018 and December 2022 were retrospectively reviewed. We evaluated the pregnancy outcomes and analyzed the factors that may affect pregnancy outcomes including time to conception, pregnancy approach, gestational age, delivery mode, neonatal outcomes, and complications during pregnancy and delivery. RESULTS Among the 27 adenomyotic patients with primary infertility, 10 patients had a total of 11 pregnancies after HIFU treatment. Of these, eight (72%) cases were natural pregnancies and three (23%) were in vitro fertilization (IVF) pregnancies. The median time to conception was 10 (range 4-25) months. There were eight (72%) successful deliveries. The rate of full-term deliveries was 90%. Of the eight live births, four (50%) were born vaginally and four (50%) by cesarean section. No severe complications occurred. The mean birth weight of newborns was 3.1 (range: 2.3-3.9) kg; all newborns developed well without complications during postpartum and breastfeeding. CONCLUSIONS HIFU treatment for adenomyosis could improve fertility of patients with primary infertility. HIFU is a promising therapeutic approach for patients with adenomyosis and infertility who wish to achieve pregnancy and have live birth deliveries.
Collapse
Affiliation(s)
- Li Xiong
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- Department of Gynaecology and Obstetrics of Hunan Provincial Maternal and Child Health Care Hospital, Changsha, China
| | - Wei Cheng
- Department of Gynaecology and Obstetrics of Hunan Provincial Maternal and Child Health Care Hospital, Changsha, China
| | - Zhibiao Wang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Qiuling Shi
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| |
Collapse
|
17
|
Wang S, Duan H. The role of the junctional zone in the management of adenomyosis with infertility. Front Endocrinol (Lausanne) 2023; 14:1246819. [PMID: 37886646 PMCID: PMC10598341 DOI: 10.3389/fendo.2023.1246819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
The junctional zone (JZ) is an important structure in the myometrium that maintains uterine fertility. Changes in the junctional zone are closely related to infertility and adenomyosis (ADS). As an increasing number of young women are affected by ADS, the disease is no longer considered typical of women over 40. With these changes, an increasing number of patients refuse hysterectomy and desire fertility preservation treatment. At the same time, ADS is a crucial factor causing female infertility. Therefore, the treatment of ADS-related infertility and preservation of reproductive function is one of the other major challenges facing clinicians. For these young patients, preserving fertility and even promoting reproduction has become a new challenge. Therefore, we searched and summarized these studies on PubMed and Google Scholar using keywords such as "adenomyosis", "junctional zone", and "infertility" to explore infertility causes, diagnosis, and treatment of ADS patients who wish to preserve their uterus or fertility and become pregnant, focusing on the junctional zone, to obtain a full appreciation of the new perspective on this disease.
Collapse
Affiliation(s)
| | - Hua Duan
- Department of Minimally Invasive Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| |
Collapse
|
18
|
Moawad G, Youssef Y, Fruscalzo A, Faysal H, Kheil M, Pirtea P, Guani B, Ayoubi JM, Feki A. The Present and the Future of Medical Therapies for Adenomyosis: A Narrative Review. J Clin Med 2023; 12:6130. [PMID: 37834773 PMCID: PMC10573655 DOI: 10.3390/jcm12196130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 09/11/2023] [Accepted: 09/15/2023] [Indexed: 10/15/2023] Open
Abstract
Uterine Adenomyosis is a benign condition characterized by the presence of endometrium-like epithelial and stromal tissue in the myometrium. Several medical treatments have been proposed, but still, no guidelines directing the management of adenomyosis are available. While a hysterectomy is typically regarded as the definitive treatment for adenomyosis, the scarcity of high-quality data leaves patients desiring fertility with limited conservative options. Based on the available data, the levonorgestrel-IUD appears to offer the most favorable outcomes. Other treatments, including GnRH antagonists, dienogest, prolactin, and oxytocin modulators, show promise; however, further data are required to establish their efficacy definitively. Furthermore, there are many emerging therapies that have been developed that seem worthy of consideration in the near future. The aim of this narrative review was to explore the current medical treatments available for adenomyosis and to provide a glimpse of future therapies under assessment. For this scope, we performed a literature search on PubMed and Medline from incept to September 2022 using the keywords: "medical treatment", "non-steroidal anti-inflammatory", "progesterone intrauterine device", "dienogest", "combined oral contraceptives", "gonadotropin releasing hormone agonist", "gonadotropin releasing hormone antagonist", "danazol", "aromatase inhibitors", "ulipristal acetate", "anti-platelet therapy", "dopamine", "oxytocin antagonists", "STAT3", "KRAS", "MAPK", "micro-RNA", "mifepristone", "valproic acid", "levo-tetrahydropalamatine", and "andrographolide". The search was limited to articles in English, with subsequent screening of abstracts. Abstracts were screened to select relevant studies.
Collapse
Affiliation(s)
- Gaby Moawad
- Department of Obstetrics and Gynecology, George Washington University, Washington, DC 20037, USA
- The Center for Endometriosis and Advanced Pelvic Surgery, Washington, DC 22101, USA
| | - Youssef Youssef
- Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY 11220, USA
| | - Arrigo Fruscalzo
- Department of Obstetrics and Gynecology, HFR—Fribourg, Chemin des Pensionnats 2-6, 1708 Fribourg, Switzerland; (A.F.)
| | - Hani Faysal
- Department of Obstetrics and Gynecology, Indiana University, Indianapolis, IN 46202, USA
| | - Mira Kheil
- Department of Obstetrics and Gynecology, Henry Ford Health, Detroit, MI 48202, USA
| | - Paul Pirtea
- Department of Obstetrics and Gynecology and Reproductive Medicine, Hopital Foch–Faculté de Médecine Paris, 92150 Suresnes, France
| | - Benedetta Guani
- Department of Obstetrics and Gynecology, HFR—Fribourg, Chemin des Pensionnats 2-6, 1708 Fribourg, Switzerland; (A.F.)
| | - Jean Marc Ayoubi
- Department of Obstetrics and Gynecology and Reproductive Medicine, Hopital Foch–Faculté de Médecine Paris, 92150 Suresnes, France
| | - Anis Feki
- Department of Obstetrics and Gynecology, HFR—Fribourg, Chemin des Pensionnats 2-6, 1708 Fribourg, Switzerland; (A.F.)
| |
Collapse
|
19
|
Maudot C, Vernet T, Debras E, Fernandez H, Capmas P. Diagnostic accuracy study of sonography in adenomyosis: A study of current practice. J Gynecol Obstet Hum Reprod 2023; 52:102604. [PMID: 37210009 DOI: 10.1016/j.jogoh.2023.102604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/24/2023] [Accepted: 05/17/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVES To estimate diagnostic accuracy of sonography in the diagnosis of adenomyosis in current practice when compared to pathology as a "gold standard". METHODS This diagnosis accuracy study was observational and retrospective, including women managed by hysterectomy for benign pathology from January 2015 to November 2018. Preoperative pelvic sonography reports were collected, including details on diagnosis criteria for adenomyosis. Sonographic findings were compared to pathological results of the hysterectomy specimens. RESULTS Our study initially concerned 510 women; 242 of them had adenomyosis confirmed by a pathological examination. The pathological prevalence of adenomyosis was 47.4% in this study. A preoperative sonography was available for 89.4% of the 242 women, with a suspicion of adenomyosis in 32.7% of them. In this study, Sensitivity is 52%, Specificity 85%, Positive Predictive Value (PPV) 77%, Negative Predictive Value (NPV) 86% and Accuracy 38,1%. CONCLUSIONS Pelvic sonography is the most common non-invasive examination used in gynecology. It is also the first recommended examination for the diagnosis of adenomyosis because of its acceptability and its cost, even if the diagnosis performances are moderate. However, these performances are comparable to MRI (Magnetic Resonance Imaging) performances. The use of a standardized sonographic classification could improve and harmonize the diagnosis of adenomyosis.
Collapse
Affiliation(s)
- Constance Maudot
- AP-HP, GHU-Sud, Hospital Bicêtre, Department of Gynecology and Obstetrics, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
| | - Thibaut Vernet
- AP-HP, GHU-Sud, Hospital Bicêtre, Department of Gynecology and Obstetrics, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
| | - Elodie Debras
- AP-HP, GHU-Sud, Hospital Bicêtre, Department of Gynecology and Obstetrics, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
| | - Hervé Fernandez
- AP-HP, GHU-Sud, Hospital Bicêtre, Department of Gynecology and Obstetrics, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France; Faculty of medicine, University Paris-Sud Saclay, 63 rue Gabriel Péri, 94270 Le Kremlin Bicêtre, France; INSERM - UMR1018 - CESP - Hopital Paul Brousse, 12 avenue Paul Vaillant Courturier, 94800 Villejuif, France
| | - Perrine Capmas
- AP-HP, GHU-Sud, Hospital Bicêtre, Department of Gynecology and Obstetrics, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France; Faculty of medicine, University Paris-Sud Saclay, 63 rue Gabriel Péri, 94270 Le Kremlin Bicêtre, France; INSERM - UMR1018 - CESP - Hopital Paul Brousse, 12 avenue Paul Vaillant Courturier, 94800 Villejuif, France.
| |
Collapse
|
20
|
Janicas C, Cunha TM. Adenomyosis at a Glance: An Integrated Review of Transvaginal Ultrasound and MR Imaging Findings. Curr Probl Diagn Radiol 2023; 52:412-417. [PMID: 37230885 DOI: 10.1067/j.cpradiol.2023.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/20/2023] [Accepted: 05/08/2023] [Indexed: 05/27/2023]
Abstract
Adenomyosis is a benign uterine disorder increasingly recognized in premenopausal women. Given its significant clinical burden, an accurate noninvasive diagnosis is paramount. Both transvaginal ultrasound (TVUS) and magnetic resonance (MR) provide an adequate assessment of adenomyosis, the former being recommended for first-line imaging evaluation and the latter being mainly used as a problem-solving technique. In this article, the authors review the TVUS and MR imaging findings of adenomyosis while referring to their histopathological background. Whereas direct signs correlate directly to ectopic endometrial tissue and are highly specific to adenomyosis, indirect signs result from myometrial hypertrophy and increase diagnostic sensitivity. Potential pitfalls, differential diagnoses, and frequently associated estrogen-dependent conditions are also discussed.
Collapse
Affiliation(s)
- Catarina Janicas
- Department of Radiology, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
| | - Teresa Margarida Cunha
- Department of Radiology, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| |
Collapse
|
21
|
Chung YJ, Rha SE, Kim MR, Shin YR. Correlation between MRI Features of Adenomyosis and Clinical Presentation. Diagnostics (Basel) 2023; 13:2749. [PMID: 37685287 PMCID: PMC10486376 DOI: 10.3390/diagnostics13172749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/19/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
This study aimed to explore the correlation between MRI features, clinical risk factors, and symptoms associated with adenomyosis. Overall, 112 patients with pathologically confirmed adenomyosis were included in this retrospective study. MRI findings and clinical presentation, including visual analog scale (VAS) scores, cancer antigen 125 (CA-125) and hemoglobin levels, and parity, were analyzed. Additionally, 131 patients undergoing active surveillance were included to validate the MRI parameters and clinical presentations. Associations between MRI parameters and adenomyosis-related clinical presentations were assessed. Patients with operated adenomyosis were younger and had larger lesions, which were more frequently of the diffuse type and posterior localization, coexisting ovarian endometriosis, deep infiltrating endometriosis, myometrial cysts, and diffusion restriction than the non-operated lesions (p < 0.05). Patients with operated adenomyosis also exhibited higher VAS scores and CA-125 levels, and nulliparity was more common in this group (p < 0.05). In contrast, patients with non-operated adenomyosis showed a higher frequency of entire localization and fibroids (p < 0.05). Among the MRI parameters, size and classification were associated with the VAS and CA-125 levels. Myometrial cysts were associated with CA-125 levels. Classification was also associated with hemoglobin levels, and posterior localization was associated with parity. We identified a significant correlation between MRI features and clinical presentation in patients with adenomyosis.
Collapse
Affiliation(s)
- Youn-Jee Chung
- Department of Obstetrics & Gynecology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (Y.-J.C.); (M.-R.K.)
| | - Sung Eun Rha
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea;
| | - Mee-Ran Kim
- Department of Obstetrics & Gynecology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (Y.-J.C.); (M.-R.K.)
| | - Yu Ri Shin
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea;
| |
Collapse
|
22
|
Marcellin L, Legay L, Santulli P, Millischer AE, Bordonne C, Maitrot Mantelet L, Maignien C, Bourdon M, Gaudet Chardonnet A, Borghese B, Goffinet F, Chapron C. Magnetic resonance imaging presentation of diffuse and focal adenomyosis before and after pregnancy. Reprod Biomed Online 2023; 47:121-128. [PMID: 37137789 DOI: 10.1016/j.rbmo.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 02/05/2023] [Accepted: 02/20/2023] [Indexed: 02/26/2023]
Abstract
RESEARCH QUESTION Is there a change in magnetic resonance imaging (MRI) criteria of diffuse and focal phenotypes of adenomyosis before and after pregnancy? DESIGN A retrospective, monocentric, observational study in a single academic tertiary referral centre for endometriosis diagnosis and management. Women were followed for symptomatic adenomyosis, and without a prior history of surgery who give birth after 24+0 weeks. For each patient, pelvic MRI pre- and post-pregnancy was performed by two experienced radiologists with the same image acquisition protocol. Diffuse and focal adenomyosis MRI presentation were analysed before and after pregnancy. RESULTS Between January 2010 and September 2020, of the 139 patients analysed, 96 (69.1%) had adenomyosis at MRI distributed as follow: 22 (15.8%) presented diffuse adenomyosis, 55 (39.6%) focal adenomyosis and 19 (13.7%) both phenotypes. The frequency of isolated diffuse adenomyosis on MRI was significantly lower before versus after pregnancy (n = 22 [15.8%] versus n = 41 [29.5%], P = 0.01). The frequency of isolated focal adenomyosis was significantly higher before pregnancy than after pregnancy (n = 55 [39.6%] versus n = 34 [24.5%], P = 0.01). The mean volume of all focal adenomyosis lesions on MRI decreased significantly after pregnancy, from 6.7 ± 2.5 mm3 to 6.4 ± 2.3 mm3, P = 0.01. CONCLUSION The current data indicate that, based on MRI, there is an increase in diffuse adenomyosis and a decrease in focal adenomyosis after pregnancy.
Collapse
Affiliation(s)
- Louis Marcellin
- Université de Paris, Faculté de Médecine, Paris, France; Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; Service de Chirurgie Gynécologie Obstétrique II et Médecine de la Reproduction, Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France; Oxidative Stress, Cellular Proliferation and Inflammation Team, Department of Development, Reproduction and Cancer, INSERM U1016, Paris, France.
| | | | - Pietro Santulli
- Université de Paris, Faculté de Médecine, Paris, France; Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; Service de Chirurgie Gynécologie Obstétrique II et Médecine de la Reproduction, Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France; Genomics, Epigenetics and Physiopathology of Reproduction Team, Department of Development, Reproduction and Cancer, INSERM U1016, Paris, France
| | - Anne Elodie Millischer
- Centre de Radiologie IMPC Bachaumont Pole Femme-Mère-Enfant, 75002 Paris, France; Institut de la Femme et de l'Endométriose (IFEEN), 75003 Paris, France
| | - Corinne Bordonne
- Centre de Radiologie IMPC Bachaumont Pole Femme-Mère-Enfant, 75002 Paris, France; Institut de la Femme et de l'Endométriose (IFEEN), 75003 Paris, France
| | - Lorraine Maitrot Mantelet
- Université de Paris, Faculté de Médecine, Paris, France; Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; Service de Chirurgie Gynécologie Obstétrique II et Médecine de la Reproduction, Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
| | - Chloé Maignien
- Université de Paris, Faculté de Médecine, Paris, France; Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; Service de Chirurgie Gynécologie Obstétrique II et Médecine de la Reproduction, Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
| | - Mathilde Bourdon
- Université de Paris, Faculté de Médecine, Paris, France; Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; Service de Chirurgie Gynécologie Obstétrique II et Médecine de la Reproduction, Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
| | - Antoine Gaudet Chardonnet
- Université de Paris, Faculté de Médecine, Paris, France; Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; Service de Chirurgie Gynécologie Obstétrique II et Médecine de la Reproduction, Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
| | - Bruno Borghese
- Université de Paris, Faculté de Médecine, Paris, France; Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; Service de Chirurgie Gynécologie Obstétrique II et Médecine de la Reproduction, Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France; Genomics, Epigenetics and Physiopathology of Reproduction Team, Department of Development, Reproduction and Cancer, INSERM U1016, Paris, France
| | - François Goffinet
- Université de Paris, Faculté de Médecine, Paris, France; Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; Maternité Port-Royal, Paris, France
| | - Charles Chapron
- Université de Paris, Faculté de Médecine, Paris, France; Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; Service de Chirurgie Gynécologie Obstétrique II et Médecine de la Reproduction, Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France; Oxidative Stress, Cellular Proliferation and Inflammation Team, Department of Development, Reproduction and Cancer, INSERM U1016, Paris, France; Genomics, Epigenetics and Physiopathology of Reproduction Team, Department of Development, Reproduction and Cancer, INSERM U1016, Paris, France
| |
Collapse
|
23
|
Mishra I, Melo P, Easter C, Sephton V, Dhillon-Smith R, Coomarasamy A. Prevalence of adenomyosis in women with subfertility: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:23-41. [PMID: 36647238 DOI: 10.1002/uog.26159] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/15/2022] [Accepted: 12/23/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To determine the prevalence of adenomyosis in women with subfertility. METHODS A systematic search was conducted in MEDLINE, EMBASE, CINAHL Plus, Google Scholar, PsycINFO and Web of Science Core Collection from database inception to October 2022. The included studies evaluated the prevalence of adenomyosis in women with subfertility, with or without endometriosis and/or uterine fibroids. Secondary analyses were conducted to identify variation in the prevalence of isolated adenomyosis according to geographical location, diagnostic modality, diagnostic criteria, type of ultrasound, ultrasound features of adenomyosis and the use of assisted reproductive technology. RESULTS Among 21 longitudinal studies evaluating 25 600 women, the overall pooled prevalence of isolated adenomyosis was 10% (95% CI, 6-15%) (I2 = 99.1%; tau2 = 0.12). The pooled prevalence was 1% (95% CI, 0-4%) for adenomyosis with concurrent fibroids (eight studies; I2 = 95.8%; tau2 = 0.03), 6% (95% CI, 3-11%) for adenomyosis with concurrent endometriosis (18 studies; I2 = 98.6%; tau2 = 0.12) and 7% (95% CI, 2-13%) for adenomyosis with concurrent endometriosis and/or fibroids (nine studies; I2 = 98.3%; tau2 = 0.09). The prevalence of isolated adenomyosis varied substantially according to geographical location, with Australia exhibiting the highest pooled prevalence of adenomyosis (19% (95% CI, 12-27%)), which was significantly higher compared with that in Asia (5% (95% CI, 1-12%)). The pooled prevalence of isolated adenomyosis diagnosed using a combination of direct and indirect ultrasound features was 11% (95% CI, 7-16%), whereas it was 0.45% (95% CI, 0-1%) in the study in which only an indirect feature was used as the diagnostic criterion. CONCLUSION One in 10 women with subfertility have a diagnosis of isolated adenomyosis. The prevalence of adenomyosis varies according to the presence of concurrent endometriosis and/or fibroids. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- I Mishra
- Institute of Metabolism and Systems Research, Tommy's National Centre for Miscarriage Research, University of Birmingham, Birmingham, UK
- CARE Fertility Birmingham, Birmingham, UK
| | - P Melo
- Institute of Metabolism and Systems Research, Tommy's National Centre for Miscarriage Research, University of Birmingham, Birmingham, UK
- CARE Fertility Birmingham, Birmingham, UK
| | - C Easter
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - R Dhillon-Smith
- Institute of Metabolism and Systems Research, Tommy's National Centre for Miscarriage Research, University of Birmingham, Birmingham, UK
| | - A Coomarasamy
- Institute of Metabolism and Systems Research, Tommy's National Centre for Miscarriage Research, University of Birmingham, Birmingham, UK
- CARE Fertility Birmingham, Birmingham, UK
| |
Collapse
|
24
|
Andersson JK, Mucelli RP, Dueholm M, Fridsten S, Grigoriadis A, Guerriero S, Leone FP, Valentin L, Van Den Bosch T, Voulgarakis N, Gemzell-Danielsson K, Epstein E. Inter-Rater Agreement for Diagnosing Adenomyosis Using Magnetic Resonance Imaging and Transvaginal Ultrasonography. Diagnostics (Basel) 2023; 13:2193. [PMID: 37443587 DOI: 10.3390/diagnostics13132193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/22/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023] Open
Abstract
Our aim was to compare the inter-rater agreement about transvaginal ultrasonography (TVS) with magnetic resonance imaging (MRI) with regard to diagnosing adenomyosis and for assessing various predefined imaging features of adenomyosis, in the same set of women. The study cohort included 51 women, prospectively, consecutively recruited based on a clinical suspicion of adenomyosis. MRIs and TVS videoclips and 3D volumes were retrospectively assessed by four experienced radiologists and five experienced sonographers, respectively. Each rater subjectively evaluated the presence or absence of adenomyosis, as well as imaging features suggestive of adenomyosis. Fleiss kappa (κ) was used to reflect inter-rater agreement for categorical data, and the intraclass correlation coefficient (ICC) was used to reflect the reliability of quantitative data. Agreement between raters for diagnosing adenomyosis was higher for TVS than for MRI (κ = 0.42 vs. 0.28). MRI had a higher inter-rater agreement in assessing wall asymmetry, irregular junctional zone (JZ), and the presence of myometrial cysts, while TVU had a better agreement for assessing globular shape. MRI showed a moderate to good reliability for measuring the JZ (ICC = 0.57-0.82). For TVS, the JZ was unmeasurable in >50% of cases, and the remaining cases had low reliability (ICC = -0.31-0.08). We found that inter-rater agreement for diagnosing adenomyosis was higher for TVS than for MRI, despite the fact that MRI showed a higher inter-rater agreement in most specific features. Measurements of JZ in the coronal plane with 3D TVS were unreliable and thus unlikely to be useful for diagnosing adenomyosis.
Collapse
Affiliation(s)
- Johanna K Andersson
- Department of Women's and Children's Health, Karolinska Institutet and Liljeholmens Gynecological Clinic, 11794 Stockholm, Sweden
| | - Raffaella Pozzi Mucelli
- Department of Clinical Science, Intervention, and Technology (CLINTEC), Division of Radiology, Karolinska Institutet, 17177 Stockholm, Sweden
- Department of Abdominal Radiology, Karolinska University Hospital, 17176 Solna, Sweden
| | - Margit Dueholm
- Department of Gynecology, Aarhus University Hospital, 8200 Skejby, Denmark
| | - Susanne Fridsten
- Department of Abdominal Radiology, Karolinska University Hospital, 17176 Solna, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Aristeidis Grigoriadis
- Department of Clinical Science, Intervention, and Technology (CLINTEC), Division of Radiology, Karolinska Institutet, 17177 Stockholm, Sweden
- Department of Abdominal Radiology, Karolinska University Hospital, 17176 Solna, Sweden
| | - Stefano Guerriero
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, 09042 Monserrato, Italy
| | - Francesco Paolo Leone
- Biomedical and Clinical Sciences Institute L. Sacco and Department of Obstetrics and Gynecology, University of Milan, 20122 Milan, Italy
| | - Lil Valentin
- Department of Clinical Sciences Malmö, Lund University, 22100 Lund, Sweden
- Department of Obstetrics and Gynecology, Skane University Hospital, 21428 Malmö, Sweden
| | | | - Nikolaos Voulgarakis
- Department of Clinical Science, Intervention, and Technology (CLINTEC), Division of Radiology, Karolinska Institutet, 17177 Stockholm, Sweden
- Department of Abdominal Radiology, Karolinska University Hospital, 17176 Solna, Sweden
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, 17176 Stockholm, Sweden
| | - Elisabeth Epstein
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, 11883 Stockholm, Sweden
- Department of Obstetrics and Gynecology, Södersjukhuset, 11883 Stockholm, Sweden
| |
Collapse
|
25
|
Gkrozou F, Vatopoulou A, Skentou C, Paschopoulos M. Diagnosis and Treatment of Adenomyosis with Office Hysteroscopy-A Narrative Review of Literature. Diagnostics (Basel) 2023; 13:2182. [PMID: 37443576 DOI: 10.3390/diagnostics13132182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION Adenomyosis is a common chronic disease in women of reproductive age, characterised by the presence of ectopic endometrial tissue within myometrium. Even though adenomyosis presents with chronic pelvic pain, menorrhagia or abnormal uterine bleeding, dysmenorrhoea, and dyspareunia and is often recognised after hysterectomies. However, the development of ultrasonography and magnetic resonance imaging has improved the pre-operative diagnosis of the disease. Hysteroscopy provides information in real time from the uterine cavity and the offers the possibility of obtaining direct biopsies. MATERIAL AND METHODS The literature was searched via Pubmed and Embase with the following headings: diagnosis of adenomyosis or adenomyoma and office hysteroscopy, hysteroscopy findings of adenomyosis or adenomyoma, treatment of adenomyosis or adenomyoma with office hysteroscopy. RESULTS The literature showed that hysteroscopy can identify superficial adenomyosis. There are a variety of hysteroscopic images that can be connected with the disease. New equipment like the spirotome has been used to access deeper layers of myometrium and obtain biopsies under direct vision from the adenomyotic areas. Different methods of treatment have been also described, like enucleation of focal superficial adenomyoma, coagulation, evacuation of cystic adenomyosis when the lesion is smaller than 1.5 cm, and resection of adenomyotic nodules in case of bigger lesions (>1.5 cm). Diffuse superficial adenomyosis is also managed by resection. CONCLUSIONS Hysteroscopy has revolutionised the approach to adenomyosis. It is a useful tool in assessing mainly superficial adenomyosis. The role of hysteroscopy in surgical management of adenomyosis need to be confirmed with further studies.
Collapse
Affiliation(s)
- Fani Gkrozou
- Department of Obstetrics and Gynaecology, Medical School, University of Ioannina, 45500 Ioannina, Greece
| | - Anastasia Vatopoulou
- Department of Obstetrics and Gynaecology, Medical School, University of Ioannina, 45500 Ioannina, Greece
| | - Chara Skentou
- Department of Obstetrics and Gynaecology, Medical School, University of Ioannina, 45500 Ioannina, Greece
| | - Minas Paschopoulos
- Department of Obstetrics and Gynaecology, Medical School, University of Ioannina, 45500 Ioannina, Greece
| |
Collapse
|
26
|
Wang Y, Yi YC, Guu HF, Chen YF, Kung HF, Chang JC, Chen LY, Chuan ST, Chen MJ. Impact of adenomyosis and endometriosis on IVF/ICSI pregnancy outcome in patients undergoing gonadotropin-releasing hormone agonist treatment and frozen embryo transfer. Sci Rep 2023; 13:6741. [PMID: 37185812 PMCID: PMC10130073 DOI: 10.1038/s41598-023-34045-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/23/2023] [Indexed: 05/17/2023] Open
Abstract
Although numerous studies have attempted to establish the relationship between adenomyosis and infertility, no consensus has emerged. Our aim was to investigate whether adenomyosis and endometriosis affected IVF outcomes in our patients. This was a retrospective study of 1720 patients from January 2016 to December 2019. In total, 1389 cycles were included: 229 cycles in the endometriosis group (group E), 89 cycles in the adenomyosis group (group A), 69 cycles in the endometriosis and adenomyosis group (group EA), and 1002 cycles in the control group (group C). Most patients in groups A and EA received GnRH agonist treatment before FET. The 1st FET live birth rates (LBR) were 39.3%, 32.1%, 25% and 48.1% in groups E, A, EA, and C. The miscarriage rates were 19.9%, 34.7%, 39%, and 17.6%. The per retrieval cycle cumulative live birth rates (cLBRs) in patients < 38 y/o were 56.4%, 58.1%, 44.8%, and 63%. The per retrieval cycle cLBRs in patients ≥ 38 y/o were 25%, 9.8%, 17.2%, and 29.5%. Among groups A and EA, LBRs were 25.58% and 18.89% in patients with a ≥ sevenfold decrease and a < sevenfold decrease in CA-125 level, respectively, after GnRH agonist treatment. Endometriosis was not associated with a poorer pregnancy outcome. Patients with adenomyosis with/without endometriosis had higher miscarriage rates, lower LBRs, and lower cLBRs, especially in patients aged ≥ 38 years, even after GnRH agonist treatment before FET cycles. Patients who have a greater than sevenfold decrease in CA-125 level after GnRH agonist treatment might have better clinical pregnancy outcomes.
Collapse
Affiliation(s)
- Yu Wang
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Women's Health, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
| | - Yu-Chiao Yi
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Women's Health, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
- Department of Obstetrics and Gynecology, School of Medicine, National Yang Ming Chiao Tung University, No.155, Sec.2, Linong St. Beitou Dist., Taipei City, 112304, Taiwan
| | - Hwa-Fen Guu
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Women's Health, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
| | - Ya-Fang Chen
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Women's Health, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
| | - Hsiao-Fan Kung
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Women's Health, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
| | - Jui-Chun Chang
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Women's Health, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
| | - Li-Yu Chen
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Women's Health, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
| | - Shih-Ting Chuan
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Women's Health, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
| | - Ming-Jer Chen
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Women's Health, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan.
- Department of Obstetrics and Gynecology, School of Medicine, National Yang Ming Chiao Tung University, No.155, Sec.2, Linong St. Beitou Dist., Taipei City, 112304, Taiwan.
| |
Collapse
|
27
|
Moldassarina RS. Modern view on the diagnostics and treatment of adenomyosis. Arch Gynecol Obstet 2023; 308:171-181. [PMID: 37060397 DOI: 10.1007/s00404-023-06982-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/14/2023] [Indexed: 04/16/2023]
Abstract
Adenomyosis is identified by the enlargement of the uterus secondary to such areas of the endometrium as the endometrial glands and stroma located deep in the myometrium, which causes its hyperplasia and hypertrophy. The most common signs of the development of adenomyosis in a patient are copious menstrual bleeding and dysmenorrhea. However, it should be borne in mind that in some patients, the disease may be asymptomatic. Despite the wide abundance of imaging and other diagnostic methods for diagnosing adenomyosis, there are currently no standard verified diagnostic criteria for pathologists. In addition, women with adenomyosis often have other concomitant gynaecological diseases, such as endometriosis or leiomyomas, which makes it difficult to diagnose and choose the optimal treatment for patients. Therefore, the purpose of this study was to highlight up-to-date and relevant information for the practitioner about the epidemiology, clinical manifestations, diagnostics and treatment options for adenomyosis. Sources from four databases (PubMed, Web of Science, Elsevier and Google Scholar) were used to search for data. As a result of a literature review, it was established that the "gold" standard for the diagnostics of adenomyosis is histological research methods, in particular, biopsy performed during hysteroscopy or laparoscopy, whereas imaging methods (transvaginal sonography, magnetic resonance imaging) are more often used for differential diagnostics of adenomyosis with other diseases. In addition, magnetic resonance imaging allows for a better differential diagnostics between adenomyosis and myomatosis and helps to recognise the disease at an early stage. Regarding treatment, there is currently no particular therapy and algorithms for the treatment of adenomyosis, which is primarily due to the lack of precise criteria for the diagnostics of the disease. However, the most effective therapeutic methods at the present stage are the use of aromatase inhibitors and gonadotropin-releasing hormone antagonists, whilst minimally invasive techniques, in particular, endometrial ablation and uterine artery embolisation, are becoming increasingly popular amongst surgical techniques.
Collapse
Affiliation(s)
- Rymgul S Moldassarina
- Department of Obstetrics and Gynecology, Pavlodar Branch of the Semey Medical University, 72/1 Toraigyrov Str., 140002, Pavlodar, Republic of Kazakhstan.
| |
Collapse
|
28
|
Zhang M, Bazot M, Tsatoumas M, Munro MG, Reinhold C. MRI of Adenomyosis: Where Are We Today? Can Assoc Radiol J 2023; 74:58-68. [PMID: 35856446 DOI: 10.1177/08465371221114197] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Purpose of Review: The purpose of this review is to (i) summarize the current literature regarding the role of magnetic resonance imaging (MRI) in diagnosing adenomyosis, (ii) examine how to integrate MRI phenotypes with clinical symptomatology and histological findings, (iii) review recent advances including proposed MRI classifications, (iv) discuss challenges and pitfalls of diagnosing adenomyosis, and (v) outline the future role of MRI in promoting a better understanding of the pathogenesis, diagnosis, and treatment options for patients with uterine adenomyosis. Recent Findings: Recent advances and the widespread use of MRI have provided new insights into adenomyosis and the range of imaging phenotypes encountered in this disorder. Summary: Direct and indirect MRI features allow for accurate non-invasive diagnosis of adenomyosis. Adenomyosis is a complex and poorly understood disorder with variable MRI phenotypes that may be correlated with different pathogeneses, clinical presentations, and patient outcomes. MRI is useful for the assessment of the extent of findings, to evaluate for concomitant gynecological conditions, and potentially can help with the selection and implementation of therapeutic options. Nevertheless, important gaps in knowledge remain. This is in part due to the lack of standardized criteria for reporting resulting in heterogeneous and conflicting data in the literature. Thus, there is an urgent need for a unified MRI reporting system incorporating standardized terminology for diagnosing adenomyosis and defining the various phenotypes.
Collapse
Affiliation(s)
- Michelle Zhang
- Department of Radiology, 54473McGill University Health Centre, Montreal, QC, Canada.,Montreal Imaging Experts Inc, Montreal, QC, Canada
| | - Marc Bazot
- Department of Radiology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), 27063Sorbonne Université, Paris, France.,Groupe de Recherche Clinique (GRC-6), Centre Expert en Endométriose (C3E), Assistance Publique des Hôpitaux de Paris, Tenon University Hospital, 27063Sorbonne Université, Paris, France
| | - Maria Tsatoumas
- Department of Radiology, 54473McGill University Health Centre, Montreal, QC, Canada.,Montreal Imaging Experts Inc, Montreal, QC, Canada
| | - Malcolm G Munro
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Department of Obstetrics and Gynecology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Caroline Reinhold
- Department of Radiology, 54473McGill University Health Centre, Montreal, QC, Canada.,Montreal Imaging Experts Inc, Montreal, QC, Canada.,Augmented Intelligence and Precision Health Laboratory of the Research Institute of McGill University Health Center, 54473McGill University, Montreal, QC, Canada
| |
Collapse
|
29
|
Harada T, Taniguchi F, Guo S, Choi YM, Biberoglu KO, Tsai SS, Alborzi S, Al‐Jefout M, Chalermchokcharoenkit A, Sison‐Aguilar AG, Fong Y, Senanayake H, Popov A, Hestiantoro A, Kaufman Y. The Asian Society of Endometriosis and Adenomyosis guidelines for managing adenomyosis. Reprod Med Biol 2023; 22:e12535. [PMID: 37701076 PMCID: PMC10493363 DOI: 10.1002/rmb2.12535] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 08/03/2023] [Indexed: 09/14/2023] Open
Abstract
This is the first guidelines for adenomyosis from the Asian Society of Endometriosis and Adenomyosis.
Collapse
Affiliation(s)
| | | | - Sun‐Wei Guo
- OB/GYN HospitalFudan UniversityShanghaiChina
| | | | | | | | | | - Moamar Al‐Jefout
- United Arab Emirates University, College of Medicine and Health SciencesAbu DhabiUAE
| | | | | | - Yoke‐Fai Fong
- National University of SingaporeSingapore CitySingapore
| | | | - Alexander Popov
- Moscow Regional Scientific Research Institute of Obstetrics and GynecologyMoscowRussia
| | | | | |
Collapse
|
30
|
Ferrier C, Hini JD, Gaillard T, Grynberg M, Kolanska K, Dabi Y, Nyangoh Timoh K, Lavoue V, Roman H, Darai E, Bendifallah S. First-line surgery vs first-line ART to manage infertility in women with deep endometriosis without bowel involvement: A multi-centric propensity-score matching comparison. Eur J Obstet Gynecol Reprod Biol 2023; 280:184-190. [PMID: 36516605 DOI: 10.1016/j.ejogrb.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/30/2022] [Accepted: 11/15/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare first-line surgery with first-line assisted reproductive techniques (ART) in infertile women with deep infiltrating endometriosis (DIE) without colorectal involvement. STUDY DESIGN A retrospective comparative cohort study with a propensity-score matching analysis, in four tertiary-care referral centers. The population was infertile women with DIE without colorectal involvement. The patients were managed either by first-line surgery followed by spontaneous conception attempts and/or ART, or by first-line ART. 284 patients were extracted from the databases. After matching, 92 patients were compared in each group. Clinical pregnancy rates (PR) and live-birth rates (LBR) were the primary outcomes, and cumulative pregnancy rate (CPR) and cumulative live birth rate (CLBR) were the secondary outcomes. RESULTS The mean number of IVF-ICSI cycles per patient was 1.4, with a significant difference between the groups: 1.6 in the first-line ART group and 1.2 in the first-line surgery group (p = 0.006). The PR was significantly higher in the first-line surgery group (72 % vs 35 %; p < 0.001). In the first-line surgery group, non-ART pregnancies occurred in 18 % (17/92) while no non-ART pregnancies was noted in the first-line ART group. The LBR was significantly higher in the first-line surgery group (61 % vs 24 %; p < 0.001). After ART, the CPR were 72 % (47/67) in the first-line surgery group, and 35 % (32/92) in the first-line ART group (p < 0.001). CONCLUSION After matching, our results support that first-line surgery offer higher pregnancy and live-birth rates than first-line ART in patients with DIE without colorectal involvement.
Collapse
Affiliation(s)
- C Ferrier
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Sorbonne-University, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.
| | - J D Hini
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Sorbonne-University, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - T Gaillard
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Sorbonne-University, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - M Grynberg
- Department of Gynaecology and Obstetrics, Jean Verdier Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Bondy, France
| | - K Kolanska
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Sorbonne-University, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Y Dabi
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Sorbonne-University, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - K Nyangoh Timoh
- Department of Gynaecology and Obstetrics, Rennes University Hospital, Rennes, France
| | - V Lavoue
- Department of Gynaecology and Obstetrics, Rennes University Hospital, Rennes, France
| | - H Roman
- Franco-European Multidisciplinary Endometriosis Institut (IFEMEndo), Clinique Tivoli-Ducos, 33000 Bordeaux, France
| | - E Darai
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Sorbonne-University, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France; Groupe de Recherche Clinique GRC6-UPMC: Centre Expert En Endométriose (C3E), France
| | - S Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Sorbonne-University, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France; Groupe de Recherche Clinique GRC6-UPMC: Centre Expert En Endométriose (C3E), France
| |
Collapse
|
31
|
Jain S, Kumar K, Shukla RC, Jain M. Diagnostic Role of Transvaginal Sonography and Magnetic Resonance Imaging in Adenomyosis of the Uterus and its Correlation with Histopathology. J Midlife Health 2023; 14:34-41. [PMID: 37680374 PMCID: PMC10482023 DOI: 10.4103/jmh.jmh_230_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/24/2023] [Accepted: 04/06/2023] [Indexed: 09/09/2023] Open
Abstract
Background and Objective The prevalence of adenomyosis of the uterus varies from 5% to 70%, and there is no clear consensus on its imaging diagnostic criteria. The objective of this study was to evaluate the role of transvaginal sonography (TVS), combined TVS and color Doppler (TVS-CD), and magnetic resonance imaging (MRI) in the diagnosis of adenomyosis. Materials and Methods This was a tertiary care hospital-based prospective study, in which 365 clinically suspected cases of adenomyosis were enrolled. All three types of imaging (TVS, TVS-CD, and MRI) were done in 233/365 patients, followed by hysterectomy in 50. Imaging features were correlated with the histopathological examination (HPE), which was taken as the gold standard for the diagnosis. The diagnostic performance of each imaging modality was assessed. Results Among patients who underwent hysterectomy, 36/50 (72%) had adenomyosis on HPE, with or without associated benign gynecological abnormalities. Sensitivity, specificity, positive predictive value (PPV), negative PV (NPV), and diagnostic accuracy (DA) of MRI were higher than that of TVS-CD (91.67% vs. 77.78%, 85.71% vs. 78.57%, 94.29% vs. 90.32%, 80% vs. 57.89%, and 90% vs. 78%, respectively). TVS alone had lower diagnostic performance (specificity: 64.29%, PPV 84.85%, NPV 52.94%, and DA74%) than TVS-CD, but equal sensitivity (77.78%). Heterogeneous myometrium was the most sensitive (80.56%), while myometrial cyst was the most specific (92.86%) TVS feature. The maximum junctional zone thickness ≥12 mm was the most sensitive (97.22%), while the hyperintense myometrial focus was the most specific (100%) MRI feature. Conclusion TVS-CD should be used as an initial diagnostic imaging modality in clinically suspected cases of adenomyosis; however, MRI due to better diagnostic efficacy should be the imaging modality of choice before subjecting such patients to hysterectomy.
Collapse
Affiliation(s)
- Shivi Jain
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Kamlesh Kumar
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ram Chandra Shukla
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Madhu Jain
- Department of Obstetrics and Gynaecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| |
Collapse
|
32
|
Leyendecker G, Wildt L, Laschke MW, Mall G. Archimetrosis: the evolution of a disease and its extant presentation : Pathogenesis and pathophysiology of archimetrosis (uterine adenomyosis and endometriosis). Arch Gynecol Obstet 2023; 307:93-112. [PMID: 35596746 PMCID: PMC9836992 DOI: 10.1007/s00404-022-06597-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/27/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE This article presents a novel concept of the evolution and, thus, the pathogenesis of uterine adenomyosis as well as peritoneal and peripheral endometriosis. Presently, no unifying denomination of this nosological entity exists. METHODS An extensive search of the literature on primate evolution was performed. This included comparative functional morphology with special focus on the evolution of the birthing process that fundamentally differs between the haplorrhine primates and most of the other eutherian mammals. The data were correlated with the results of own research on the pathophysiology of human archimetrosis and with the extant presentation of the disease. RESULTS The term Archimetrosis is suggested as a denomination of the nosological entity. Archimetrosis occurs in human females and also in subhuman primates. There are common features in the reproductive process of haplorrhine primates such as spontaneous ovulation and corpus luteum formation, spontaneous decidualization and menstruation. These have fused Müllerian ducts resulting in a uterus simplex. Following a usually singleton pregnancy, the fetus is delivered in the skull position. Some of these features are shared by other mammals, but not in that simultaneous fashion. In haplorrhine primates, with the stratum vasculare, a new myometrial layer has evolved during the time of the Cretaceous-Terrestrial Revolution (KTR) that subserves expulsion of the conceptus and externalization of menstrual debris in non-conceptive cycles. Hypercontractility of this layer has evolved as an advantage with respect to the survival of the mother and the birth of a living child during delivery and may be experienced as primary dysmenorrhea during menstruation. It may result in tissue injury by the sheer power of the contractions and possibly by the associated uterine ischemia. Moreover, the lesions at extra-uterine sites appear to be maintained by biomechanical stress. CONCLUSIONS Since the pathogenesis of archimetrosis is connected with the evolution of the stratum vasculare, tissue injury and repair (TIAR) turns out to be the most parsimonious explanation for the development of the disease based on clinical, experimental and evolutionary evidence. Furthermore, a careful analysis of the published clinical data suggests that, in the risk population with uterine hypercontractility, the disease develops with a yet to be defined latency phase after the onset of the biomechanical injury. This opens a new avenue of prevention of the disease in potentially affected women that we consider to be primarily highly fertile.
Collapse
Affiliation(s)
| | | | - Matthias W. Laschke
- Institut für Klinisch-Experimentelle Chirurgie, Universität des Saarlandes, 66421 Homburg, Germany
| | - Gerhard Mall
- Wiesenbacher Str. 10, 69151 Neckargemünd, Germany
| |
Collapse
|
33
|
Alcázar JL, Vara J, Usandizaga C, Ajossa S, Pascual MÁ, Guerriero S. Transvaginal ultrasound versus magnetic resonance imaging for diagnosing adenomyosis: A systematic review and head-to-head meta-analysis. Int J Gynaecol Obstet 2022; 161:397-405. [PMID: 36461921 DOI: 10.1002/ijgo.14609] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/14/2022] [Accepted: 10/24/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND Transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI) are used for the clinical diagnosis of adenomyosis. OBJECTIVES To compare the diagnostic accuracy of TVS and MRI for the diagnosis of adenomyosis. SEARCH STRATEGY A search of studies was performed in five databases comparing TVS and MRI for the diagnosis of adenomyosis from January 1990 to May 2022. SELECTION CRITERIA Studies were eligible if they reported on the use of TVS and MRI in the same set of patients. The reference standard must be pathology (hysterectomy). DATA COLLECTION AND ANALYSIS The quality of studies was assessed using the QUADAS-2 tool. Pooled sensitivity and specificity of both techniques were estimated and compared. MAIN RESULTS Six studies comprising 595 women were included. The risk of bias of patient selection was high in three studies. The risk of bias for index tests and reference test was low. Pooled estimated sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio for TVS were 75%, 81%, 3.9, and 0.31, respectively. These figures for MRI were 69%, 80%, 3.5, and 0.39, respectively. No statistically significant differences were found (p = 0.7509). Heterogeneity was high. CONCLUSIONS MRI and TVS have similar performances for the diagnosis of adenomyosis.
Collapse
Affiliation(s)
- Juan Luis Alcázar
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Julio Vara
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Claudia Usandizaga
- Department of Obstetrics and Gynecology, Puerta de Mar University Hospital, Cadiz, Spain
| | - Silvia Ajossa
- Centro Integrato di Procreazione Medicalmente Assistita (PMA) e Diagnostica Ostetrico-Ginecologica, Azienda Ospedaliero Universitaria-Policlinico Duilio Casula Monserrato, Monteserrato, Italy.,Department of Obstetrics and Gynecology, University of Cagliari, Cagliari, Italy
| | - María Á Pascual
- Department of Obstetrics, Gynecology, and Reproduction, Hospital Universitari Dexeus, Barcelona, Spain
| | - Stefano Guerriero
- Centro Integrato di Procreazione Medicalmente Assistita (PMA) e Diagnostica Ostetrico-Ginecologica, Azienda Ospedaliero Universitaria-Policlinico Duilio Casula Monserrato, Monteserrato, Italy.,Department of Obstetrics and Gynecology, University of Cagliari, Cagliari, Italy
| |
Collapse
|
34
|
Harmsen MJ, Trommelen LM, de Leeuw RA, Tellum T, Juffermans LJM, Griffioen AW, Thomassin-Naggara I, Van den Bosch T, Huirne JAF. Uterine junctional zone and adenomyosis: comparison of MRI, transvaginal ultrasound and histology. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022. [PMID: 36370446 DOI: 10.1002/uog.26117] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 09/27/2022] [Accepted: 10/21/2022] [Indexed: 06/02/2023]
Abstract
The uterine junctional zone is the subendometrial area in the myometrium that contributes to peristalsis and aids in spermatozoa and blastocyst transport. Alterations in the appearance of the junctional zone on transvaginal sonography (TVS) or magnetic resonance imaging (MRI) are associated with adenomyosis. The lack of standardization of description of its appearance and ill-defined boundaries on both histology and imaging hamper understanding of the junctional zone and limit its role in the diagnosis of adenomyosis. The objectives of this review were to investigate the accordance in definition of the junctional zone across different diagnostic approaches and to examine how imaging findings can be linked to histological findings in the context of diagnosis of adenomyosis. A comprehensive literature review was conducted of articles describing the appearance on imaging and the histological structure of the uterine junctional zone. Our review suggests that the junctional zone is distinguished from the middle and outer myometrium by gradual changes in smooth-muscle cell density, extracellular space, connective tissue, water content and vascular properties. However, while the signal intensity from the junctional zone to the middle myometrium changes abruptly on MRI, the histopathological changes are gradual and its border may be difficult or impossible to distinguish on two-dimensional TVS. Moreover, the thickness of the junctional zone measured on MRI is larger than that measured on TVS. Thus, these two imaging modalities reflect this zone differently. Although a thickened junctional zone is often used to diagnose adenomyosis on MRI, the presence of adenomyosis can be described more accurately as interruptions of the junctional zone by endometrial tissue, which leads to direct signs on imaging such as subendometrial lines and buds on two- and three-dimensional TVS or bright foci on MRI. The histopathological criteria for diagnosis are based on enlargement of the uterus with severe adenomyosis, and might not reflect its early stages. Clinicians should be aware that findings on MRI cannot be extrapolated readily to ultrasound. An understanding of this is necessary when investigating the uterine junctional zone as a functional unit and the association between visualization of direct features of adenomyosis in the junctional zone and clinical symptoms. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- M J Harmsen
- Department of Obstetrics & Gynaecology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - L M Trommelen
- Department of Obstetrics & Gynaecology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - R A de Leeuw
- Department of Obstetrics & Gynaecology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - T Tellum
- Department of Gynecology, Oslo University Hospital, Oslo, Norway
| | - L J M Juffermans
- Department of Obstetrics & Gynaecology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - A W Griffioen
- Angiogenesis Laboratory, Department of Medical Oncology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - I Thomassin-Naggara
- Department of Diagnostic and Interventional Imaging (IRIS), Sorbonne Université, Assistance Publique Hopitaux de Paris, Paris, France
| | - T Van den Bosch
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium
| | - J A F Huirne
- Department of Obstetrics & Gynaecology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| |
Collapse
|
35
|
Movilla P, van Reesema L, Andrews B, Gaughan T, Loring M, Bhakta A, Hoffman M. Impact of Race and Ethnicity on Perioperative Outcomes During Hysterectomy for Endometriosis. J Minim Invasive Gynecol 2022; 29:1268-1277. [PMID: 36130704 DOI: 10.1016/j.jmig.2022.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 08/22/2022] [Accepted: 09/13/2022] [Indexed: 12/15/2022]
Abstract
STUDY OBJECTIVE To assess whether complications incurred during hysterectomy for the treatment of endometriosis differ among racial-ethnic groups. DESIGN Retrospective cohort study. SETTING American College of Surgeons National Surgical Quality Improvement Program database from 2014 to 2019. This database is a robust, comprehensive, multi-institutional database with nearly 700 participating hospitals. PATIENTS Patients with a diagnosis of endometriosis or with an endometriosis-associated symptom as the primary indication for surgery and surgical intraoperative documentation of endometriosis. INTERVENTIONS Compare perioperative complications based on patient race and ethnicity. MEASUREMENTS AND MAIN RESULTS A total of 5639 patients underwent hysterectomy for endometriosis; of these, 4368 were White patients (77.5%), 528 Black patients (9.4%), 491 Hispanic patients (8.7%), 252 Asian patients (4.5%). There was no association between location of endometriosis and patient race and ethnicity. However, White patients had highest rate, and Asian patients had the lowest rate of laparoscopic hysterectomy, 85.3% vs 69.8%, respectively (p <.01). In addition, there were differences in concomitant procedures performed at time of hysterectomy based on race and ethnicity, with White patients having the highest rates of adnexal/peritoneal surgery at 12.5% (p <.01) compared with patients of the other racial and ethnic groups. Asian patients had the highest rate of ureteral surgery at 6.8% (p <.01) and highest rate of intestinal surgery at 16.3% (p <.01) compared with patients of other racial and ethnic groups. There was no association of rates of concomitant bladder surgery, appendectomy, or rectal surgery with patient race and ethnicity. Black patients had the highest rate of minor complications at 13.5% (p <.01) and the highest rate of major complications at 6.6% (p <.01) compared with patients of other racial and ethnic groups. After multivariable analysis, Black patients still had increased odds of having a major complication compared with patients of other racial and ethnic groups even after controlling for patient characteristics and perioperative factors such as endometriosis lesion location, surgical approach, and concomitant procedures (odds ratio 1.64; 95% confidence interval, 1.10-2.45). CONCLUSION Endometriosis lesion location did not differ with patient race and ethnicity. However, patient race and ethnicity did have an impact on the surgical approach and the concomitant surgical procedures performed at time of hysterectomy. Black patients had the highest odds of major complications.
Collapse
Affiliation(s)
- Peter Movilla
- From the Center for Minimally Invasive Gynecologic Surgery, Newton Wellesley Hospital, Newton, Massachusetts.
| | | | | | | | - Megan Loring
- University of Kentucky, Lexington, Kentucky, and Gynecologic Surgery Department, Virginia Mason Medical Center, Seattle, Washington
| | | | | |
Collapse
|
36
|
Miao J, Lu J, Tang J, Lu P. Long-term treatment of dienogest with symptomatic adenomyosis: retrospective analysis of efficacy and safety in clinical practice. Gynecol Endocrinol 2022; 38:656-660. [PMID: 35850637 DOI: 10.1080/09513590.2022.2098948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Objective: To evaluate the efficacy and safety of dienogest (DNG) in women with symptomatic adenomyosis.Methods: Women with symptomatic adenomyosis were included in this retrospective observation study. Group 1 (maximum uterine dimension ≥ 100.0 mm) began DNG after 4 months of GnRH-a administration, Group 2 (maximum uterine dimension < 100.0 mm) received DNG with no prior GnRH-a treatment. All women were assessed for their pain symptoms, uterine size, adverse effects and laboratory hematology at baseline and every 6 months during the treatment.Results: 123 women were enrolled in this study, in Group 1 (71 women) with severe uterine enlargement, the median VAS score was 80 mm prior to GnRH-a administration and 10, 10, 10, 20, and 20 mm, respectively, after 0, 6,12,18, and 24 months of DNG treatment. The mean uterine volume decreased from 262.9 ml to 104.7 ml after GnRH-a therapy, and slowly increased from 104.7 ml to 139.5 ml after 24 month-treatment of DNG. Another 52 women with mild uterine enlargement received DNG without prior GnRH-a administration, median VAS score was 70 mm at baseline and decreased to 20, 20, 10, and 10 mm at 6,12,18, and 24 months. The mean uterine volume slightly decreased from 157.9 ml to 153.3 ml after 24 months of DNG treatment (p > 0.05). All laboratory parameters were in the normal range.Conclusions: DNG is effective and well tolerated as a long-term treatment for symptomatic adenomyosis, and it can be used as maintenance therapy after discontinuation of GnRH-a administration.
Collapse
Affiliation(s)
- Juan Miao
- Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jing Lu
- Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Juanjuan Tang
- Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Pinhong Lu
- Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| |
Collapse
|
37
|
MRI of Adenomyosis: Where Are We Today? CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2022. [DOI: 10.1007/s13669-022-00342-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
38
|
Khan KN, Fujishita A, Mori T. Pathogenesis of Human Adenomyosis: Current Understanding and Its Association with Infertility. J Clin Med 2022; 11:4057. [PMID: 35887822 PMCID: PMC9316454 DOI: 10.3390/jcm11144057] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/22/2022] [Accepted: 07/11/2022] [Indexed: 12/10/2022] Open
Abstract
The aim of this review article was to summarize our current understanding on the etiologies and pathogenesis of human adenomyosis and to clarify the relative association between adenomyosis and infertility. The exact pathogenesis of adenomyosis is still elusive. Among different reported concepts, direction invagination of gland cells from the basalis endometrium deep into myometrium is the most widely accepted opinion on the development of adenomyosis. According to this concept, endometrial epithelial cells and changed fibroblasts, abnormally found in the myometrium in response to repeated tissue injury and/or disruption at the endometrium-myometrium interface (EMI), elicit hyperplasia and hypertrophy of the surrounding smooth muscle cells. In this review, a comprehensive review was performed with a literature search using PubMed for all publications in English and Japanese (abstract in English), related to adenomyosis and infertility, from inception to April 2021. As an estrogen-regulated factor, hepatocyte growth factor (HGF) exhibits multiple functions in endometriosis, a disease commonly believed to arise from the functionalis endometrium. As a mechanistic basis of gland invagination, we investigated the role of HGF, either alone or in combination with estrogen, in the occurrence of epithelial-mesenchymal transition (EMT) in adenomyosis. Aside from microtrauma at the EMI, metaplasia of displaced Müllerian remnants, differentiation of endometrial stem/progenitor cells within the myometrium and somatic mutation of some target genes have been put forward to explain how adenomyosis develops. In addition, the possible role of microRNAs in adenomyosis is also discussed. Besides our knowledge on the conventional classification (focal and diffuse), two recently proposed classifications (intrinsic and extrinsic) of adenomyosis and the biological differences between them have been described. Although the mechanistic basis is unclear, the influence of adenomyosis on fertility outcome is important, especially considering the recent tendency to delay pregnancy among women. Besides other proposed mechanisms, a recent transmission election microscopic (TEM) study indicated that microvilli damage and an axonemal alteration in the apical endometria of human adenomyosis, in response to endometrial inflammation, may be involved in negative fertility outcomes. We present a critical analysis of the literature data concerning the mechanistic basis of infertility in women with adenomyosis and its impact on fertility outcome.
Collapse
Affiliation(s)
- Khaleque N. Khan
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan;
| | - Akira Fujishita
- Department of Gynecology, Saiseikai Nagasaki Hospital, Nagasaki 850-0003, Japan;
| | - Taisuke Mori
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan;
| |
Collapse
|
39
|
Yıldırır M, Aytan H, Durukan H, Gürses İ. A clinical scoring system for the diagnosis of adenomyosis. Turk J Obstet Gynecol 2022; 19:138-144. [PMID: 35770456 PMCID: PMC9249356 DOI: 10.4274/tjod.galenos.2022.88289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective To develop a scoring system using clinical evaluation methods to predict the presence of adenomyosis. Materials and Methods A cohort of 232 patients who underwent hysterectomy for benign gynecologic disorders was prospectively enrolled. A detailed anamnesis was obtained and physical/pelvic examinations with trans-vaginal ultrasound imaging were performed one day before the hysterectomy. The diagnosis of adenomyosis was based on histopathologic examination. Findings were compared between patients with (n=55) and without (n=166) adenomyosis. Factors associated with adenomyosis were assessed with regression analysis and odds ratios (OR) were calculated. The variables found to be significant were chosen for the scoring system. Receiver operating characteristic analysis was carried out to find the cut-off values for these variables. Results Number of parity, dyspareunia and dysmenorrhea visual analogue scale (VAS) scores, age of menarche, presence of uterine tenderness and detection of heterogeneous myometrium and myometrial cysts during ultrasonography were found to be the significant parameters. OR for the presence of myometrial heterogeneity, myometrial cysts, uterine tenderness were 27.2, 3.6 and 9.3 respectively. Cut-off values were calculated; 3 for parity (OR=2.8), 13-years for menarche (OR=1.6), 2 for dyspareunia VAS scores (OR=1.9) and 4 for dysmenorrhea VAS scores (OR=1.2). The total sum of maximum OR that a patient can obtain was calculated as 47.6 and this value was assumed to predict the presence of adenomyosis 100%. The multiplication of the sum of the OR in a patient by 2.1 (100/47.2) was found to have a predictive ability for the presence of adenomyosis. Conclusion A scoring system is developed to predict adenomyosis non-invasively based on clinical evaluation.
Collapse
Affiliation(s)
- Muhammet Yıldırır
- Mersin University Faculty of Medicine, Department of Obstetrics and Gynecology, Mersin, Turkey
| | - Hakan Aytan
- Mersin University Faculty of Medicine, Department of Obstetrics and Gynecology, Mersin, Turkey
| | - Hüseyin Durukan
- Mersin University Faculty of Medicine, Department of Obstetrics and Gynecology, Mersin, Turkey
| | - İclal Gürses
- Mersin University Faculty of Medicine, Department of Pathology, Mersin, Turkey
| |
Collapse
|
40
|
Krentel H, De Wilde RL. Prevalence of adenomyosis in women undergoing hysterectomy for abnormal uterine bleeding, pelvic pain or uterine prolapse – A retrospective cohort study. Ann Med Surg (Lond) 2022; 78:103809. [PMID: 35734686 PMCID: PMC9206934 DOI: 10.1016/j.amsu.2022.103809] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/13/2022] [Accepted: 05/14/2022] [Indexed: 12/02/2022] Open
Abstract
Background Adenomyosis can cause symptoms like dysmenorrhea, dyspareunia, pelvic pain and bleeding disorders and is related to subfertility and obstetrical complications. The disease is probably underestimated and underdiagnosed because of difficulties in reliable clinical examination and imaging results. The age-related prevalence of adenomyosis still remains unclear. In this retrospective analysis we describe the rate of adenomyosis in two independent cohorts of patients undergoing hysterectomy for benign diseases (2011–2013 and 2015–2018) and its correlation to presurgical symptoms respectively indications for hysterectomy. Materials and methods All surgeries have been performed in the same department of minimally invasive gynecological surgery by a total of two experienced surgeons following a surgical internal standard for the indication bleeding disorder, dysmenorrhea. We analyzed the overall rate of patients with adenomyosis in both cohorts and related the histological presence of adenomyosis to presurgical symptoms. We also analyzed a subgroup of postmenopausal patients with uterine prolapse. Results In 307 patients we detected 42.0% of cases with histologically proven adenomyosis. In the group of patients with bleeding disorders and dysmenorrhea as indication for surgery we found the highest rate of adenomyosis (59.3%, cohort 1). 81,1% patients with adenomyosis (cohort 1) reported symptoms. In the subgroup of 42 postmenopausal patients, we found 23.8% of cases with adenomyosis. Conclusion Our data shows that a positive anamnesis regarding the symptoms bleeding disorders and dysmenorrhea is suspicious for adenomyosis. In hysterectomy specimen adenomyosis can be found in more than 40%. The role of adenomyosis-related symptoms requires further investigation, especially in adolescent and postmenopausal patients. In 307 patients undergoing hysterectomy we detected 42.0% of cases with adenomyosis. In patients with bleeding disorders and dysmenorrhea we found the highest rate of adenomyosis (59.3%). 81,1% of patients with adenomyosis reported symptoms. In 58.9% of patients with adenomyosis we found additional fibroids. In 42 postmenopausal patients we found adenomyosis in 23.8% of cases.
Collapse
Affiliation(s)
- Harald Krentel
- Clinic of Gynecology, Obstetrics and Gynecological Oncology, Bethesda Hospital Duisburg, Academic Teaching Hospital, Duisburg, Germany
- Corresponding author. Bethesda Hospital Duisburg, Heerstrasse 219, 47053, Duisburg, Germany.
| | - Rudy Leon De Wilde
- Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius-Hospital Oldenburg, Medical Campus University of Oldenburg, Germany
| |
Collapse
|
41
|
MRI and Adenomyosis: What Can Radiologists Evaluate? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105840. [PMID: 35627376 PMCID: PMC9140978 DOI: 10.3390/ijerph19105840] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 04/27/2022] [Accepted: 05/05/2022] [Indexed: 11/17/2022]
Abstract
Uterine adenomyosis is a common benign condition defined by the presence of heterotopic endometrial glands and stroma within the myometrium. Adenomyosis is often related to infertility and other adverse pregnancy outcomes. Modern imaging techniques allow the non-invasive diagnosis of adenomyosis and, in this framework, Magnetic Resonance Imaging (MRI) has assumed a central role due to its high diagnostic accuracy in the detection of adenomyosis. Currently, there is still a lack of international consensus on adenomyosis diagnostic criteria and classification, despite the fact that an agreed reporting system would promote treatment outcomes and research. This review aims to emphasize the important contribution of MRI to the diagnosis of adenomyosis and to highlight how, thanks to the great tissue differentiation provided by MRI, it is possible to identify the main direct (cystic component) and indirect (junctional zone features) signs of adenomyosis and to distinguish its various subtypes according to different MRI-based classifications. We also explored the main MRI criteria to identify the most common pitfalls and differential diagnoses of adenomyosis, whose features should be considered to avoid misdiagnosis.
Collapse
|
42
|
Trinchant R, Cruz M, Requena A. Adenomyosis decreases the live birth rate but may not affect perinatal outcomes in assisted reproductive cycles. Int J Gynaecol Obstet 2022; 159:918-922. [PMID: 35521659 DOI: 10.1002/ijgo.14256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/27/2022] [Accepted: 05/03/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine if uterine adenomyosis is associated with worse perinatal outcomes in ovum donation assisted reproductive treatment cycles. MATERIALS AND METHODS A multicenter and retrospective cohort study in which a total of 3307 patients undergoing an ovum donation cycle in 2018-2019 were included and divided into two groups: adenomyosis (n = 179) and controls (n = 3128). Clinical, obstetrical, and perinatal outcomes were analyzed. RESULTS A lower live birth rate per embryo transfer was observed in women diagnosed with adenomyosis versus control women: 67/179 (37%) versus 1560/3128 (49.9%), respectively (odds ratio 0.6, 95% confidence interval 0.43-0.83, P = 0.002). There was no statistically significant difference in childbirth delivery method (vaginal versus cesarean section) between the adenomyosis and control groups. Mean gestational age at the time of delivery, newborn length and weight, and incidences of low birth weight, preterm birth, and admission to the neonatal intensive care unit did not differ between the two groups. In addition, in vitro fertilization and perinatal outcomes were similar in patients with diffuse compared with focal adenomyosis. CONCLUSIONS Adenomyosis affects clinical but may not affect perinatal outcomes in ovum donation cycles.
Collapse
Affiliation(s)
| | - María Cruz
- IVI Madrid, Madrid, Spain.,IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - Antonio Requena
- IVI Madrid, Madrid, Spain.,IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| |
Collapse
|
43
|
Caridi TM, De la Garza-Ramos C, Brook OR, Learman LA, Opoku-Anane J, Phipps D, Ascher SM, Lipman JC, Lohle PNM, Halvorson LM, Abi-Jaoudeh N, Kohi MP. Uterine Artery Embolization for Symptomatic Adenomyosis: Proceedings from a Society of Interventional Radiology Foundation Research Consensus Panel. J Vasc Interv Radiol 2022; 33:586-592. [PMID: 35489788 DOI: 10.1016/j.jvir.2022.01.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 10/18/2022] Open
Abstract
Adenomyosis poses an important diagnostic and therapeutic challenge in women's health because of a variety of clinical/imaging presentations and frequent coexistence with other benign gynecologic conditions. In recent years, uterine artery embolization (UAE) for the treatment of adenomyosis has shown encouraging and favorable outcomes and long-term symptom improvement. To expand the current understanding of adenomyosis pathophysiology, imaging diagnostic criteria, and treatment outcomes, the Society of Interventional Radiology Foundation gathered a multidisciplinary Research Consensus Panel with experts from diverse backgrounds. The topics addressed were centered around the following: (i) the clinical presentation and imaging findings to diagnose adenomyosis; (ii) the currently available medical, interventional, and surgical treatment options; and (iii) existing literature for and experiences with UAE in symptomatic disease. The panel acknowledged that before the pursuit of a clinical trial, it would be necessary to first evaluate the imaging criteria for adenomyosis and correlate them with pathology and symptoms to establish a noninvasive imaging classification system. Second priority was given to the development of a quality of life questionnaire to assess patient outcomes following treatment. The third priority was the performance of a prospective clinical trial comparing UAE with medical therapy, which would help establish UAE in the treatment algorithm and societal guidelines for symptomatic adenomyosis.
Collapse
Affiliation(s)
- Theresa M Caridi
- Department of Radiology, Division of Interventional Radiology, University of Alabama at Birmingham, Birmingham, Alabama.
| | - Cynthia De la Garza-Ramos
- Division of Interventional Radiology, Department of Radiology, Mayo Clinic Florida, Jacksonville, Florida
| | - Olga R Brook
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Lee A Learman
- Department of Obstetrics and Gynecology, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Jessica Opoku-Anane
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California
| | - Debbie Phipps
- Departments of Family Medicine and Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Susan M Ascher
- Department of Radiology, Georgetown University School of Medicine, Washington, DC
| | | | - Paul N M Lohle
- Department of Radiology, Elisabeth Tweesteden Ziekenhuis, Tilburg, The Netherlands
| | - Lisa M Halvorson
- Gynecologic Health and Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, Maryland
| | - Nadine Abi-Jaoudeh
- Department of Radiological Sciences, University of California Irvine, Orange, California
| | - Maureen P Kohi
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
44
|
He B, Teng XM, Hao F, Zhao M, Chen ZQ, Li KM, Yan Q. Decreased intracellular IL-33 impairs endometrial receptivity in women with adenomyosis. Front Endocrinol (Lausanne) 2022; 13:928024. [PMID: 35937844 PMCID: PMC9353328 DOI: 10.3389/fendo.2022.928024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/29/2022] [Indexed: 11/29/2022] Open
Abstract
Adenomyosis is a common benign uterine lesion that is associated with female infertility, reduced clinical pregnancy rate and high miscarriage risk. While it has been known that the impaired endometrial receptivity is implicated in infertility in patients with adenomyosis, the underlying mechanism remains unclear. In the present study, we showed that intracellular protein level of IL-33 was downregulated in the endometrium of patients with adenomyosis, and IL-33 expression status was shown to be positively correlated with that of HOXA10, an endometrial receptivity marker. The subsequent analysis indicated IL-33 overexpression led to the increase of HOXA10 expression and enhancement of embryo implantation in vitro, which was accompanied with induction of STAT3 phosphorylation. Meanwhile, cryptotanshinone, a potent STAT3 inhibitor, was found to significantly suppress the increase of HOXA10 expression and embryo implantation caused by IL-33 overexpression in vitro, revealing the critical role of STAT3 activity. Consistently, the positive relationship between IL33 and HOXA10 expression in the endometrium was verified in the analysis of adenomyosis mouse model.
Collapse
Affiliation(s)
- Bin He
- Reproductive Medical Center, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
- Center for Clinical Research and Translational Medicine, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiao-Ming Teng
- Reproductive Medical Center, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Fan Hao
- Reproductive Medical Center, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Mei Zhao
- Reproductive Medical Center, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhi-Qin Chen
- Reproductive Medical Center, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Kun-Ming Li
- Reproductive Medical Center, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
- *Correspondence: Qiang Yan, ; Kun-Ming Li,
| | - Qiang Yan
- Reproductive Medical Center, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
- *Correspondence: Qiang Yan, ; Kun-Ming Li,
| |
Collapse
|
45
|
OUP accepted manuscript. Hum Reprod 2022; 37:1470-1479. [DOI: 10.1093/humrep/deac083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/05/2022] [Indexed: 11/13/2022] Open
|
46
|
Bourdon M, Pham B, Marcellin L, Bordonne C, Millischer AE, Maignien C, Santulli P, Chapron C. Endometriosis increases the rate of spontaneous early miscarriage in women who have adenomyosis lesions. Reprod Biomed Online 2022; 44:104-111. [PMID: 34819248 DOI: 10.1016/j.rbmo.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/31/2021] [Accepted: 10/06/2021] [Indexed: 11/27/2022]
Abstract
RESEARCH QUESTION In women with radiologically diagnosed adenomyosis, is the presence of endometriosis associated with a higher rate of miscarriage? DESIGN An observational cohort study of women who received medical care for benign gynaecological conditions between May 2005 and May 2018. Women who had adenomyosis lesions visualized by uterine magnetic resonance imaging (MRI) were included. Women who had never been pregnant were excluded. Women with adenomyosis identified by MRI but who did not have endometriosis lesions (control group) were compared with women with adenomyosis and endometriosis lesions (study group). Primary outcome was rate of a previous history of early miscarriage. RESULTS A total of 214 pregnancies in the study group and 53 pregnancies in the control group were analysed. The rate of a previous miscarriage was significantly higher among women with adenomyosis and endometriosis lesions compared with women in the control group (61/214 [28.5%] versus 6/53 [11.3%], respectively, P = 0.009). A multivariable generalized estimating equation logistic regression model, adjusted for adenomyosis and endometriosis phenotypes, found that the association between endometriosis and adenomyosis significantly increased the risk of miscarriage (OR 3.2, 95% CI 1.1 to 9.65). The risk was significantly higher with deep infiltrating endometriosis (OR 4.37, 95% CI 1.32 to 14.53). CONCLUSIONS Women affected by endometriosis had a significantly higher rate of previous spontaneous miscarriage than women without endometriosis with adenomyosis lesions identified by MRI. Mechanistic studies are needed to establish the complex link between the presence of endometriosis and adenomyosis and the rate of spontaneous miscarriage.
Collapse
Affiliation(s)
- Mathilde Bourdon
- Université de Paris, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France; Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre. (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Département de Gynécologie Obstétrique II et Médecine de la Reproduction, Paris, France; Département 3I 'Infection, Immunité et Inflammation', Institut Cochin, INSERM U1016, Paris, France
| | - Benjamine Pham
- Université de Paris, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France
| | - Louis Marcellin
- Université de Paris, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France; Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre. (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Département de Gynécologie Obstétrique II et Médecine de la Reproduction, Paris, France; Département 3I 'Infection, Immunité et Inflammation', Institut Cochin, INSERM U1016, Paris, France
| | - Corinne Bordonne
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre. (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Département de Gynécologie Obstétrique II et Médecine de la Reproduction, Paris, France; Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Hotel Dieu, Département Radiology, Paris, France; Centre de Radiologie Bachaumont, IMPC, Paris, France
| | | | - Chloé Maignien
- Université de Paris, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France; Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre. (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Département de Gynécologie Obstétrique II et Médecine de la Reproduction, Paris, France
| | - Pietro Santulli
- Université de Paris, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France; Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre. (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Département de Gynécologie Obstétrique II et Médecine de la Reproduction, Paris, France; Département 3I 'Infection, Immunité et Inflammation', Institut Cochin, INSERM U1016, Paris, France.
| | - Charles Chapron
- Université de Paris, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France; Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre. (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Département de Gynécologie Obstétrique II et Médecine de la Reproduction, Paris, France; Département 3I 'Infection, Immunité et Inflammation', Institut Cochin, INSERM U1016, Paris, France
| |
Collapse
|
47
|
Preoperative MRI Classification May Not Predict Symptom Relief after Uterine Artery Embolization in Patients with Adenomyosis. Curr Med Sci 2021; 41:1252-1256. [PMID: 34839435 DOI: 10.1007/s11596-021-2473-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 04/09/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To investigate the association between magnetic resonance imaging (MRI) classification and symptom relief after uterine artery embolization (UAE) in patients with adenomyosis. METHODS Totally, 73 patients with symptomatic adenomyosis who underwent UAE were retrospectively analyzed. Preoperative MRI classification was defined as: type I, high signal on both T2-weighted images (T2WI) and T1-weighted images (T1WI); type III, high signal only on T2WI, and type II, high signal on neither T1WI nor T2WI. Dysmenorrhea was measured with the visual-analog scales and the degree of menorrhagia was measured according to the number of sanitary pads used in one menstrual cycle. Dysmenorrhea and menorrhagia were measured before UAE and 12 months after UAE. RESULTS The number of the type I, II, III cases was 23, 37, and 13, respectively. The baseline characteristics of the three groups exhibited no significant difference. The alleviation rates of dysmenorrhea among type I, II, III cases were 73.9%, 89.2%, and 84.6%, respectively (P=0.455). The alleviation rates of menorrhagia for type I, II, III were 69.6%, 78.4%, and 92.3%, respectively (P=0.714). CONCLUSION Pre-procedure MRI classification and symptom relief after UAE exhibited no significant association. UAE has a favorable mid-term control on dysmenorrhea and menorrhagia among patients with adenomyosis. Preoperative MRI classification might not indicate symptom relief. More research is needed before changing clinical practice.
Collapse
|
48
|
Habiba M, Benagiano G. Classifying Adenomyosis: Progress and Challenges. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312386. [PMID: 34886111 PMCID: PMC8656514 DOI: 10.3390/ijerph182312386] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022]
Abstract
Classically, the diagnosis of adenomyosis relied on histological examination of uteri following hysterectomy and classifications focused on the depth of endometrial invasion within the myometrium. There remain uncertainties around the cut-off point for the histological diagnosis. Imaging-based diagnosis enables recognition of the condition in women not undergoing surgery and facilitates the assessment of the extent of adenomyosis within the whole uterus, as well as of affections of the uterovesical pouch and of the pouch of Douglas. In this article, we explore the diagnostic uncertainties, the need to produce a classification of the condition and the challenges towards that goal. A distinction should be drawn between disease mapping and a classification that may link histological or image-based features with clinical characteristics, or with pathophysiology. An agreed system for reporting adenomyotic lesions may enable comparisons of research studies and thus contribute towards an informed classification. To this aim, we outline the features of the condition and explore the characteristics that are considered when producing a taxonomy. These include the latest proposal for subdivision of adenomyosis into an internal and an external variant. We also explore the uncertainties linked to classifying involvement of the uterovesical pouch, the pouch of Douglas and lesions in the outer myometrium. The limitations of currently available evidence suggest that agreement on a hypothesis to underpin a classification is unlikely at present. Therefore, current efforts will probably remain focused on disease mapping.
Collapse
Affiliation(s)
- Marwan Habiba
- Department of Health Sciences, University of Leicester, Leicester LE1 7HA, Leicestershire, UK
- Women and Perinatal Services, Leicester Royal Infirmary, Leicester LE1 5WW, Leicestershire, UK
- Correspondence:
| | - Giuseppe Benagiano
- Department of Maternal & Child Health, Gynecology and Urology, “Sapienza” University of Rome, 00100 Rome, Italy;
| |
Collapse
|
49
|
Diagnostic accuracy of clinically reported adenomyosis on pelvic ultrasound and MRI compared to surgical pathology. Clin Imaging 2021; 82:117-120. [PMID: 34808582 DOI: 10.1016/j.clinimag.2021.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 11/05/2021] [Accepted: 11/14/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Adenomyosis is a common gynecologic pathology that relies on diagnostic imaging to guide treatment. Accuracy of both pelvic ultrasound and magnetic resonance imaging (MRI) when specifically evaluating for the presence of adenomyosis is high. However, the accuracy of reported rates in clinical practice is less well understood. PURPOSE To demonstrate the accuracy in reporting of adenomyosis on pelvic ultrasound and MRI compared to histopathology in common clinical practice. BASIC PROCEDURES An institutional database was searched for women with a pelvic ultrasound and a pelvic MRI with a subsequent hysterectomy. Findings were extracted from radiology and pathology reports, and the documented presence or absence of adenomyosis was recorded for each modality. Blinded radiologists viewed each imaging pair to directly evaluate for adenomyosis. MAIN FINDINGS Compared to prior published data, imaging had lower accuracy in clinical practice when adenomyosis was not specifically evaluated for. For the finding of adenomyosis, pelvic ultrasound had a sensitivity of 10.9%, a specificity of 98.3%, positive predictive value (PPV) of 77.8%, negative predictive value (NPV) of 66.7%, an accuracy of 67.2%, and a diagnostic odds ratio (DOR) of 7. Pelvic MRI had a sensitivity of 29.7%, specificity of 85.3%, PPV of 52.8%, NPV of 68.8%, an accuracy of 65.6%, and DOR of 2.5. Overall accuracy of MRI improved when adenomyosis was directly evaluated for (82.4% vs 65.6%). PRINCIPLE CONCLUSIONS Without direct communication to evaluate for adenomyosis, pelvic ultrasound and MRI may underestimate or misreport adenomyosis. Providers should be aware of these discrepancies when relying on radiology reports to guide treatment and potential interventions when diagnosing and managing adenomyosis.
Collapse
|
50
|
Liu L, Li W, Leonardi M, Condous G, Da Silva Costa F, Mol BW, Wong L. Diagnostic Accuracy of Transvaginal Ultrasound and Magnetic Resonance Imaging for Adenomyosis: Systematic Review and Meta-Analysis and Review of Sonographic Diagnostic Criteria. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2289-2306. [PMID: 33502767 DOI: 10.1002/jum.15635] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/16/2020] [Accepted: 01/02/2021] [Indexed: 05/14/2023]
Abstract
We aim to first systematically review and perform a meta-analysis of the diagnostic accuracy of transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI) and, second, to evaluate the accuracy of various sonographic diagnostic criteria for adenomyosis. A search of PubMed and Embase yielded 32 eligible studies. In diagnosing adenomyosis, the diagnostic performance of TVUS was found to be high and comparable to the performance of MRI. Of the eight sonographic criteria, only five were assessable. The best individual criterion was echogenic subendometrial lines and buds. Limited data exist for the various sonographic criteria, and further studies are required to compare their performance.
Collapse
Affiliation(s)
- Linly Liu
- Monash Women's, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia
| | - Wentao Li
- Monash Women's, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia
- Department of Obstetrics and Gynecology, Monash University, Clayton, Victoria, Australia
| | - Mathew Leonardi
- Acute Gynecology, Early Pregnancy and Advanced Endoscopy Surgery Unit, Nepean Hospital, Kingswood, New South Wales, Australia
- Nepean Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - George Condous
- Acute Gynecology, Early Pregnancy and Advanced Endoscopy Surgery Unit, Nepean Hospital, Kingswood, New South Wales, Australia
- Nepean Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Fabricio Da Silva Costa
- Department of Obstetrics and Gynecology, Monash University, Clayton, Victoria, Australia
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Ben W Mol
- Monash Women's, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia
- Department of Obstetrics and Gynecology, Monash University, Clayton, Victoria, Australia
| | - Lufee Wong
- Monash Women's, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia
| |
Collapse
|