Consensus on revised definitions of Morphological Uterus Sonographic Assessment (<scp>MUSA</scp>) features of adenomyosis: results of modified Delphi procedure

Harmsen, Marissa J.; Bosch, T. Van den; Leeuw, Robert de; Dueholm, Margit; Exacoustòs, C.; Valentin, Lil; Hehenkamp, Wouter J.K.; Groenman, Freek; Bruyn, C. De; Rasmussen, Carsten; Lazzeri, Lucia; Jokubkiene, L.; Jurkovic, D.; Naftalin, J.; Tellum, Tina; Bourne, Tom; Timmerman, Dirk; Huirne, Judith A F

doi:10.1002/uog.24786

Cited by 111 publications

(125 citation statements)

References 31 publications

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“…For leiomyomas, the Steering Committee recommends reporting according to the well-established FIGO-fibroid classification ( Munro et al , 2018 ). For adenomyosis, adherence to well-defined terminology is recommended until an internationally accepted and validated reporting system is developed ( Van den Bosch et al , 2015 ; Harmsen et al , 2022 ). The scope of this work specifically excluded defining adenomyosis diagnostic criteria (imaging, histopathological or other), as the Steering Committee determined that such criteria should be defined by experts based on valid scientific evidence.…”

Section: Resultsmentioning

confidence: 99%

Development of a core outcome set and outcome definitions for studies on uterus-sparing treatments of adenomyosis (COSAR): an international multistakeholder-modified Delphi consensus study

et al. 2022

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STUDY QUESTION What outcomes should be reported in all studies investigating uterus-sparing interventions for treating uterine adenomyosis? SUMMARY ANSWER We identified 24 specific and 26 generic core outcomes in nine domains. WHAT IS KNOWN ALREADY Research reporting adenomyosis treatment is not patient-centred and shows wide variation in outcome selection, definition, reporting and measurement of quality. STUDY DESIGN, SIZE, DURATION An international consensus development process was performed between March and December 2021. Participants in round one were 150 healthcare professionals, 17 researchers and 334 individuals or partners with lived experience of adenomyosis from 48 high-, middle- and low-income countries. There were 291 participants in the second round. PARTICIPANTS/MATERIALS, SETTING, METHODS Stakeholders included active researchers in the field, healthcare professionals involved in diagnosis and treatment, and people and their partners with lived experience of adenomyosis. The core component of the process was a 2-step modified Delphi electronic survey. The Steering Committee analysed the results and created the final core outcome set (COS) in a semi-structured meeting. MAIN RESULTS AND THE ROLE OF CHANCE A total of 241 outcomes was identified and distilled into a ‘long list’ of 71 potential outcomes. The final COS comprises 24 specific and 26 generic core outcomes across nine domains, including pain, uterine bleeding, reproductive outcomes, haematology, urinary system, life impact, delivery of care, adverse events and reporting items, all with definitions provided by the Steering Committee. Nineteen of these outcomes will apply only to certain study types. Although not included in the COS, the Steering Committee recommended that three health economic outcomes should be recorded. LIMITATIONS, REASONS FOR CAUTION Patients from continents other than Europe were under-represented in this survey. A lack of translation of the survey might have limited the active participation of people in non-English speaking countries. Only 58% of participants returned to round two, but analysis did not indicate attrition bias. There is a significant lack of scientific evidence regarding which symptoms are caused by adenomyosis and when they are related to other co-existent disorders such as endometriosis. As future research provides more clarity, the appropriate review and revision of the COS will be necessary. WIDER IMPLICATIONS OF THE FINDINGS Implementing this COS in future studies on the treatment of adenomyosis will improve the quality of reporting and aid evidence synthesis. STUDY FUNDING/COMPETING INTEREST(S) No specific funding was received for this work. T.T. received a grant (grant number 2020083) from the South Eastern Norwegian Health Authority during the course of this work. T.T. receives personal fees from General Electrics and Medtronic for lectures on ultrasound. E.R.L. is the chairman of the Norwegian Endometriosis Association. M.G.M. is a consultant for Abbvie Inc and Myovant, receives research funding from AbbVie and is Chair of the Women’s Health Research Collaborative. S.-W.G. is a board member of the Asian Society of Endometriosis and Adenomyosis, on the scientific advisory board of the endometriosis foundation of America, previous congress chair for the World Endometriosis Society, for none of which he received personal fees. E.S. received outside of this work grants for two multicentre trials on endometriosis from the National Institute for Health Research UK, the Rosetrees Trust, and the Barts and the London Charity, he is a member of the Medicines and Healthcare Products Regulatory Agency (MHRA), Medicines for Women’s Health Expert Advisory Group, he is an ambassador for the World Endometriosis Society, and he received personal fees for lectures from Hologic, Olympus, Medtronic, Johnson & Johnson, Intuitive and Karl Storz. M.H. is member of the British Society for Gynaecological Endoscopy subcommittee. No other conflict of interest was declared. TRIAL REGISTRATION NUMBER N/A.

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Section: Resultsmentioning

confidence: 99%

Development of a core outcome set and outcome definitions for studies on uterus-sparing treatments of adenomyosis (COSAR): an international multistakeholder-modified Delphi consensus study

et al. 2022

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“…The literature has reported that readiness to diagnose and manage rare cases of UR could improve maternal-fetal outcome. Consequently, based on our experience and other authors’ opinions, high-risk patients should be promptly identified and, after counselling, referred to adequate obstetric emergency units for urgent surgical treatment [ 19 , 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Uterine Rupture and Adenomyosis, a Rare but Possible Correlation: Case Report and Literature Review

Vimercati

Dellino

Suma³

et al. 2022

Diagnostics

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(1) Background: Uterine rupture during pregnancy is a serious obstetric complication with a high incidence of maternal morbidity and mortality. (2) Methods: The present case is a rare event of a uterine rupture occurring in an unscarred uterus in a nonlaboring primigravida woman in the second trimester. The only risk factor in this case was adenomyosis found in the preconceptional phase. (3) Results: The diagnosis of adenomyosis can often be difficult, so patients should be evaluated by a specialized gynecologist. After careful amnestic collection, a gynecological examination and II level ultrasound should be performed in accordance with the Morphological Uterus Sonographic Assessment classification. (4) Conclusions: This evaluation allows us to identify classes of patients at high risk of uterine rupture who, therefore, must be properly informed of the risks both during preconceptional counseling and during pregnancy.

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“…It has been shown that several 2D and 3D TVUS features are associated with adenomyosis; however the importance of each item, the minimum number of items or their combination in the diagnosis of adenomyosis has yet to be defined 1 , 31 . Indeed, there is no current consensus on the criteria for the diagnosis of adenomyosis by TVUS.…”

Section: Discussionmentioning

confidence: 99%

Adenomyosis is an independent risk factor for complications in deep endometriosis laparoscopic surgery

Gràcia

Guirior

Valdés-Bango

et al. 2022

Sci Rep

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Deep endometriosis (DE) occurs in 15–30% of patients with endometriosis and is associated with concomitant adenomyosis in around 25–49% of cases. There are no data about the effect of the presence of adenomyosis in terms of surgical outcomes and complications. Thus, the aim of the present study was to evaluate the impact of adenomyosis on surgical complications in women with deep endometriosis undergoing laparoscopic surgery. A retrospective cohort study including women referred to the endometriosis unit of a referral teaching hospital. Two expert sonographers preoperatively diagnosed DE and adenomyosis. DE was defined according to the criteria of the International Deep Endometriosis Analysis group. Adenomyosis was considered when 3 or more ultrasound criteria of the Morphological Uterus Sonographic Assessment group were present. Demographical variables, current medical treatment, symptoms, DE location, surgical time, hospital stay and difference in pre and post hemoglobin levels were collected. The Clavien–Dindo classification was used to assess surgical complications, and multivariate analysis was performed to compare patients with and without adenomyosis. 157 DE patients were included into the study; 77 (49.05%) had adenomyosis according to transvaginal ultrasound (TVS) and were classified in the A group, and 80 (50.95%) had no adenomyosis and were classified in the noA group. Adenomyosis was associated with a higher rate of surgical complications: 33.76% (A group) vs. 12.50% (noA group) (p < 0.001). Multivariate analysis showed a 4.56-fold increased risk of presenting complications in women with adenomyosis (CI 1.90–11.30; p = 0.001) independently of undergoing hysterectomy. There was a statistically significant association between the number of criteria of adenomyosis present in each patient and the proportion of patients presenting surgical complications (p < 0.001). Adenomyosis is an independent preoperative risk factor for surgical complications in DE surgery after adjustment for known demographic, clinical and surgical risk factors.

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Consensus on revised definitions of Morphological Uterus Sonographic Assessment (MUSA) features of adenomyosis: results of modified Delphi procedure

Cited by 111 publications

References 31 publications

Development of a core outcome set and outcome definitions for studies on uterus-sparing treatments of adenomyosis (COSAR): an international multistakeholder-modified Delphi consensus study

Development of a core outcome set and outcome definitions for studies on uterus-sparing treatments of adenomyosis (COSAR): an international multistakeholder-modified Delphi consensus study

Spontaneous Uterine Rupture and Adenomyosis, a Rare but Possible Correlation: Case Report and Literature Review

Adenomyosis is an independent risk factor for complications in deep endometriosis laparoscopic surgery

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