Development of a clinical prediction model for diagnosing adenomyosis

Tellum, Tina; Nygaard, Staale; Skovholt, Else Kathrine; Qvigstad, Erik; Lieng, Marit

doi:10.1016/j.fertnstert.2018.06.009

Cited by 40 publications

(60 citation statements)

References 151 publications

(210 reference statements)

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“…Nearly one third of the 482 women with a surgical diagnosis of incident adenomyosis also had preoperative imaging findings compatible with adenomyosis (149, or 30.9%). Of the 490 women with incident adenomyosis, 180 (36.7%) had prior imaging during the study period with characteristics of adenomyosis, 5,6 but the word "adenomyosis" was not found in the report. Thus, nearly 70% of confirmed incident adenomyosis cases had imaging diagnoses or characteristics consistent with adenomyosis at or prior to the incident diagnosis date.…”

Section: Adenomyosis and Imagingmentioning

confidence: 98%

“…But increasingly, imaging studies, particularly pelvic ultrasound, have defined features indicative of adenomyosis, including a globular enlarged uterus, indistinct or irregular endometrial myometrial junction, heterogeneous myometrium, and myometrial cysts. 5,6 Diagnostic accuracy of ultrasound for adenomyosis is unknown, as prior studies evaluating this outcome were performed in select populations. 5 Adenomyosis symptoms can be disabling and have been treated medically, despite no U.S. Food and Drug Administrationeapproved therapies, 1 and surgically.…”

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confidence: 99%

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Adenomyosis incidence, prevalence and treatment: United States population-based study 2006–2015

Schulze‐Rath

Grafton

et al. 2020

American Journal of Obstetrics and Gynecology

127

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BACKGROUND: Adenomyosis symptoms are disabling. Populationbased data on incidence and prevalence of adenomyosis are lacking that could guide future evidence-based treatments and clinical management. OBJECTIVE: To evaluate the incidence, 10-year secular trends, and prevalence of adenomyosis diagnoses and to describe symptoms and treatment patterns in a large U.S. cohort. STUDY DESIGN: We performed a retrospective population-based cohort study of women aged 16e60 years in 2006e2015, enrolled in Kaiser Permanente Washington, a mixed-model health insurance and care delivery system. Adenomyosis diagnoses identified by ICD codes from the International Classification of Diseases 9th and 10th editions and potential covariates were extracted from computerized databases. Women with prior hysterectomy, and for incidence estimates women with prior adenomyosis diagnoses, were excluded. Linear trends in incidence rates over the 10-year study period were evaluated using Poisson regression. Rates and trend tests were examined for all women adjusting for age using direct standardization to the 2015 study population, by age groups, and by race/ethnicity. Chart reviews were performed to validate diagnostic accuracy of ICD codes in identifying adenomyosis incidence. Symptoms and treatment patterns at diagnosis and in the following 5 years were assessed. RESULTS: A total of 333,693 women contributed 1,185,855 woman-years (2006e2015) for incidence calculations. Associated symptom-related codes (menorrhagia or abnormal uterine bleeding, dysmenorrhea or pelvic pain, dyspareunia, and infertility) were observed in 90.8%; 18.0% had co-occurrent endometriosis codes and 47.6% had cooccurrent uterine fibroid codes. The overall adenomyosis incidence was 1.03% or 28.9 per 10,000 woman-years, with a high of 30.6 in 2007 and a low of 24.4 in 2014. Overall age-adjusted estimated incidence rates declined during the 10-year study interval (linear trend P < .05). Incidence was highest for women aged 41e45 years (69.1 per 10,000 womanyears in 2008) and was higher for black (highest 44.6 per 10,000 woman-years in 2011) vs white women (highest 27.9 per 10,000 womanyears in 2010). Overall prevalence in 2015 was 0.8% and was highest among women aged 41e45 years (1.5%). Among the 624 potential adenomyosis cases identified by diagnostic codes in 2012e2015 and with sufficient information in the medical record to determine true case status, 490 were confirmed as incident cases, yielding a 78.5% (95% confidence interval, 75.1%, 81.7%) positive predictive value of adenomyosis ICD-9/ICD-10 codes for identifying an incident adenomyosis case. Health care burden was substantial: 82.0% of women had hysterectomies, nearly 70% had imaging studies suggestive of adenomyosis, and 37.6% used chronic pain medications. CONCLUSION: Adenomyosis burden to the individual and the health care system is high. Incidence rates are disproportionately high among black women. These findings are of concern, as currently available longterm medical therapies remain limited beyond hysterec...

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Section: Adenomyosis and Imagingmentioning

confidence: 98%

mentioning

confidence: 99%

Adenomyosis incidence, prevalence and treatment: United States population-based study 2006–2015

Schulze‐Rath

Grafton

et al. 2020

American Journal of Obstetrics and Gynecology

127

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“…In recognition of the known age-related increased junctional zone thickness, it was also suggested that this category is limited to women aged 35 years and younger (Gordts et al, 2018). For 2 decades, a maximum thickness of the junctional zone (JZmax), of 12 mm or over, was considered as highly suggestive of adenomyosis, but this has recently been questioned (Dartmouth, 2014;Tellum et al, 2018;Bazot and Daraï, 2018). A confident diagnosis requires the presence of the additional feature of numerous high-signal intensity myometrial foci using T2-weighted or less frequently on T1weighted imaging (Togashi et al, 1988).…”

Section: Gordts Et Al 2008mentioning

confidence: 99%

Exploring the challenges for a new classification of adenomyosis

Habiba

Gordts²,

Bazot

et al. 2020

Reproductive BioMedicine Online

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“…Recently, a scoring system to define the severity of adenomyosis was proposed 46 ; similarly, Tellum et al . developed a clinical prediction model to identify the disease by using the most relevant features 47 . However, those models need to be externally validated and more evidence should support their reliability.…”

Section: Definition and Diagnosis Of Adenomyosismentioning

confidence: 99%

Recent advances in understanding and managing adenomyosis

2019

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Adenomyosis is a benign uterine disorder in which endometrial glands and stroma are pathologically demonstrated in the uterine myometrium and it is considered a specific entity in the PALM-COEIN FIGO (polyp; adenomyosis; leiomyoma; malignancy and hyperplasia; coagulopathy; ovulatory dysfunction; endometrial; iatrogenic; and not yet classified – International Federation of Gynecology and Obstetrics) classification of causes of abnormal uterine bleeding (AUB). Although it has always been considered the classic condition of multiparous women over 40 years old who have pain and heavy menstrual bleeding, diagnosed at hysterectomy, the epidemiological scenario has completely changed. Adenomyosis is increasingly identified in young women with pain, AUB, infertility, or no symptoms by using imaging techniques such as transvaginal ultrasound and magnetic resonance. However, there is no agreement on the definition and classification of adenomyotic lesions from both the histopathology and the imaging point of view, and the diagnosis remains difficult and unclear. A uniform and shared reporting system needs to be implemented in order to improve our understanding on imaging features, their relationship with pathogenic theories, and their importance in terms of clinical symptoms and response to treatment. In fact, adenomyosis pathogenesis remains elusive and not a single theory can explain all of the different phenotypes of the disease. Furthermore, adenomyosis often coexists with other gynecological conditions, such as endometriosis and uterine fibroids, increasing the heterogeneity of available data. Treatment requires a lifelong management plan as the disease has a negative impact on quality of life in terms of menstrual symptoms, fertility, and pregnancy outcome and has a high risk of miscarriage and obstetric complications.

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Development of a clinical prediction model for diagnosing adenomyosis

Cited by 40 publications

References 151 publications

Adenomyosis incidence, prevalence and treatment: United States population-based study 2006–2015

Adenomyosis incidence, prevalence and treatment: United States population-based study 2006–2015

Exploring the challenges for a new classification of adenomyosis

Recent advances in understanding and managing adenomyosis

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