New Sonographic Classification of Adenomyosis: Do Type and Degree of Adenomyosis Correlate to Severity of Symptoms?

Exacoustòs, C.; Morosetti, G.; Conway, Francesca; Camilli, S.; Martire, Francesco Giuseppe; Lazzeri, Lucia; Piccione, Emilio; Zupi, Errico

doi:10.1016/j.jmig.2019.09.788

Cited by 85 publications

(80 citation statements)

References 36 publications

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“…49 Diffuse adenomyosis has been associated with worse dysmenorrhea than focal disease, while the later has been associated with infertility especially when located in the outer myometrium. 50,51 Conflicting data have been reported concerning the relationship of AUB and histologic features such as depth and glandular density. Most studies have shown that there is no relationship between AUB and glandular depth, but the numbers of adenomyotic foci per slide show a strong correlation with the reported bleeding volume.…”

Section: Pathology-based Classificationmentioning

confidence: 99%

Pathology and Pathogenesis of Adenomyosis

et al. 2020

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Adenomyosis represents a unique pathophysiological condition in which normal-appearing endometrial mucosa resides within myometrium and is thus protected from menstrual shedding. The resulting ectopic presence of endometrial tissue composed of glands and stroma is thought to affect normal contractile function and peristalsis of uterine smooth muscle, causing menometrorrhagia, infertility, and adverse obstetric outcomes. Since the first description of adenomyosis more than 150 years ago, pathologists have studied this lesion by examining tissue specimens, and have proposed multiple explanations to account for its pathogenesis. However, as compared with endometriosis, progress of adenomyosis research has been, at best, incremental mainly due to the lack of standardized protocols in sampling tissue and a lack of consensus diagnostic criteria in pathology practice. Despite these limitations, recent advances in revealing the detailed anatomy and biology of eutopic endometrium offer an unprecedented opportunity to study this common but relatively understudied disorder. Here, we briefly summarize the pathological aspects of adenomyosis from an historical background, and discuss conventional morphology and recent tissue-based molecular studies with a special emphasis on elucidating its tissue of origin from a pathologist's perspective. We also discuss unmet needs in pathology studies that would be important for advancing adenomyosis research.

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Section: Pathology-based Classificationmentioning

confidence: 99%

Pathology and Pathogenesis of Adenomyosis

et al. 2020

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“…Higher values of menstrual bleeding were found for severe diffuse adenomyosis, with the highest values being found in those with adenomyomas. 7 A study done by Champaneria et al concluded that both MRI and ultrasound had high levels of accuracy in diagnosing adenomyosis. TVUS having 72% sensitivity and 81% specificity vs MRI having 77% sensitivity and 89% specificity.…”

Section: Resultsmentioning

confidence: 99%

Evaluating the Efficacy of Radiological Investigations of Adenomyosis with Clinical Symptomatology

Sidhu¹,

Pahwa²

2021

AMEI's Current Trends in Diagnosis &Amp; Treatment

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Introduction: Adenomyosis is a benign gynecological condition that predominantly affects women in the late reproductive age. It is a real challenge in healthcare with prevalence ranging from 5 to 70%. It is characterized by uterine enlargement caused by ectopic rests of the endometrium within the myometrium. It is mainly associated with abnormal menstrual bleeding and severe dysmenorrhea. But now it can be done by advanced imaging modalities like transvaginal ultrasound (USG) and magnetic resonance imaging (MRI). Materials and methods: A prospective longitudinal study was conducted from November 1, 2018 to January 31, 2020 on subjects with complaints of abnormal uterine bleeding and or with dysmenorrhea in the department of obstetrics and gynecology (OBG) of a tertiary care hospital and medical institution. Various medical and surgical treatments were offered on merit depending on age group and clinical symptomatology. The subjects were followed up for a minimum period of six months thereafter. Results: It was found that out of the patients who had visual analog scale (VAS) score less than 7, 22.58% had adenomyosis with normal uterus while 12.90% had bulky uterus with adenomyosis on ultrasound. Of the patients who had VAS score more than or equal to 7, 9.68% had adenomyosis with normal uterus while 54.84% had bulky uterus with adenomyosis. MRI supplemented the ultrasound findings and was found useful in the confirmation of adenomyosis. Conclusion: The clinical diagnosis of adenomyosis has been called enigmatic largely because there are no pathognomonic symptoms of this disease. Ultrasound and MRI are found to be highly useful in supplementing the correct diagnosis of adenomyosis.

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“…In support of our findings, the use of combined 2D/3D-TVUS has been shown to increase the accuracy and specificity of adenomyosis diagnosis [ 35 , 37 ]. Exacoustos et al reported a higher incidence of infertility and miscarriage in adenomyosis of the JZ junction [ 38 ]. It should be noted, however, that the lack of a standardized reporting system for sonographic findings associated with adenomyosis translated to a large amount of heterogeneity in the previously reported data related to adenomyosis, making the comparison of studies difficult.…”

Section: Discussionmentioning

confidence: 99%

Sonographic Signs of Adenomyosis in Women with Endometriosis Are Associated with Infertility

Decter

Arbib

Markovitz

et al. 2021

JCM

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We compared the prevalence of ultrasound signs of adenomyosis in women with endometriosis who underwent surgery to those who were managed conservatively. This was a retrospective study of women evaluated at a tertiary endometriosis referral center who underwent 2D/3D transvaginal ultrasound. Adenomyosis diagnosis was based on the presence of at least three sonographic signs. The study group subsequently underwent laparoscopic surgery while the control group continued conservative management. Statistical analysis compared the two groups for demographics, symptoms, clinical data, and sonographic findings. The study and control groups included 244 and 158 women, respectively. The presence of any, 3+, or 5+ sonographic signs of adenomyosis was significantly more prevalent in the study group (OR = 1.93–2.7, p < 0.004, 95% CI; 1.24–4.09). After controlling for age, for all findings but linear striations, the OR for having a specific feature was higher in the study group. Women in the study group with ≥ 5 sonographic signs of adenomyosis had more than twice the risk of experiencing infertility (OR = 2.31, p = 0.012, 95% CI; 1.20–4.45). Sonographic signs of adenomyosis are more prevalent in women with symptomatic endometriosis who underwent surgery compared with those who continued conservative management. Women with 5+ findings have a significantly increased risk of infertility. Adenomyosis on ultrasound should be considered in the management decisions regarding these patients.

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New Sonographic Classification of Adenomyosis: Do Type and Degree of Adenomyosis Correlate to Severity of Symptoms?

Cited by 85 publications

References 36 publications

Pathology and Pathogenesis of Adenomyosis

Pathology and Pathogenesis of Adenomyosis

Evaluating the Efficacy of Radiological Investigations of Adenomyosis with Clinical Symptomatology

Sonographic Signs of Adenomyosis in Women with Endometriosis Are Associated with Infertility

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