Question Mark Sign and Transvaginal Ultrasound Uterine Tenderness for the Diagnosis of Adenomyosis

Zannoni, Letizia; Ambrosio, Marco; Raimondo, Diego; Arena, Alessandro; Forno, Simona Del; Borghese, Giulia; Paradisi, Roberto; Seracchioli, Renato

doi:10.1002/jum.15237

Cited by 28 publications

(22 citation statements)

References 27 publications

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“…Adenomyosis represents one of the most frequent findings in the EC hysterectomy specimens [ 7 , 8 ]. It is a benign disease characterized by the migration of glands and stroma from the basal layer of the endometrium to the myometrium [ 9 ]. The exact pathogenesis is still poorly understood; since adenomyosis shows rapid growth, angiogenesis, and invasion of ectopic endometrial cells such as the malignant tumors, a possible link between adenomyosis and EC has been suggested [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical Characteristics of Patients with Endometrial Cancer and Adenomyosis

Casadio

Raffone

Maletta

et al. 2021

Cancers

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A better endometrial cancer (EC) prognosis in patients with coexistent adenomyosis has been reported. Unfortunately, it is still unclear if this better prognosis is related to a more favorable clinical profile of adenomyosis patients. We aimed to evaluate differences in the clinical profiles of EC patients with and without adenomyosis. A systematic review and meta-analysis was performed by searching seven electronics databases for all studies that allowed extraction of data about clinical characteristics in EC patients with and without adenomyosis. Clinical characteristics assessed were: age, Body Mass Index (BMI), premenopausal status, and nulliparity. Mean difference in mean ± standard deviation (SD) or odds ratio (OR) for clinical characteristics between EC patients with and without adenomyosis were calculated for each included study and as a pooled estimate, and graphically reported on forest plots with a 95% confidence interval (CI). The Z test was used for assessing the overall effect by considering a p value < 0.05 as significant. Overall, eight studies with 5681 patients were included in the qualitative analysis, and seven studies with 4366 patients in the quantitative analysis. Pooled mean difference in mean ± SD between EC women with and without adenomyosis was −1.19 (95% CI: −3.18 to 0.80; p = 0.24) for age, and 0.23 (95% CI: −0.62 to 1.07; p = 0.60) for BMI. When compared to EC women without adenomyosis, EC women with adenomyosis showed a pooled OR of 1.53 (95% CI: 0.92 to 2.54; p = 0.10) for premenopausal status, and of 0.60 (95% CI: 0.41 to 0.87; p = 0.007) for nulliparity. In conclusion, there are not significant differences in clinical characteristics between EC patients with and without adenomyosis, with the exception for nulliparity. Clinical features seem to not underlie the better EC prognosis of patients with adenomyosis compared to patients without adenomyosis.

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Section: Introductionmentioning

confidence: 99%

Clinical Characteristics of Patients with Endometrial Cancer and Adenomyosis

Casadio

Raffone

Maletta

et al. 2021

Cancers

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“…It has been reported to have a specificity of 93% for ultrasonographic diagnosis of adenomyosis, improving the agreement between TVUS and histology (90% agreement) [21]. A recent prospective study [20] proposed a validation for the use of the question mark sign as a radiologic characteristic of adenomyosis. In our study, only 1 patient (the same one) presented with a question mark sign on both radiologists' revisions, with a specificity of 100%.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Sensitivity and Specificity of Structured and Narrative Reports of Transvaginal Ultrasonogaphy for Adenomyosis

Silva¹,

Andres

Leite³

et al. 2021

Journal of Minimally Invasive Gynecology

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Study Objective: To compare the sensitivity and specificity of the transvaginal ultrasonography (TVUS) narrative report with those of the structured report for the diagnosis of adenomyosis. Design: Retrospective study. Setting: A tertiary teaching hospital. Patients: One hundred ninety-two patients (45 with adenomyosis and 147 controls) who underwent hysterectomy between 2012 and 2016 and were aged 30 years to 55 years, with available preoperative TVUS images, were included. Interventions: To compare preoperative TVUS with histologic analysis of the uterus after hysterectomy for the diagnostic of adenomyosis. Measurements and Main Results: Data regarding the presence of the ultrasonographic characteristics previously described for the diagnosis of adenomyosis were obtained from the original TVUS report (narrative report) and the structured report from 2 blinded radiologists (R1 and R2). Histologic analysis is defined as the gold standard for the diagnosis of adenomyosis. The mean age (45.4 § 5.3 years vs 44.9 § 4.8 years; p = .496) and clinical symptoms were similar between the adenomyosis and control groups, except for dyspareunia, which was more frequently reported in the patients with adenomyosis (25.6% vs 9.4%; p = .006). Most of TVUS characteristics were more frequently observed in the structured reports than in the narrative reports. The structured report presented higher sensitivity (R1: 84.4%, R2: 69.1%; narrative report: 31.1%; p <.05) and lower specificity (R1: 28.0%, R2: 31.2%; narrative report: 90.5%; p <.05) for adenomyosis. The structured report presented higher sensitivity and lower specificity for most of sonographic characteristics evaluated. After logistic regression analysis, no sonographic characteristics presented with statistical significance for the diagnosis of adenomyosis on R1's structured report, while globular uterus (odds ratio [OR] 0.276; p = .006; 95% CI, 0.11−0.697) and poorly defined junctional zone (OR 3.6; p = .007; 95% CI, 1.4−9.2) were significantly associated with adenomyosis. In the narrative report, a myometrial cyst was associated with a higher risk of adenomyosis (odds ratio 9.486, p =.002; CI, 2.359-38.149). Conclusion:The narrative reports were more specific, whereas the structured reports were more sensitive for the diagnosis of adenomyosis. In addition, the sensitivity of most of sonographic feature of adenomyosis was higher and the specificity was lower in the structured report. Future prospective studies comparing both reports are needed to validate the current findings.

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“…Nowadays, advances in modern imaging technology, including transvaginal ultrasound and magnetic resonance imaging (MRI), have made it possible to diagnose different phenotypes (diffuse or localized) of adenomyosis [7]. The detection of the "question mark" sign by transvaginal ultrasound is effective for the diagnosis of adenomyosis [8]. In young girls in their 10s to 20s with a history of chronic pelvic pain, the prevalence of adenomyosis reached 46.0% [9].…”

Section: Introductionmentioning

confidence: 99%

Clinicopathological features of different subtypes in adenomyosis: Focus on early lesions

2021

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Background The aim of this study is to investigate the clinicopathological features of intrinsic and extrinsic subtypes in adenomyosis. In particular, we focused on the early lesions of adenomyosis. Methods This is a single-center, prospective study of women who elected surgery for adenomyosis at the Department of Gynecology, Nara Medical University Hospital, Kashihara, Japan, from April 2008 to March 2018. Adenomyosis was histologically classified as intrinsic, extrinsic, and others, depending on the type of intramural growth. Adenomyosis that occurs at the inner and outer myometrium was defined as an intrinsic and extrinsic type, respectively. Results One hundred eighty-nine patients with histologically confirmed adenomyosis were classified into three different types, 74 intrinsic type, 78 extrinsic type, and 37 other type. Compared to the intrinsic type, the extrinsic type was more likely to have endometriosis, including ovarian endometrioma (OMA), superficial peritoneal endometriosis (SUP), or deep infiltrating endometriosis (DIE). To further identify the clinicopathological features of early-stage adenomyosis, we focused only on patients with intrinsic and extrinsic types of adenomyosis with less than one-third of muscular layer infiltration. Patients with early-stage intrinsic adenomyosis were more likely to experience induced abortions. Patients with early-stage extrinsic adenomyosis were more likely to have endometriosis. The coexistence of endometriosis and the lack of induced abortion were independent predictors of extrinsic adenomyosis. Multivariate logistic regression analysis identified coexistence of endometriosis as independent predictors of the early stage extrinsic adenomyosis. Conclusion The study suggests that there are at least two types of adenomyosis, where the intrinsic type is closely associated with a history of induced abortion, while the extrinsic type is strongly associated with endometriosis. Adenomyosis might be a gynecological disorder with complex pathogenesis implicating both traumatic and endometriotic factors.

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Question Mark Sign and Transvaginal Ultrasound Uterine Tenderness for the Diagnosis of Adenomyosis

Cited by 28 publications

References 27 publications

Clinical Characteristics of Patients with Endometrial Cancer and Adenomyosis

Clinical Characteristics of Patients with Endometrial Cancer and Adenomyosis

Comparison of Sensitivity and Specificity of Structured and Narrative Reports of Transvaginal Ultrasonogaphy for Adenomyosis

Clinicopathological features of different subtypes in adenomyosis: Focus on early lesions

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