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• W2897328322 abstract "Adenomyosis is a frequent gynecological disease, characterized by the migration of glands and stroma from basal layer of the endometrium to the myometrium. Until now the concept that this disease could be diagnosed only by histology was very diffused. Since this disease is often found in women over 40 years of age who underwent hysterectomy, it was common thinking that it was not a real disease. Imaging (magnetic resonance imaging and ultrasound) showed that adenomyosis had a typical appearance (1Exacoustos C. Manganaro L. Zupi E. Imaging for the evaluation of endometriosis and adenomyosis.Best Pract Res Clin Obstet Gynaecol. 2014; 28: 655-681Crossref PubMed Scopus (155) Google Scholar) and that this could also be detected in younger women with or without typical symptoms. Transvaginal sonography (TVS) especially is often performed in women of all ages, showed typical sonographic features. Several ultrasound imaging studies have been performed to analyse the diagnostic accuracy to detect adenomyosis in comparison to histological examination of hysterectomy specimens. Beyond the evaluation of different ultrasound features and their numbers, in relation to presence or absence of adenomyosis on hysterectomy specimens, also the correlation to symptoms has been performed. The main problem with the use of histology for the diagnosis of adenomyosis in these studies is the heavy selection bias incurred. Patients who underwent hysterectomy are generally in advanced age and showed heavy symptoms which indicate surgery and do not represent the general population. Younger fertile patients with or without pain symptoms very seldom had a histological confirmation of adenomyosis, despite TVS often detecting typical features of adenomyosis (2Pinzauti S. Lazzeri L. Tosti C. Centini G. Orlandini C. Luisi S. et al.Transvaginal sonographic features of diffuse adenomyosis in 18-30-year-old nulligravid women without endometriosis: association with symptoms.Ultrasound Obstet Gynecol. 2015; 46: 730-736Crossref PubMed Scopus (78) Google Scholar). Despite this, the comparison of TVS features to histology, also performed by Tellum et al. (3Tellum T. Nygaard S. Skovholt E.K. Qvigstad E. Lieng M. Development of a clinical prediction model for diagnosing adenomyosis.Fertil Steril. 2018; 110: 957-964Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar), is the basis to assess TVS accuracy in diagnosis of adenomyosis. Since transvaginal ultrasound has been used for the non-invasive diagnosis of adenomyosis and several studies such as the one by Tellum et al. (3Tellum T. Nygaard S. Skovholt E.K. Qvigstad E. Lieng M. Development of a clinical prediction model for diagnosing adenomyosis.Fertil Steril. 2018; 110: 957-964Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar) showed a high accuracy in the diagnosis, we must accept now that diagnosis of adenomyosis could be based on ultrasound. This will give us the opportunity to correlate this disease to real symptoms and fertility in the general population. In fact, the presence of one or more of the ultrasound features has often been noticed in asymptomatic young women. There are obviously some problems, since the studies published up until now on TVS and adenomyosis show is not always very clear how many features should be considered for the final diagnosis of adenomyosis, as the prevalence of the disease is in inhomogeneous study populations. On the other hand, TVS is able to detect not only different features, but also different configuration and localization inside the uterus according to different histopahological adenomyosis types in the myometrium: diffuse, focal, and adenomyoma (4Ferenczy A. Pathophysiology of adenomyosis.Hum Reprod Update. 1998; 4: 312-322Crossref PubMed Scopus (374) Google Scholar). The number of features does not play an important role in evaluating adenomyosis since several features could be present in a small focal adenomyosis and few features in a diffuse disease. It also seems that localization according the inner myometrium (junctional zone) or middle or outer myometrium, as the degree of myometrial involvement, could be important in describing, by ultrasound, the adenomyosis (5Van den Bosch T. de Bruijn A.M. de Leeuw R.A. Dueholm M. Exacoustos C. Valentin L. et al.A sonographic classification and reporting system for diagnosing adenomyosis.Ultrasound Obstet Gynecol. 2018; https://doi.org/10.1002/uog.19096Crossref Scopus (68) Google Scholar). Because it is so like fibroids, the adenomyotic disease must be better described inside the uterus to evaluate the impact on symptoms especially on infertility and treatment. In some ways the study of Tellum et al. (3Tellum T. Nygaard S. Skovholt E.K. Qvigstad E. Lieng M. Development of a clinical prediction model for diagnosing adenomyosis.Fertil Steril. 2018; 110: 957-964Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar), including several features and the thickness of the wall in their predictive model, confirmed that the number of single ultrasound features is not enough to give an accurate diagnosis of adenomyosis. However, the prediction model developed in this study for diagnosing adenomyosis cannot still be used in the general population since the age, fertility, association to deep infiltrating endometriosis, the type (focal, diffuse), and the extension inside the myometrium of the adenomyosis are not considered. Also, the correlation to pain symptoms and menorrhagia is in this study seems questionable as it included all patients who underwent surgery (mostly for symptoms indication) and 48% of the patients with adenomyosis had endometriosis which can cause similar symptoms. In conclusion, diagnosing adenomyosis should now be based mostly on TVS since it is an accurate and easy method which can be performed on all types of patients. Only the presence of single TVS features is not enough to diagnose accurately the adenomyotic disease inside the uterus. As well as the only correlation of presence or absence of adenomyosis to symptoms seems actually too superficial. Like the endometriotic disease where ovarian, retroperitoneal, and superficial disease had different impacts on symptoms, treatment, and prognosis, type and degree of adenomyosis may also be considered in the management of this disease. In the future, transvaginal ultrasound diagnosis will be a key point in the evaluation of adenomyosis and may require expert sonographers in dedicated centers. Development of a clinical prediction model for diagnosing adenomyosisFertility and SterilityVol. 110Issue 5PreviewTo develop a multivariate prediction model for diagnosing adenomyosis using predictors available through transvaginal ultrasonography and clinical examinations. Full-Text PDF" @default.
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• W2897328322 title "A new era in diagnosing adenomyosis is coming" @default.
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