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Huang Y, Zhou Y, Chen H, Xu Y. Changes of serum CA125 and PGE2 before and after high-intensity focused ultrasound combined with GnRH-a in treatment of patients with adenomyosis. Open Med (Wars) 2024; 19:20230794. [PMID: 38463528 PMCID: PMC10921450 DOI: 10.1515/med-2023-0794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 06/18/2023] [Accepted: 08/11/2023] [Indexed: 03/12/2024] Open
Abstract
This study aimed to investigate the changes of serum carbohydrate antigen 125 (CA125) and prostaglandin E2 (PGE2) in patients with adenomyosis before and after treatment with high-intensity focused ultrasound (HIFU) combined with gonadotropin-releasing hormone agonist (GnRH-a). One hundred and sixty-five patients with adenomyosis who received HIFU combined with GnRH-a were selected as case group. Sixty-five healthy women who underwent physical examination at the same time were taken as normal control group. At the end of follow-up 6 months after treatment, the case group were divided into effective subgroup and ineffective subgroup according to clinical efficacy. Changes of serum CA125 and PGE2 were analyzed. Serum CA125 and PGE2 levels in the case group were higher than those in the normal control group before treatment (both P < 0.001). Serum CA125 and PGE2 levels in the case group 6 months after treatment were lower than those before treatment (both P < 0.001). There was no difference in serum CA125 and PGE2 levels between effective subgroup and ineffective subgroup before treatment (P = 0.351, 0.284, respectively). Serum CA125 and PGE2 levels in the effective subgroup were lower than those in the ineffective subgroup 6 months after treatment (both P < 0.001). Serum CA125 and PGE2 may be involved in the development of adenomyosis, and their expression levels may be related to the prognosis of patients. Levels of serum CA125 and PGE2 in patients with adenomyosis decrease after treatment with HIFU combined with GnRH-a. The detection of serum CA125 and PGE2 may be used as an index to diagnose adenomyosis and evaluate the therapeutic effect of HIFU combined with GnRH-a.
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Affiliation(s)
- Yan Huang
- Department of Obstetrics and Gynecology, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine, Suzhou, Jiangsu, 215101, China
| | - Yuzhen Zhou
- Department of Obstetrics and Gynecology, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine, Suzhou, Jiangsu, 215101, China
| | - Huixian Chen
- Department of Obstetrics and Gynecology, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine, Suzhou, Jiangsu, 215101, China
| | - Yanyi Xu
- Department of Obstetrics and Gynecology, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine, Suzhou, Jiangsu, 215101, China
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Chen M, Kong W, Li B, Tian Z, Yin C, Zhang M, Pan H, Bai W. Revolutionizing hysteroscopy outcomes: AI-powered uterine myoma diagnosis algorithm shortens operation time and reduces blood loss. Front Oncol 2023; 13:1325179. [PMID: 38144535 PMCID: PMC10739391 DOI: 10.3389/fonc.2023.1325179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 11/24/2023] [Indexed: 12/26/2023] Open
Abstract
Background The application of artificial intelligence (AI) powered algorithm in clinical decision-making is globally popular among clinicians and medical scientists. In this research endeavor, we harnessed the capabilities of AI to enhance the precision of hysteroscopic myomectomy procedures. Methods Our multidisciplinary team developed a comprehensive suite of algorithms, rooted in deep learning technology, addressing myomas segmentation tasks. We assembled a cohort comprising 56 patients diagnosed with submucosal myomas, each of whom underwent magnetic resonance imaging (MRI) examinations. Subsequently, half of the participants were randomly designated to undergo AI-augmented procedures. Our AI system exhibited remarkable proficiency in elucidating the precise spatial localization of submucosal myomas. Results The results of our study showcased a statistically significant reduction in both operative duration (41.32 ± 17.83 minutes vs. 32.11 ± 11.86 minutes, p=0.03) and intraoperative blood loss (10.00 (6.25-15.00) ml vs. 10.00 (5.00-15.00) ml, p=0.04) in procedures assisted by AI. Conclusion This work stands as a pioneering achievement, marking the inaugural deployment of an AI-powered diagnostic model in the domain of hysteroscopic surgery. Consequently, our findings substantiate the potential of AI-driven interventions within the field of gynecological surgery.
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Affiliation(s)
- Minghuang Chen
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Weiya Kong
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Bin Li
- Department of Magnetic Resonance Imaging (MRI), Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Zongmei Tian
- Information Center, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Cong Yin
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Meng Zhang
- College of Software, Beihang University, Beijing, China
| | - Haixia Pan
- College of Software, Beihang University, Beijing, China
| | - Wenpei Bai
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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Moldassarina RS. Modern view on the diagnostics and treatment of adenomyosis. Arch Gynecol Obstet 2023; 308:171-181. [PMID: 37060397 DOI: 10.1007/s00404-023-06982-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/14/2023] [Indexed: 04/16/2023]
Abstract
Adenomyosis is identified by the enlargement of the uterus secondary to such areas of the endometrium as the endometrial glands and stroma located deep in the myometrium, which causes its hyperplasia and hypertrophy. The most common signs of the development of adenomyosis in a patient are copious menstrual bleeding and dysmenorrhea. However, it should be borne in mind that in some patients, the disease may be asymptomatic. Despite the wide abundance of imaging and other diagnostic methods for diagnosing adenomyosis, there are currently no standard verified diagnostic criteria for pathologists. In addition, women with adenomyosis often have other concomitant gynaecological diseases, such as endometriosis or leiomyomas, which makes it difficult to diagnose and choose the optimal treatment for patients. Therefore, the purpose of this study was to highlight up-to-date and relevant information for the practitioner about the epidemiology, clinical manifestations, diagnostics and treatment options for adenomyosis. Sources from four databases (PubMed, Web of Science, Elsevier and Google Scholar) were used to search for data. As a result of a literature review, it was established that the "gold" standard for the diagnostics of adenomyosis is histological research methods, in particular, biopsy performed during hysteroscopy or laparoscopy, whereas imaging methods (transvaginal sonography, magnetic resonance imaging) are more often used for differential diagnostics of adenomyosis with other diseases. In addition, magnetic resonance imaging allows for a better differential diagnostics between adenomyosis and myomatosis and helps to recognise the disease at an early stage. Regarding treatment, there is currently no particular therapy and algorithms for the treatment of adenomyosis, which is primarily due to the lack of precise criteria for the diagnostics of the disease. However, the most effective therapeutic methods at the present stage are the use of aromatase inhibitors and gonadotropin-releasing hormone antagonists, whilst minimally invasive techniques, in particular, endometrial ablation and uterine artery embolisation, are becoming increasingly popular amongst surgical techniques.
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Affiliation(s)
- Rymgul S Moldassarina
- Department of Obstetrics and Gynecology, Pavlodar Branch of the Semey Medical University, 72/1 Toraigyrov Str., 140002, Pavlodar, Republic of Kazakhstan.
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Tilva H, Tayade S, Makhija N, Chadha A. Uterine Artery Embolization and Double-J (DJ) Stenting in a Case of Urinary Retention Due to a Massive Cervical Fibroid: A Case Report. Cureus 2022; 14:e30013. [PMID: 36381696 PMCID: PMC9637450 DOI: 10.7759/cureus.30013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022] Open
Abstract
In women, the most common solid tumor of the pelvis is a uterine fibroid. A large cervical fibroid can also cause urinary incontinence in women. We report a case of a 45-year-old woman with urinary retention that was initially diagnosed as an anterior wall uterine fibroid in the peripheral health center but turned out to be a massive cervical fibroid. After the initial evaluation, it was determined that the cervical fibroid was huge and impacted the pelvis, and there was a possibility of a torrential operative hemorrhage. Thus, preoperative uterine artery embolization (UAE) was performed to prevent intraoperative blood loss, and Double-J (DJ) stenting was performed to avoid ureteric injury. This was followed by a total abdominal hysterectomy, without facing any intraoperative complications. This case demonstrates the importance of proper clinical assessment and the use of skilled interventional radiology procedures such as UAE and DJ stenting in the treatment of a massive cervical fibroid.
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Moawad G, Kheil MH, Ayoubi JM, Klebanoff JS, Rahman S, Sharara FI. Adenomyosis and infertility. J Assist Reprod Genet 2022; 39:1027-1031. [PMID: 35347501 PMCID: PMC9107544 DOI: 10.1007/s10815-022-02476-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 03/22/2022] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Adenomyosis is a poorly understood entity with no unified treatment protocol. It has been thought to only affect the quality of life of older women, but growing evidence is highlighting the increased frequency of adenomyosis in younger patients and its possible effects on fertility outcomes. This can have a great impact on how clinicians screen, diagnose, and treat this condition. The aim of this review is to explore the relationship between adenomyosis and infertility. METHODS A literature search of the keywords "adenomyosis", "infertility", "pregnancy" and "fertility" was conducted using the PubMed and Medline search engines. The articles selected were observational, systematic reviews, meta-analyses, and randomized controlled trials. The search was limited to English, abstracts were screened, and articles were selected. RESULTS The literature reports lower clinical pregnancy rates, lower live birth rates, higher miscarriage rates, and higher odds of adverse obstetric outcomes in patients with adenomyosis. Treatment seems to be associated with higher pregnancy rates and live births rates. CONCLUSION An association between adenomyosis and infertility seems to exist, and treatment could lead to improved fertility outcomes.
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Affiliation(s)
- Gaby Moawad
- Department of Obstetrics and Gynecology, The George Washington University Hospital, Washington, DC, USA.
| | - Mira H Kheil
- Department of Pathology, Wayne State University, Detroit, MI, USA
| | - Jean Marc Ayoubi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Paris Quest (UVSQ), Foch Hospital, Suresnes, France
| | - Jordan S Klebanoff
- Department of Obstetrics and Gynecology, Maine Line Health, Wynnewood, PN, 19096, USA
| | - Sara Rahman
- Department of Obstetrics and Gynecology, The George Washington University Hospital, Washington, DC, USA
| | - Fady I Sharara
- Department of Obstetrics and Gynecology, The George Washington University Hospital, Washington, DC, USA
- Virginia Center for Reproductive Medicine, Reston, VA, USA
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Jones DC, Ronald J, Pabon-Ramos W, Prescott J, Martin JG. The Prevalence of Uterine Fibroids in African American Women with Hemoglobin SS Sickle Cell Disease as Determined by Pelvic Magnetic Resonance Imaging. Acad Radiol 2021; 28:1748-1753. [PMID: 32819834 DOI: 10.1016/j.acra.2020.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/24/2020] [Accepted: 07/24/2020] [Indexed: 11/18/2022]
Abstract
RATIONALE AND OBJECTIVES This study explores the relationship between the development of uterine fibroids and hemoglobin SS sickle cell disease (SCD) by examining the prevalence of uterine fibroids as detected by pelvic magnetic resonance imaging (MRI) in African American (AA) women with and without SCD. MATERIALS AND METHODS A single-center, retrospective review was performed of all adult AA women at a large, academic medical center who received pelvic MRI from January 1, 2007 to December 31, 2018. Propensity score matching conditional on age and ZIP code evaluated the differences in fibroid prevalence between the two groups. Subanalyses by age in 10-year intervals were also performed. RESULTS Twenty-one (23.9%) of 88 patients with SCD had fibroids on pelvic MRI versus 1493 (52.1%) of 2868 patients without SCD (p value <0.001). After propensity score matching, 21 (24.7%) of 85 patients with SCD compared to 52 (61.2%) of 85 patients without SCD had fibroids (p value <0.001). Subanalyses in 10-year age intervals showed significance for patients between 30 and 39 years old in which 4 (13.8%) of 29 SCD patients versus 374 (65.3%) of 573 no SCD patients had fibroids (p value <0.001), and for patients between 40 and 49 years old in which 9 (42.9%) of 21 SCD patients versus 667 (73.8%) of 904 no SCD patients had fibroids (p value = 0.002). CONCLUSION These findings indicate an overall significantly lower prevalence of uterine fibroids in AA women with SCD, suggesting that SCD may be protective against the development of uterine fibroids in these patients.
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Affiliation(s)
- David C Jones
- Duke University School of Medicine, Durham, North Carolina
| | - James Ronald
- Department of Radiology, Division of Interventional Radiology, Duke University School of Medicine, DUMC 3808, 2301 Erwin Rd, 1502 Duke North, Durham, NC 27710
| | - Waleska Pabon-Ramos
- Department of Radiology, Division of Interventional Radiology, Duke University School of Medicine, DUMC 3808, 2301 Erwin Rd, 1502 Duke North, Durham, NC 27710
| | - Jessica Prescott
- Department of Radiology, Division of Interventional Radiology, Duke University School of Medicine, DUMC 3808, 2301 Erwin Rd, 1502 Duke North, Durham, NC 27710
| | - Jonathan G Martin
- Department of Radiology, Division of Interventional Radiology, Duke University School of Medicine, DUMC 3808, 2301 Erwin Rd, 1502 Duke North, Durham, NC 27710.
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Loddo A, Djokovic D, Drizi A, De Vree BP, Sedrati A, van Herendael BJ. Hysteroscopic myomectomy: The guidelines of the International Society for Gynecologic Endoscopy (ISGE). Eur J Obstet Gynecol Reprod Biol 2021; 268:121-128. [PMID: 34902749 DOI: 10.1016/j.ejogrb.2021.11.434] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/11/2021] [Accepted: 11/27/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE With this publication, the International Society for Gynecologic Endoscopy (ISGE) aims to provide the clinicians with the recommendations arising from the best evidence currently available on hysteroscopic myomectomy (HM). STUDY DESIGN The ISGE Task Force for HM defined key clinical questions, which led the search of Medline/PubMed and the Cochrane Database. We selected and analyzed relevant English-language articles, published from January 2005 to June 2021, including original works, reviews and the guidelines previously published by the European Society for Gynecological Endoscopy (ESGE) and the American Association of Gynecologic Laparoscopists (AAGL), in which bibliographies were also checked in order to identify additional references, using the medical subject heading (MeSH) term "Uterine Myomectomy" (MeSH Unique ID: D063186) in combination with ''Myoma" (MeSH Unique ID: D009214) and ''Hysteroscopy" (MeSH Unique ID: D015907). We developed the recommendations through multiple cycles of literature analysis and expert discussion. RESULTS The ISGE Task Force did develop 10 grade 1A-C and 4 grade 2A-C recommendations. For planning HM, evaluation of the uterus with saline infusion sonohysterography (SIS) or combined assessment by transvaginal ultrasound (TVUS) and diagnostic hysteroscopy is recommended (Grade 1A). The use of STEPW (Size, Topography, Extension of the base, Penetration and lateral Wall position) classification system of submucosal leiomyoma (LM) is recommended to predict the complex surgeries, incomplete removal of the LM, long operative time, fluid overload and other major complications (grade 1B). For type 0 LMs, in addition to resectoscopy (slicing technique), morcellation is recommended, being faster and having a shorter learning curve with respect to resectoscopy (grade 1C). For type 1-2 LMs, slicing technique is currently recommended (grade 1C). A fluid deficit of 1000 mL also in case of bipolar myomectomy with saline solution, in healthy women of reproductive age, contains low risk for major complications. Lower thresholds (750 mL) for fluid deficit should be considered in the elderly and in women with cardiovascular, renal or other co-morbidities (Grade 1B). CONCLUSION HM is the most effective conservative minimally invasive gynecologic intervention for submucous LM. The set of 14 ISGE recommendations can significantly contribute to the success of HM and the safety of patients for whom the choice of appropriate surgical technique, as well as the surgeon's awareness and measures to prevent complications are of the utmost importance.
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Affiliation(s)
- Alessandro Loddo
- Clinica Ostetrica e Ginecologica Azienda Ospedaliero-Universitaria di Cagliari, Policlinico Duilio Casula, Monserrato, CA, Italy
| | - Dusan Djokovic
- Maternidade Dr. Alfredo da Costa, Centro Hospitalar Universitário Lisboa Central (CHULC), Lisbon, Portugal; Department of Obstetrics and Gynecology, NOVA Medical School - Faculdade de Ciências Médicas, NOVA University of Lisbon, Lisbon, Portugal; Department of Obstetrics and Gynecology, Hospital CUF Descobertas, Lisbon, Portugal
| | - Amal Drizi
- Independent Consultant in Obstetrics and Gynecology, Algiers, Algeria
| | - Bart Paul De Vree
- Department of Obstetrics & Gynecology, Ziekenhuis Netwerk Antwerpen (ZNA), Campus Middelheim, Antwerp, Belgium; Department of Obstetrics & Gynecology, Universitair Ziekenhuis Antwerpen (UZA), Edegem, Belgium
| | - Adel Sedrati
- Independent Consultant in Gynecology Obstetrics and Gynecology, Constantine, Algeria
| | - Bruno J van Herendael
- Endoscopic Training Center Antwerp (ETCA), Stuivenberg General Hospital, Ziekenhuis Netwerk Antwerpen (ZNA), Antwerp, Belgium; Università degli Studi dell'Insubria, Varese, Italy
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8
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Liu L, Li W, Leonardi M, Condous G, Da Silva Costa F, Mol BW, Wong L. Diagnostic Accuracy of Transvaginal Ultrasound and Magnetic Resonance Imaging for Adenomyosis: Systematic Review and Meta-Analysis and Review of Sonographic Diagnostic Criteria. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2289-2306. [PMID: 33502767 DOI: 10.1002/jum.15635] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/16/2020] [Accepted: 01/02/2021] [Indexed: 05/14/2023]
Abstract
We aim to first systematically review and perform a meta-analysis of the diagnostic accuracy of transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI) and, second, to evaluate the accuracy of various sonographic diagnostic criteria for adenomyosis. A search of PubMed and Embase yielded 32 eligible studies. In diagnosing adenomyosis, the diagnostic performance of TVUS was found to be high and comparable to the performance of MRI. Of the eight sonographic criteria, only five were assessable. The best individual criterion was echogenic subendometrial lines and buds. Limited data exist for the various sonographic criteria, and further studies are required to compare their performance.
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Affiliation(s)
- Linly Liu
- Monash Women's, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia
| | - Wentao Li
- Monash Women's, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia
- Department of Obstetrics and Gynecology, Monash University, Clayton, Victoria, Australia
| | - Mathew Leonardi
- Acute Gynecology, Early Pregnancy and Advanced Endoscopy Surgery Unit, Nepean Hospital, Kingswood, New South Wales, Australia
- Nepean Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - George Condous
- Acute Gynecology, Early Pregnancy and Advanced Endoscopy Surgery Unit, Nepean Hospital, Kingswood, New South Wales, Australia
- Nepean Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Fabricio Da Silva Costa
- Department of Obstetrics and Gynecology, Monash University, Clayton, Victoria, Australia
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Ben W Mol
- Monash Women's, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia
- Department of Obstetrics and Gynecology, Monash University, Clayton, Victoria, Australia
| | - Lufee Wong
- Monash Women's, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia
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Nougaret S, Cunha TM, Benadla N, Neron M, Robbins JB. Benign Uterine Disease: The Added Role of Imaging. Obstet Gynecol Clin North Am 2021; 48:193-214. [PMID: 33573786 DOI: 10.1016/j.ogc.2020.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Benign uterine diseases are very common gynecologic conditions that affect women mostly in reproductive age. Ultrasound examination is the first-line imaging technique, but MRI is more accurate for diagnosis, characterization, and patient management. In this review, we especially highlight the added value of MRI in the diagnosis of benign uterine disease, discuss their imaging characteristics, and describe the therapeutic options and the added value of MRI in the treatment planning.
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Affiliation(s)
- Stephanie Nougaret
- Montpellier Cancer Research Institute, Montpellier, France; Department of Radiology, Montpellier Cancer Institute, INSERM, U1194, University of Montpellier, 208 Avenue des Apothicaires, Montpellier 34295, France.
| | - Teresa Margarida Cunha
- Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil, R. Prof. Lima Basto, Lisboa Codex 1099-023, Portugal
| | - Nadia Benadla
- Department of Radiology, Montpellier Cancer Institute, INSERM, U1194, University of Montpellier, 208 Avenue des Apothicaires, Montpellier 34295, France
| | - Mathias Neron
- Department of Surgery, Montpellier Cancer Institute, 208 Avenue des Apothicaires, Montpellier 34295, France
| | - Jessica B Robbins
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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A Detailed Study in Adenomyosis and Endometriosis: Evaluation of the Rate of Coexistence Between Uterine Adenomyosis and DIE According to Imaging and Histopathology Findings. Reprod Sci 2021; 28:2387-2397. [PMID: 33725313 DOI: 10.1007/s43032-021-00527-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/01/2021] [Indexed: 01/11/2023]
Abstract
The current study was designed to evaluate the relationship between adenomyosis and its subtypes with endometriotic lesions (ovarian endometrioma (OMAs) and posterior deep infiltrative endometriosis (DIE)), to examine the probability of existence of a common cause of these mysterious diseases, and to evaluate the accuracy, sensitivity, and specificity of both transvaginal ultrasonography (TVS) and MRI in diagnosis of adenomyotic uterus. In this retrospective cross-sectional study, we selected 154 women with coexistence of endometriosis and adenomyosis according to their imaging, intraoperative, or pathological findings who were nominated for laparoscopic surgery. Eighty-six patients with just DIE resection without LH (laparoscopic hysterectomy) (group 1), and 68 patients with LH + DIE resection (group 2). The accuracy, sensitivity, and specificity of ultrasonographic and MRI findings for diagnosing adenomyosis were 72.1%, 77.6%, 40.0% and 49.2%, 41.5%, 90.0% respectively. So, TVS is a more sensitive diagnostic tool for diagnosing adenomyosis. However, MRI was more specific than TVS in the diagnosis of diffuse adenomyosis especially with simultaneous presence of uterine leiomyoma. Regarding the association of different types of adenomyosis (focal and diffuse) with different endometriosis lesions (OMA and posterior compartment DIE), we just found diffuse type of adenomyosis more frequent in the absence of rectal and rectovaginal septum (RVS) DIE (p ≤ 0.05). In addition to the questionable different nature of rectal and RVS DIE lesion, there is no relationship between adenomyosis subtypes and endometriotic lesions.
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Abstract
To summarize and update our current knowledge regarding adenomyosis diagnosis, prevalence, and symptoms. Systematic review of PubMed between January 1972 and April 2020. Search strategy included: "adenomyosis [MeSH Terms] AND (endometriosis[MeSH Term OR prevalence study [MeSH Terms] OR dysmenorrhea[Text Word] OR prevalence[Text Word] OR young adults [Text Word] OR adolesce* [Text Word] OR symptoms[Text Word] OR imaging diagnosis [Text Word] OR pathology[Text Word]. Articles published in English that addressed adenomyosis and discussed prevalence, diagnosis, and symptoms were included. Included articles described: pathology diagnosis, imaging, biopsy diagnosis, prevalence and age of onset, symptoms, and concomitant endometriosis. Sixteen articles were included in the qualitative analysis. The studies are heterogeneous when diagnosing adenomyosis with differing criteria, protocols, and patient populations. Prevalence estimates range from 20% to 88.8% in symptomatic women (average 30-35%) with most diagnosed between 32-38 years old. The correlation between imaging and pathology continues to evolve. As imaging advances, newer studies report younger symptomatic women are being diagnosed with adenomyosis based on both magnetic resonance imaging (MRI) and/or transvaginal ultrasound (TVUS). High rates of concomitant endometriosis create challenges when discerning the etiology of pelvic pain. Symptoms that are historically attributed to endometriosis may actually be caused by adenomyosis. Adenomyosis remains a challenge to identify, assess and research because of the lack of standardized diagnostic criteria, especially in women who wish to retain their uterus. As noninvasive diagnostics such as imaging and myometrial biopsies continue to improve, younger women with variable symptoms will likely create criteria for diagnosis with adenomyosis. The priority should be to create standardized histopathological and imaging diagnoses to gain deeper understandings of adenomyosis.
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Affiliation(s)
- Keith Isaacson
- Department of OB/GYN Harvard Medical School, Department of MIGS and Infertility, Newton, Massachusetts
| | - Megan Loring
- Department of MIGS and Infertility, Newton Wellesley Hospital, Department of MIGS and Infertility, Newton, Massachusetts
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12
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Loring M, Chen TY, Isaacson KB. A Systematic Review of Adenomyosis: It Is Time to Reassess What We Thought We Knew about the Disease. J Minim Invasive Gynecol 2020; 28:644-655. [PMID: 33371949 DOI: 10.1016/j.jmig.2020.10.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To summarize and update our current knowledge regarding adenomyosis diagnosis, prevalence, and symptoms. DATA SOURCES Systematic review of PubMed between January 1972 and April 2020. Search strategy included: "adenomyosis [MeSH Terms] AND (endometriosis[MeSH Term OR prevalence study [MeSH Terms] OR dysmenorrhea[text word] OR prevalence[Text Word] OR young adults [Text Word] OR adolesce* [Text Word] OR symptoms[Text Word] OR imaging diagnosis [Text Word] OR pathology[Text Word]. METHODS OF STUDY SELECTION Articles published in English that addressed adenomyosis and discussed prevalence, diagnosis, and symptoms were included. The included articles described pathology diagnosis, imaging, biopsy diagnosis, prevalence and age of onset, symptoms, and concomitant endometriosis. TABULATION, INTEGRATION, AND RESULTS Sixteen articles were included in the qualitative analysis. The studies are heterogeneous when diagnosing adenomyosis with differing criteria, protocols, and patient populations. The prevalence estimates range from 20% to 88.8% in women who are symptomatic (average 30%-35%), with most diagnosed between the ages of 32 years and 38 years. The correlation between imaging and pathology continues to evolve. As imaging advances, newer studies report that younger women who are symptomatic are being diagnosed with adenomyosis on the basis of both magnetic resonance imaging and/or transvaginal ultrasound. High rates of concomitant endometriosis create challenges when discerning the etiology of pelvic pain. Symptoms that are historically attributed to endometriosis may actually be caused by adenomyosis. CONCLUSION Adenomyosis remains a challenge to identify, assess, and research because of the lack of standardized diagnostic criteria, especially in women who wish to retain their uterus. As noninvasive diagnostics such as imaging and myometrial biopsies continue to improve, younger women with variable symptoms will likely create criteria for diagnosis with adenomyosis. The priority should be to create standardized histopathologic and imaging diagnoses to gain a deeper understanding of adenomyosis.
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Affiliation(s)
- Megan Loring
- Center for Minimally Invasive Gynecologic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts (all authors).
| | - Tammy Y Chen
- Center for Minimally Invasive Gynecologic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts (all authors)
| | - Keith B Isaacson
- Center for Minimally Invasive Gynecologic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts (all authors)
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Bourdon M, Santulli P, Oliveira J, Marcellin L, Maignien C, Melka L, Bordonne C, Millisher AE, Plu-Bureau G, Cormier J, Chapron C. Focal adenomyosis is associated with primary infertility. Fertil Steril 2020; 114:1271-1277. [PMID: 32868104 DOI: 10.1016/j.fertnstert.2020.06.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/03/2020] [Accepted: 06/08/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To study the association between adenomyosis and infertility, according to the adenomyosis phenotype as diagnosed by magnetic resonance imaging (MRI). DESIGN A single-center, cross-sectional study. SETTING University hospital-based research center. PATIENT(S) Patients between 18 and 42 years of age who were surgically explored for benign gynecological conditions at our institution between May 2005 and May 2018. Only women with uterine MRIs performed by a senior radiologist were retained for this study. INTERVENTION(S) Primary and secondary infertile women were compared with women without infertility. In addition, the women were diagnosed according to the MRI findings as having adenomyosis (focal adenomyosis of the outer myometrium [FAOM] and/or diffuse adenomyosis phenotypes) or no adenomyosis. MAIN OUTCOME MEASURE(S) Primary and secondary infertility-associated factors. RESULT(S) A total of 496 women were included in the study population. Three groups were compared: a no infertility group (n = 361), a primary infertility group (n = 84), and a secondary infertility group (n = 51). Among them, 248 women did not present adenomyosis lesions and 248 women had a radiological diagnosis of adenomyosis. The presence of FAOM was significantly associated with primary infertility. Diffuse adenomyosis was not found to be associated with infertility. The distribution of endometriosis or leiomyomas was not significantly different between the groups. After a multinomial regression model including the women's age and associated endometriosis or leiomyoma, the presence of FAOM was identified as an independent associated factor of primary infertility (adjusted odds ratio 1.9; 95% confidence interval 1.1-3.3). CONCLUSION(S) The presence of FAOM was associated with primary infertility. This study opens the door to future clinical and basic studies aimed at better characterization of FAOM and its infertility-related physiopathology.
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Affiliation(s)
- Mathilde Bourdon
- Faculté de Médecine, Université de Paris, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire, Paris, France; Department 3I "Infection, Immunité et inflammation," Institut Cochin, INSERM U1016, Paris, France; Department of Gynaecology Obstetrics and Reproductive Medicine, Hopital Port Royal Cochin, Paris, France
| | - Pietro Santulli
- Faculté de Médecine, Université de Paris, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire, Paris, France; Department 3I "Infection, Immunité et inflammation," Institut Cochin, INSERM U1016, Paris, France; Department of Gynaecology Obstetrics and Reproductive Medicine, Hopital Port Royal Cochin, Paris, France.
| | - Joana Oliveira
- Faculté de Médecine, Université de Paris, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire, Paris, France; Department of Gynaecology Obstetrics and Reproductive Medicine, Hopital Port Royal Cochin, Paris, France
| | - Louis Marcellin
- Faculté de Médecine, Université de Paris, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire, Paris, France; Department 3I "Infection, Immunité et inflammation," Institut Cochin, INSERM U1016, Paris, France; Department of Gynaecology Obstetrics and Reproductive Medicine, Hopital Port Royal Cochin, Paris, France
| | - Chloé Maignien
- Faculté de Médecine, Université de Paris, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire, Paris, France; Department of Gynaecology Obstetrics and Reproductive Medicine, Hopital Port Royal Cochin, Paris, France
| | - Léa Melka
- Faculté de Médecine, Université de Paris, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire, Paris, France; Department of Gynaecology Obstetrics and Reproductive Medicine, Hopital Port Royal Cochin, Paris, France
| | - Corinne Bordonne
- Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire, Hotel Dieu, Paris, France; Department of Radiology, Hopital Hotel Dieu, Paris, France
| | | | - Geneviève Plu-Bureau
- Faculté de Médecine, Université de Paris, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire, Paris, France; Department of Gynaecology Obstetrics and Reproductive Medicine, Hopital Port Royal Cochin, Paris, France
| | - Julie Cormier
- Faculté de Médecine, Université de Paris, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire, Paris, France; Department of Gynaecology Obstetrics and Reproductive Medicine, Hopital Port Royal Cochin, Paris, France
| | - Charles Chapron
- Faculté de Médecine, Université de Paris, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire, Paris, France; Department 3I "Infection, Immunité et inflammation," Institut Cochin, INSERM U1016, Paris, France; Department of Gynaecology Obstetrics and Reproductive Medicine, Hopital Port Royal Cochin, Paris, France
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Li Z, Zhang J, Song Y, Yin X, Chen A, Tang N, Prince MR, Yang G, Wang H. Utilization of radiomics to predict long-term outcome of magnetic resonance-guided focused ultrasound ablation therapy in adenomyosis. Eur Radiol 2020; 31:392-402. [PMID: 32725335 DOI: 10.1007/s00330-020-07076-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/07/2020] [Accepted: 07/15/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To develop and evaluate a T2 MR-based radiomics prediction model incorporating radiomics features and clinical parameters to predict the response to magnetic resonance-guided focused ultrasound surgery (MRgFUS) in patients with adenomyosis. MATERIALS AND METHODS Sixty-nine patients (mean age, 38.6 years; age range, 26-50 years) with adenomyosis treated by MRgFUS were reviewed and allocated to training (n = 48) and testing cohorts (n = 21). One thousand one hundred eighteen radiomics features were extracted from T2-weighted imaging before MRgFUS. The radiomics features' dimension was reduced by Pearson correlation coefficient after normalization. Analysis of variance and logistical regression were used for feature selection by fivefold cross-validation in the training cohort, and the machine learning model was constructed for comparing the clinical model, radiomics model, and radiomics-clinical model which combined survived radiomics features and clinical parameters. The discrimination result of the model was obtained by bootstrap; receiver operating characteristic curve, area under the curve (AUC), and decision curve analyses were performed to illustrate the model performance in both the training and testing cohorts. RESULTS Good response was achieved in 47 patients (68.1%) and failed in 22 patients (38.9%). The radiomics model comprised four selected features and demonstrated a degree of prediction capability of patients' poor response to MRgFUS treatment. The radiomics-clinical model showed good discrimination, with an AUC of 0.81 (95% confidence interval, 0.592-0.975) in the testing cohort. The decision curve analysis also showed favorable performance of the radiomics-clinical model. CONCLUSIONS A prediction model composed of T2WI-based radiomics features and clinical parameters could be applied to guide the radiologist to evaluate MRgFUS for patients with adenomyosis who will achieve good response. KEY POINTS • Magnetic resonance imaging-guided focused ultrasound surgery represents an alternative treatment for adenomyosis, but nearly one third of patients remain symptomatic 6 months after MRgFUS. • Combining four radiomics features of T2-weighted MRI with eight clinical features further improves prediction of poor responders to MR-guided focused ultrasound treatment of uterine adenomyosis (AUC = 0.81 in the testing cohort). • The radiomics model based on T2-weighted imaging combined with clinical parameters can help predict which patients are likely to have a good response to MRgFUS for adenomyosis.
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Affiliation(s)
- Zhicong Li
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 100 Haining Rd, Shanghai, 200080, People's Republic of China
| | - Jing Zhang
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, 3663 N. Zhongshan Rd, Shanghai, 200062, People's Republic of China
| | - Yang Song
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, 3663 N. Zhongshan Rd, Shanghai, 200062, People's Republic of China
| | - Xiaorui Yin
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 100 Haining Rd, Shanghai, 200080, People's Republic of China.,Department of Radiology, Weill Cornell Medicine, 416 East 55th St, New York, NY, 10022, USA
| | - An Chen
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 100 Haining Rd, Shanghai, 200080, People's Republic of China
| | - Na Tang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 100 Haining Rd, Shanghai, 200080, People's Republic of China
| | - Martin R Prince
- Department of Radiology, Weill Cornell Medicine, 416 East 55th St, New York, NY, 10022, USA
| | - Guang Yang
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, 3663 N. Zhongshan Rd, Shanghai, 200062, People's Republic of China
| | - Han Wang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 100 Haining Rd, Shanghai, 200080, People's Republic of China.
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16
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Noninvasive Diagnosis of Adenomyosis: A Structured Review and Meta-analysis of Diagnostic Accuracy in Imaging. J Minim Invasive Gynecol 2020; 27:408-418.e3. [DOI: 10.1016/j.jmig.2019.11.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/06/2019] [Accepted: 11/04/2019] [Indexed: 12/11/2022]
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17
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Tellum T, Matic GV, Dormagen JB, Nygaard S, Viktil E, Qvigstad E, Lieng M. Diagnosing adenomyosis with MRI: a prospective study revisiting the junctional zone thickness cutoff of 12 mm as a diagnostic marker. Eur Radiol 2019; 29:6971-6981. [DOI: 10.1007/s00330-019-06308-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 05/05/2019] [Accepted: 06/05/2019] [Indexed: 12/20/2022]
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18
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Bourdon M, Santulli P, Chouzenoux S, Maignien C, Bailly K, Andrieu M, Millischer AE, Doridot L, Marcellin L, Batteux F, Chapron C. The Disease Phenotype of Adenomyosis-Affected Women Correlates With Specific Serum Cytokine Profiles. Reprod Sci 2018; 26:198-206. [DOI: 10.1177/1933719118816852] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Mathilde Bourdon
- Department of Gynaecology Obstetrics II and Reproductive Medicine, Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Assistance Publique–Hôpitaux de Paris (AP–HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department “Development, Reproduction and Cancer”, Institut Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Pietro Santulli
- Department of Gynaecology Obstetrics II and Reproductive Medicine, Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Assistance Publique–Hôpitaux de Paris (AP–HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department “Development, Reproduction and Cancer”, Institut Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Sandrine Chouzenoux
- Department “Development, Reproduction and Cancer”, Institut Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Chloé Maignien
- Department of Gynaecology Obstetrics II and Reproductive Medicine, Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Assistance Publique–Hôpitaux de Paris (AP–HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
| | - Karine Bailly
- Institut Cochin, Plateforme de Cytométrie et d’Immuno-Biologie (CYBIO), Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Muriel Andrieu
- Institut Cochin, Plateforme de Cytométrie et d’Immuno-Biologie (CYBIO), Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | | | - Ludivine Doridot
- Department “Development, Reproduction and Cancer”, Institut Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Louis Marcellin
- Department of Gynaecology Obstetrics II and Reproductive Medicine, Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Assistance Publique–Hôpitaux de Paris (AP–HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department “Development, Reproduction and Cancer”, Institut Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Fréderic Batteux
- Department “Development, Reproduction and Cancer”, Institut Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Charles Chapron
- Department of Gynaecology Obstetrics II and Reproductive Medicine, Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Assistance Publique–Hôpitaux de Paris (AP–HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department “Development, Reproduction and Cancer”, Institut Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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Gupta A, Gupta P, Manaktala U. Varied Clinical Presentations, the Role of Magnetic Resonance Imaging in the Diagnosis, and Successful Management of Cervical Leiomyomas: A Case-Series and Review of Literature. Cureus 2018; 10:e2653. [PMID: 30034975 PMCID: PMC6053254 DOI: 10.7759/cureus.2653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Cervical leiomyomas or fibroids constitute a rare variety of benign pelvic tumors. The symptoms may vary from urinary retention, frequency, dyspareunia to rare clinical presentations such as prolapsed cervical fibroid polyp which may mimic procidentia or even uterine inversion. Preoperative clinical evaluation, radiological imaging, and proper intra-operative delineation of pelvic anatomy can help in their successful management. We are presenting a series of three cases of cervical leiomyomas which presented as a diagnostic challenge but their proper evaluation ultimately led us to manage these cases judiciously. The first case of cervical fibroid polyp mimicked incarcerated procidentia, the second case mimicked pelvic organ prolapse while the third case presented with acute urinary retention. All these cases were evaluated by ultrasound as well as magnetic resonance imaging (MRI) and were managed surgically without any complications. The MRI features of all the cases have been described. One should be aware of the uncommon presentations of cervical fibroid and should consider it in the differential diagnosis of any pelvic mass.
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Affiliation(s)
- Avantika Gupta
- Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
| | - Purnima Gupta
- Obstetrics & Gynecology, Maulana Azad Medical College, New Delhi, IND
| | - Usha Manaktala
- Obstetrics & Gynecology, Maulana Azad Medical College, New Delhi, IND
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From Clinical Symptoms to MR Imaging: Diagnostic Steps in Adenomyosis. BIOMED RESEARCH INTERNATIONAL 2017; 2017:1514029. [PMID: 29349064 PMCID: PMC5733957 DOI: 10.1155/2017/1514029] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 11/09/2017] [Indexed: 12/27/2022]
Abstract
Adenomyosis or endometriosis genitalis interna is a frequent benign disease of women in fertile age. It causes symptoms like bleeding disorders and dysmenorrhea and seems to have a negative effect on fertility. Adenomyosis can be part of a complex genital and extragenital endometriosis but also can be found as a solitary uterine disease. While peritoneal endometriosis can be easily diagnosed by laparoscopy with subsequent biopsy, the determination of adenomyosis is difficult. In the following literature review, the diagnostic methods clinical history and symptoms, gynecological examination, 2D and 3D transvaginal ultrasound, MRI, hysteroscopy, and laparoscopy will be discussed step by step in order to evaluate their predictive value in the diagnosis of adenomyosis.
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Kara Bozkurt D, Bozkurt M, Cil AS, Barut MU, Ersahin AA, Çalıskan E. Concomitant use of transvaginal sonography and Doppler indices improve diagnosis of adenomyosis. J OBSTET GYNAECOL 2017; 37:888-895. [DOI: 10.1080/01443615.2016.1256952] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Duygu Kara Bozkurt
- Department of Radiology, Kafkas University School of Medicine, Kars, Turkey
| | - Murat Bozkurt
- Department of Obstetrics and Gynecology, Kafkas University School of Medicine, Kars, Turkey
| | - Ahmet Said Cil
- Department of Radiology, Universal Hospital Group, Malatya, Turkey
| | - Mert Ulaş Barut
- Department of Obstetrics and Gynecology, Health Woman Research Hospital, Ankara, Turkey
| | - Aynur Adeviye Ersahin
- Department of Obstetrics and Gynecology, Bahcesehir University School of Medicine, Istanbul, Turkey
| | - Eray Çalıskan
- Department of Obstetrics and Gynecology, Bahcesehir University Medical Faculty, Istanbul, Turkey
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Kassam Z, Petkovska I, Wang CL, Trinh AM, Kamaya A. Benign Gynecologic Conditions of the Uterus. Magn Reson Imaging Clin N Am 2017; 25:577-600. [DOI: 10.1016/j.mric.2017.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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23
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Saito A, Hirata T, Koga K, Takamura M, Fukuda S, Neriishi K, Pastorfide G, Harada M, Hirota Y, Wada-Hiraike O, Fujii T, Osuga Y. Preoperative assessment of factors associated with difficulty in performing total laparoscopic hysterectomy. J Obstet Gynaecol Res 2017; 43:320-329. [PMID: 28150406 DOI: 10.1111/jog.13198] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 09/07/2016] [Indexed: 12/24/2022]
Abstract
AIM Our objective was to determine the preoperative factors associated with difficulty in total laparoscopic hysterectomy (TLH). METHODS This retrospective clinical study included 157 patients who underwent TLH for leiomyoma or adenomyosis between 2009 and 2013. All patients underwent magnetic resonance imaging (MRI) before surgery. We categorized patients as 'difficult' if the operation time was > 243 min, if total blood loss was > 500 mL, or if conversion to laparotomy was necessary. Preoperative information, including MRI findings, was compared between the difficult and 'other' patients. Stepwise logistic regression analysis was used to control for covariates that were significant on univariate analysis (P < 0.05). RESULTS The presence of an endometrioma, a previous cesarean section (CS), a wide uterus, and a high body mass index were independent risk factors for being a difficult patient. For adenomyosis patients, the presence of an endometrioma, a prior CS, subtype II adenomyosis, and high body mass index were independent risk factors for being a difficult patient. For leiomyoma patients, the presence of an endometrioma, a prior CS, and having at least seven leiomyomas were independent risk factors for being a difficult patient. All laparotomy conversion patients had multiple risk factors. CONCLUSION We have elucidated the factors associated with difficult TLH patients using patients' background and preoperative MRI findings. Awareness of these predictive factors may enable surgeons to prepare for the operation, minimize complications, or choose another more appropriate route of hysterectomy than TLH.
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Affiliation(s)
- Ako Saito
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Tetsuya Hirata
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Kaori Koga
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Masashi Takamura
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Shinya Fukuda
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Kazuaki Neriishi
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Gia Pastorfide
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Miyuki Harada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Yasushi Hirota
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Osamu Wada-Hiraike
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Tomoyuki Fujii
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
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Prise en charge des léiomyomes utérins. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 38:S550-S576. [PMID: 28063565 DOI: 10.1016/j.jogc.2016.09.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Intravoxel incoherent motion diffusion-weighted imaging in differentiating uterine fibroid from focal adenomyosis: initial results. SPRINGERPLUS 2016; 5:9. [PMID: 26759748 PMCID: PMC4700030 DOI: 10.1186/s40064-015-1635-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 12/17/2015] [Indexed: 12/14/2022]
Abstract
To evaluate the performance of intravoxel incoherent motion (IVIM)-diffusion-weighted imaging (DWI) in differentiating uterine fibroids from focal adenomyosises. Twenty-five uterine fibroids and 21 focal adenomyosises prospectively underwent IVIM-DWI examination prior to surgery. Four parameters including apparent diffusion coefficient total values (ADCtot), true diffusion coefficient (D), pseudodiffusion coefficient (D*) and perfusion fraction (f) derived from IVIM-DWI images were separately calculated and compared across four groups. There was a statistically significant difference in IVIM-derived f parameter between fibroid and focal adenomyosis (p = 0.01) and control group (p = 0.02). Uterine fibroids gave higher coefficient of variation (CV) of all IVIM-derived parameters than focal adenomyosises. IVIM-DWI could improve the sensitivity and specificity of detecting focal adenomyosis to 100 and 92.6 %, respectively. IVIM-f parameter could be potentially used to better distinguish uterine fibroid from focal adenomyosis. The higher CV of IVIM-derived parameters with acceptable range is often observed in the diseased group.
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Regression of Adenomyosis on Magnetic Resonance Imaging after a Course of Hormonal Suppression in Adolescents: A Case Series. J Pediatr Adolesc Gynecol 2015; 28:437-40. [PMID: 26233288 DOI: 10.1016/j.jpag.2014.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 12/10/2014] [Accepted: 12/19/2014] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE To demonstrate that adenomyosis is a rare cause of dysmenorrhea or chronic pelvic pain (CPP) in the adolescent population that can be identified with magnetic resonance imaging (MRI) and to report resolution of adenomyosis by MRI after a course of hormonal suppression in 4 adolescents. DESIGN, SETTING, AND PARTICIPANTS Retrospective case series of 4 adolescents with adenomyosis on pelvic MRI at Texas Children's Hospital. INTERVENTIONS Continuous oral contraceptive (COC) therapy or leuprolide acetate. MAIN OUTCOME MEASURES Lesions on pelvic MRI after treatment. METHODS We reviewed medical records of 4 adolescents with CPP and adenomyosis on T2-weighted pelvic MRI. All patients had initial diagnostic pelvic MRI and then definitive hormonal intervention. Repeat imaging was obtained after a symptom-free interval. RESULTS Patient ages ranged from 12 to 16 years. One patient had resolution of symptoms with COC therapy. MRI performed 3 years later showed no adenomyosis. Three patients failed COC therapy. All were symptomatically improved after therapy with a gonadotropin-releasing hormone agonist. Follow-up MRI performed at intervals between 6 months and 3 years showed resolution of adenomyosis. CONCLUSION MRI can raise suspicion for the diagnosis of adenomyosis in adolescents with refractory CPP. Subsequent MRI can show regression of lesions after symptom resolution with hormonal therapy.
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Ferrari F, Arrigoni F, Miccoli A, Mascaretti S, Fascetti E, Mascaretti G, Barile A, Masciocchi C. Effectiveness of Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS) in the uterine adenomyosis treatment: technical approach and MRI evaluation. Radiol Med 2015; 121:153-61. [DOI: 10.1007/s11547-015-0580-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 08/25/2015] [Indexed: 11/29/2022]
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Revisiting the role of MRI in gynecological emergencies – An institutional experience. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Huang X, Huang Q, Chen S, Zhang J, Lin K, Zhang X. Efficacy of laparoscopic adenomyomectomy using double-flap method for diffuse uterine adenomyosis. BMC WOMENS HEALTH 2015; 15:24. [PMID: 25783654 PMCID: PMC4359498 DOI: 10.1186/s12905-015-0182-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 02/24/2015] [Indexed: 11/10/2022]
Abstract
Background Adenomyomectomy has recently been considered the priority option for the treatment of adenomyosis, however, the surgical efficacy and modes are still debated. We aimed to evaluate the efficacy of laparoscopic adenomyomectomy using a double-flap method for the treatment of uterine diffuse adenomyosis when compared with conventional laparoscopic adenomyomectomy. Methods Laparoscopic adenomyomectomy using the conventional method (group A, n = 48) and the double-flap method (group B, n = 46) to treat diffuse uterine adenomyosis, respectively. Visual analog scale (VAS), menstrual amount, serum CA125 levels, and uterine volume were comparatively analyzed in both groups. Results The VAS scores, menstrual amount, serum CA125 levels, and uterine volume at 12 or 24 months after surgery significantly reduced in group B than in group A (P < 0.05); these parameters were statistically decreased in both groups after surgery compared with those obtained before surgery (P < 0.001). Moreover, serum CA125 levels and uterine volume at six months of follow up were significantly lower in group B than in group A (P < 0.01). In addition, blood loss during surgery was similar in groups A and B (P > 0.05), although the operative time was significantly longer in group B than that in group A (P < 0.05). Conclusions Laparoscopic adenomyomectomy using the double-flap method may be an effective technique to treat uterine diffuse adenomyosis.
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Affiliation(s)
- Xiufeng Huang
- The Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, 1 Xueshi Road, Hangzhou, Zhejiang, 310006, P. R. China,
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Dashottar S, Singh AK, Debnath J, Muralidharan CG, Singh RK, Kumar S. Comparative analysis of changes in MR imaging of pre and post intrauterine progesterone implants in adenomyosis cases. Med J Armed Forces India 2015; 71:145-51. [PMID: 25859077 DOI: 10.1016/j.mjafi.2015.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 01/11/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Magnetic Resonance Imaging (MRI) plays an important role in the evaluation and management of adenomyosis. In this study, we first diagnosed the adenomyosis on MRI and then we analyzed the MRI changes in the uterus in pre and post intrauterine progesterone implants cases. METHOD All the patients with clinical diagnosis of menorrhagia or dysmenorrhea were screened by Ultrasonography (USG) of the pelvis. Patients with heterogeneous echo texture of the uterus were then evaluated by the MRI of the pelvis. All patients with MRI findings suggestive of adenomyosis formed the study group. RESULT On MRI study 60 patients were diagnosed as adenomyosis, 68.33% had diffuse adenomyosis and 31.66% had focal adenomyosis. 83% of diagnosed adenomyosis cases had high intensity signal foci which were seen in 75% cases of diffuse adenomyosis and 100% cases of focal adenomyosis. 50 diagnosed adenomyosis cases were then reviewed after 03 months, 06 months and 12 months to see for any change in the MRI findings in the post intrauterine implant cases. On follow up MRI after post progesterone intrauterine implant, 50% of the cases showed reduction in the high intensity signals, 10% of the cases showed mild reduction in the junctional zone thickness with no significant change in the uterine size. CONCLUSIONS It is inferred that MR imaging is not only helpful in diagnosing but also helpful in monitoring the effects of hormonal therapy in adenomyosis.
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Affiliation(s)
- S Dashottar
- Classified Specialist (Radiodiagnosis), Military Hospital (Cardio Thoracic Centre), Pune 410040, India
| | - A K Singh
- Senior Adviser (Radiodiagnosis), Army Hospital (R & R), New Delhi, India
| | - J Debnath
- Professor, Department of Radiodiagnosis, Armed Forces Medical College, Pune 411040, India
| | - C G Muralidharan
- Senior Adviser (Radiodiagnosis), Command Hospital (Southern Command), Pune 411040, India
| | - R K Singh
- Ex Deputy Commandant, Command Hospital (Eastern Command), Kolkata, India
| | - Suman Kumar
- Classified Specialist (Medicine and Clinical Hematology), Command Hospital (Eastern Command), Kolkata, India
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Abstract
Hysteroscopic surgery is pivotal in management of many gynecological pathologies. The skills required for performing advanced hysteroscopic surgery (AHS), eg, transcervical hysteroscopic endometrial resection (TCRE), hysteroscopic polypectomy and myomectomy in the management of menorrhagia, hysteroscopic septulysis in fertility-related gynecological problems and hysteroscopic removal of chronically retained products of conception and excision of intramural ectopic pregnancy ought to be practiced by contemporary gynecological surgeons in their day-to-day clinical practice. AHS is a minimally invasive procedure that preserves the uterus in most cases. Whilst the outcome is of paramount importance, proper training should be adopted and followed through so that doctors, nurses, and institutions may deliver the highest standard of patient care.
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Affiliation(s)
- Mark M Erian
- Teaching and Research Department, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Glenda R McLaren
- University of Queensland and Mater Mothers Hospital, Brisbane, Australia
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Imaging for the evaluation of endometriosis and adenomyosis. Best Pract Res Clin Obstet Gynaecol 2014; 28:655-81. [DOI: 10.1016/j.bpobgyn.2014.04.010] [Citation(s) in RCA: 165] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 04/10/2014] [Accepted: 04/23/2014] [Indexed: 01/21/2023]
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Zhang GF, Zhang H, Tian XM, Zhang H. Magnetic resonance and diffusion-weighted imaging in categorization of uterine sarcomas: correlation with pathological findings. Clin Imaging 2014; 38:836-44. [PMID: 25027800 DOI: 10.1016/j.clinimag.2014.06.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 05/19/2014] [Accepted: 06/02/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVES We investigated the utility of magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) in the categorization of uterine sarcoma (US) and compared them with pathological findings. METHODS The baseline and MRI characteristics were recorded and compared across the subtypes of USs. RESULTS There were no differences in the conventional or DWI signals among the four subtypes of US, except in the heterogeneity of T2-weighted imaging. A difference in the mean apparent diffusion coefficient value for USs and uterine fibroids differed significantly (P=.019). CONCLUSIONS MRI characteristics showed no specific differences between any subtypes of US.
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Affiliation(s)
- Guo-Fu Zhang
- Department of Radiology, Obstetrics and Gynecology Hospital, Fudan University
| | - He Zhang
- Department of Radiology, Obstetrics and Gynecology Hospital, Fudan University.
| | - Xiao-Mei Tian
- Department of Radiology, Obstetrics and Gynecology Hospital, Fudan University
| | - Hao Zhang
- Department of Pathology, Obstetrics and Gynecology Hospital, Fudan University
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Grimbizis GF, Mikos T, Tarlatzis B. Uterus-sparing operative treatment for adenomyosis. Fertil Steril 2014; 101:472-87. [DOI: 10.1016/j.fertnstert.2013.10.025] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 10/15/2013] [Accepted: 10/15/2013] [Indexed: 10/26/2022]
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Fonseca-Moutinho JA, Barbosa LS, Torres DG, Nunes SM. Abnormal uterine bleeding as a presenting symptom is related to multiple uterine leiomyoma: an ultrasound-based study. Int J Womens Health 2013; 5:689-94. [PMID: 24194648 PMCID: PMC3814927 DOI: 10.2147/ijwh.s50786] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine the prevalence of uterine leiomyomas, diagnosed by ultrasound, in a private health care setting located in the central eastern region of Portugal, and to explore the demographic and clinical factors related to diagnosis and symptomatology. Patients and methods The files of 624 patients attending a private clinic in Covilhã, Portugal, from January 2 to December 31, 2010 were retrieved for evaluation. Pelvic ultrasound record, age, weight, height, age at menarche, number of pregnancies and deliveries, marital status, menstrual cycles characteristic, and contraceptive method at consultation were included in the analysis. Results Uterine leiomyoma (UL) was diagnosed by ultrasonography in 161 (25.8%) patients. A single UL was diagnosed in 80 (49.7%) patients. In 79 (49.1%) patients, the largest leiomyoma had a dimension <20 mm. Prevalence of UL was age dependent: at 11.0% for women 20–39 years old; 45.4% for those aged 40–59 years; and 19.5% for women 60 years or older. Metrorrhagia was the most distressing presenting symptom. When menorrhagia was the presenting symptom, the probability of having an ultrasound diagnosis of UL was 73.3%. Metrorrhagia or menorrhagia, as presenting symptom, was significantly related to the ultrasound diagnosis of multiple ULs. Conclusion UL was especially prevalent in women aged between 40 and 59 years. Patients with multiple ULs had significantly more abnormal uterine bleeding. In patients with menorrhagia or metrorrhagia, special attention should be taken in searching for the presence of multiple ULs during ultrasound.
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Affiliation(s)
- José Alberto Fonseca-Moutinho
- Faculty of Health Sciences, School of Medicine, Beira Interior University, Covilhã, Portugal ; Child and Women Department, Cova da Beira Academic Medical Center, Covilhã, Portugal
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Abstract
Biomarkers are biologic compounds that are easily accessible and reflect normal physiology or pathology. They are useful in a variety of clinical situations that involve detection of subclinical disease, risk stratification, preoperative planning, and monitoring treatment. A useful intervention needs to exist for a biomarker to be an effective tool. Many compounds have been investigated as potential biomarkers for the diagnosis and surveillance of uterine leiomyomas. Most of these compounds demonstrate subtle differences among patients when leiomyomas are compared with controls. The compounds investigated lack the diagnostic accuracy necessary to add any benefit to the current available modalities used to diagnose and monitor uterine leiomyomas.
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Affiliation(s)
- Gary Levy
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892-1109, USA
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